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The cause is thought to be relaxation of the lower oesophageal sphincter - that is the muscle between the oesopahagus and the stomach. Although soilage of the perianal region is a common etiology of pruritus, many patients cause more excoriation through overzealous hygiene. The use of prepared wipes and witch hazel pads should be avoided—unscented toilet paper moistened with warm water is preferable. This is the kind of question which many men want to hear. Bowel frequency or diarrhea is sometimes noted, as are anal incontinence, seepage, moisture, and sweatiness. He has rectal bleeding off and on now for at least 2 years with out having it checked out.
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