Anal Tattooing

Anal tattooing can be considered in patients with pruritus ani who have failed other treatment measures, become steroid-dependent, or in whom symptoms severely impact on quality of life. I am presently one of the few specialists in the UK able to offer this treatment option.

This procedure is performed on a day-stay basis under general anaesthesia and involves several injections of diluted methylene blue (a dye) mixed with a local anaesthetic agent and a steroid in and around the anus. The whole procedure takes about 30 minutes.

The tattoo itself lasts only a matter of weeks and the skin looks no different in the long term. Methylene blue is thought to work by destroying the nerve endings in the skin around the anus. The reduced sensation in and around the anus can be maintained for up to a year and the procedure can be repeated if necessary.

Unless you are also having a colonoscopy, you can follow a normal diet without bowel preparation before your procedure. You need to fast from midnight on the night before if your surgery is scheduled for the morning, or from 7 am if scheduled for the afternoon.

After the procedure you will be transferred to the recovery area and then to the ward. You should be able to go home the same day. You should not drive after your surgery, so a friend or relative will need to take you home.

It is important to keep your bowel movements soft and regular after this type of surgery. Eat foods high in fibre and drink plenty of water (6–8 glasses a day). It is also a good idea to take laxatives after your procedure to prevent constipation. Analgesia and laxatives will be given to you to take home.

Spotting of blood will occur at the injection sites, and blue discoloration in the perianal region will persist for some time. A sanitary towel changed twice daily will help to prevent staining of underwear.

Excessive cleaning or scratching with abrasive toilet paper should be avoided, as should use of soaps and chemicals on the tattooed area. Generally, use water to wash the affected area twice a day and after every bowel movement.

There is a small chance of ulceration in the tattooed area postoperatively. This heals well with no long-term problems, but if you are concerned please contact the clinic.

Exactly when patients can resume driving after this type of surgery is determined on a case-by-case basis and will be discussed with you after your surgery. This is usually 1–2 weeks. Please let your insurance company know when you have been given the all-clear to resume driving.

You will have the opportunity to discuss fully all the risks and benefits of the operation with me before signing your consent form.

A follow-up appointment will be made for 1–2 weeks after your surgery to review your condition and discuss further management if necessary.


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