I too resolved this seriously frustrating, irritating and annoying condition!! I found on another patient directed site a solution. For me I think it all started when I suddenly used a patterned toilet paper - though the white version of this same toilet paper also still will cause itching. Without realising what the problem was, I created an overcleaning and itch/scratch/itch cycle. I also in desperation after cleaning and drying and wanting it to stay dray would sit on the toilet and strongly pull the area apart (by pulling on my cheeks) I was desperately trying NOT to scratch and to find some relief! I am pretty sure that my efforts then resulted in one of the haemorrhoids that are naturally inside our anal cavity, coming outside (I have found medical articles to suggest that this can cause haemmorhoids to come out.). I on one occasion only had a very small amount of blood which was either the haemmorhoid slightly ruptured from scratching (as cleanly as possible!), or from scratching and causing a small bleed on my skin. But I definitely had a little spongy part external to my anus (= haemmorhoid).
I put up with this, trying to clean regularly, clean only with water after every toilet visit, only pat dry never rub, using moistened toilet tissues only and eventually only natural fibre/no chemical toilet paper. It went on for more than six months!!! interrupted my sleep at night. Was uncomfortable often at work in front of customers, colleagues.
I had tried EVERYTHING! Then finally I found a site with slightly different information, and together with some of my GP friend's suggestions - resolved it COMPLETELY!!! OH MY GOODNESS I CANNOT TELL YOU MY RELIEF! (as I'm sure anyone reading this will understand! Being told not to scratch is at times nigh on impossible!) So here's what worked.
Now know that it took THREE to FOUR days for it to resolve - even though I was doing everything that follows, so DON'T despair! Just stick with it!
Ok - do all of those things above - use water gently to wash, sensitive moist toilet wipes or baby wipes for sensitive skin (unscented), NEVER use patterned toilet papers and ideally get the 'natural' type - as I've noticed whenever I use the other paper (I still have about 10 rolls to use up!) I do get itchy afterwards and deal with it as described below. Also I've noticed that cheese DEFINITELY aggravates it! So I really limit myself to only the tiniest amount of my beloved hard goat's cheese.
First thing after the above is to use ICE to relieve the itching and to prevent yourself from scratching during those 3-4 days. I used small lunch box ice-blocks and had 4 or 5 always in the freezer ready to use. You can put it into a thin sock, or wrap it with gauze or a chux type wipe (PLAIN DRY TYPE no moisture) that you use for cleaning. I cut the chux wipes into smaller squares for that purpose. Then after cleaning, use a hydrocortisone cream prescribed by your GP - you REALLY only need the tiniest amount as it says on the directions - don't be tempted to use more as I was, as it can burn. Just be patient - it takes 3-4 days for it to completely settle and resolve. The cream I was prescribed is called : Advantan Ointment (1g contains Methylprednisolone Aceponate 1mg). You will only need ONE little tube. I still have the tube more than 3/4 full and carry it with me if ever I have a tiny little flare up which happens rarely now - only when I've not wiped with wet wipes (as I'm out and I've run out), if it's a really hot day (and so sweaty) and/or if I've eaten cheese or anything yeasty or too sugary (which feeds yeast) (both of which I avoid totally now. Coconut palm sugar or fruit sugar are fine, they seem not to have the same impact).
After each time of going to the toilet, clean gently, dry gently (NO SCRATCHING!!!!! at all!!! It's tough but stick with it for 3-4 days and you'll be done!!) Then wrap the ice block (I sometimes didn't wrap as it was the middle of the night and I was just too exhausted but it does hurt a little as the ice is VERY cold! Worked a treat to stop the itching though) - place the ice block between your butt cheeks as close in to your anus as you can so you can really feel the relief. (The ice apparently also causes NEW haemmorhoids that have come outside, to shrink up and pull back inside. Lifting your legs up against the wall - for haemmorhoids only, not if it's only itching - can also help my GP friend said as you're using gravity to help it pull back in to where it should be.) If a haemmorhoid is not treated immediately (less than 24 hours), the little thing corterises itself (cuts off circulation) and will stay as a tiny little spongey cushion outside of your anus - who sees that though - so don't be worried about it. They are tiny - nobody else will know. If you've left it too late it won't retract back inside. This is the case for me - and it's really no big deal at all.
The other thing is make sure you're drinking plenty of water and have fibre (fruits - especially papaya, pears, apples etc, psyllium husks added at the very last moment before drinking (otherwise it swells and goes thick and gluggy) to a shake or on your breakfast (or bran flakes if you're not gluten intolerant). Hard faeces/constipation can aggravate the haemmorhoids (often related to itching - at least 50% of people experience haemmorhoids at ANY age but more common after 40/50 - and everyone has them inside along the wall of the anus - they're normal, healthy and natural, They're only problematic when they're scratched, torn or come outside).
Persevere with this for 3-4 days (even at work I was using the ice packs and cream during the day!! which was a little awkward!) BUTT (pun intended 'o) ) I now NO LONGER HAVE PRURITIS ANI!!! and the haemmorhoids are NOT a problem! I do however very occasionally - maybe once every couple of weeks get a wee itch. Now I just clean. In the first month after resolving it I would use the cream as well, and I still carry it for any time it might get too itchy - again usually to do with heat, sweating and/or something I've eaten - usually cheese. ??wine/alcohol might be the same?? vinegar aggravates it for me as it also has a fermenation process to create it = yeast-like)
Good luck everyone!! I am now 3 months relatively itch free!!! Now if only I could give up my goat's cheese! 'o) Nahh...