This topic is about someone experiencing discomfort and unusual sensations in the perineal area 12 years after having a panproctocolectomy, which is a surgery that involves removing the colon and rectum, often resulting in a "Barbie-butt" closure. The person is seeking advice on the causes and relief for these symptoms. Here are some insights and suggestions shared by others:

1. After such surgeries, it's common to experience phantom sensations, where nerves might still signal an urge to empty the bowel even though the rectum is no longer present.

2. The person has tried topical antifungals and antihistamines, but these increased irritation. Amitriptyline provided slight relief but caused side effects like drowsiness and jitteriness. Gabapentin is suggested as an alternative that might cause less drowsiness.

3. External skin care can help manage symptoms:
- Eucerin cream is recommended for relieving itchiness.
- Ice packs can provide soothing relief for perineal discomfort at home.

4. If itching persists, it's important to rule out skin cancer by requesting a biopsy.

5. Some imaging evidence suggests that the small bowel can fall into the pelvic area after colectomy, so it's worth considering a second surgical opinion if this is suspected.

6. Contacting stoma nurses directly can be beneficial, as they are experienced in managing post-operative perineal issues and can help expedite referrals.

7. It's important to persist with specialists, as some issues like nerve entrapment or hernia may require a multidisciplinary approach. Conflicting advice from general practitioners should not be the final word.

8. Maintaining activities that are well-tolerated, such as cycling, and avoiding prolonged standing can help manage symptoms. Pelvic-floor exercises might also aid in circulation and symptom control.

The person is using products like Sheriproct, Anusol, and Eucerin, and is considering switching medications due to side effects. They are also worried about the impact of these symptoms on their work and holidays, and are awaiting further treatment options.