Pruritus ani


Pruritus ani

Description, Causes and Risk Factors:

Itching around the anal area, called pruritus ani, is a common condition.

Pruritus ani is a common problem but the exact number of people who get pruritus ani is unknown. However, it does seem to be more common in men than women. It most commonly affects people between the ages of 40-60 but it can affect children and someone of any age.

In many cases, the cause is not clear. In some people, it may be that something is 'sensitizing' your skin (such as an ointment that you are using, or your sweat, or the toilet tissue that you use) but you cannot pinpoint the cause exactly.

In other people it is thought to be caused by a small amount of faeces (stools or motions) leaking from the anus and irritating the nearby skin, causing itching. Also, pruritus ani may affect some people with problems such as depression. However, the cause can remain a complete mystery in some people.

Predisposing tendencies to pruritus ani include any one of a variety of conditions that will lead to perpetually moist perianal skin. These include vaginal discharge, urinary leakage, excessive sweating, mucous discharge from the anus with third degree piles or mucosal prolapse, a purulent discharge associated with a fistula-in-ano or perianal sepsis, and frequent defecation-particularly of watery stools. Moisture in the natal cleft may be aggravated by wearing tight clothes that compress the buttocks, underclothes of synthetic non-porous material, a hot occupation, or prolonged sitting on plastic seats. The increasing popularity of nylon tights and nylon underpants in recent decades has been said to be associated with a real increase in the incidence of pruritus ani. Other predisposing factors include systemic diseases such as diabetes, intestinal helminthiasis, scabies, anogenital herpes, molluscum contagiosum, a tendency to an eczematoid skin reaction, and a tendency to fungal skin infection elsewhere on the body.

In addition, drinking certain beverages, including some alcoholic beverages - especially beer - milk, citrus fruit juices and drinks containing caffeine, such as coffee, tea and cola, may be aggravating for some people. Similarly, some foods that may be a problem include chocolate, fruits, tomatoes, nuts and popcorn. Other rare causes of pruritus ani may include pinworms, psoriasis, eczema, dermatitis, hemorrhoids, anal fissures, anal infections and allergies.

Symptoms:

Once the sensitive skin of the perianal area has beendamaged a vicious circle begins. Because of the rich cutaneousnerve supply the damaged skin is sensitive and either itches oris painful. The sufferer then tends to scratch the affected areaso damaging the epithelium further. Once the natural resistanceof the perianal skin to infection is damaged saprophytic bacteria and fungi from the skin can gain access, giving rise todermatitis. He may then develop sensitivity to the byproducts of micro-organisms and, particularly if he has aneczematoid tendency, a skin sensitivity reaction may twist thevicious circle into a vicious spiral.

Diagnosis:

Diagnosis may include:

    History: There may be no other symptoms than severe itching of the anal area. Individuals may report that the itching seems to be particularly noticeable at night during sleep. Skin changes may or may not be seen.

  • Physical exam: The exam may reveal any of the following: red, irritated skin; bumps; an unusual thickening or softening of the skin; and/or scratches or breaks in the skin from scratching. Hemorrhoids, fistulae, or evidence of an incompetent anal sphincter may also be present. Stool incontinence may be observed. A gynecological exam can rule out any underlying disease process, such as sexually transmitted diseases.

  • Tests: Blood glucose levels, blood nitrogen levels, liver (hepatic) functions, analysis of feces, and a skin biopsy may be performed. An examination of the inside of the rectum and lower colon is done using a viewing tube inserted through the anus (proctocolonoscopy). Because there are so many possible causes of pruritus ani, it is very important that it is diagnosed and treated accurately.

Treatment:

The essentials of treatment are keeping the perianal skin scrupulously clean, dry, and protected from physical trauma.

Avoid further trauma to the affected area:

    Do not use soap of any kind on the anal area.

  • Do not scrub the anal area with anything - even toilet paper.

  • For hygiene, use wet toilet paper, baby wipes or a wet washcloth to blot the area clean. Never rub.

  • Try not to scratch the itchy area. Scratching produces more damage, which in turn makes the itching worse.

Avoid moisture in the anal area:

    Apply either a few wisps of cotton, a 4 x 4 gauze or some cornstarch powder to keep the area dry.

  • Avoid all medicated, perfumed and deodorant powders.

Use only medications prescribed by your physician and use them only as directed. Apply prescription medications sparingly to the skin around the anal area and avoid rubbing.

Avoid excess fluids and the foods previously mentioned. In most instances, a maximum of six glasses of fluid daily is reasonable. There is not usually any health benefit to drinking more fluid than this in the course of a day.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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