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Pruritus Ani - Causes, Symptoms and Treatment

 

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Pruritus ani is a chronic itching of the skin around the anus. It is a symptom with many causes, but sometimes no obvious cause can be found. Pruritus ani is common, affecting up to 5% of the population, and occurs more often in men than women. Itching is the main symptom, often occurring after the bowels have opened. It may be bad enough to interfere with sleep. Sometimes the skin becomes sore after scratching, making it uncomfortable to open your bowels. Anal itching can be caused by irritating chemicals in the foods we eat, such as are found in spices, hot sauces, and peppers. It also can be caused by the irritation of frequent liquid stools, diarrhea, or escape of small amounts of stool. Other problems that can cause anal itching include pinworms, hemorrhoids, tears of the anal skin, and skin tags. Pruritus Ani causes an irresistible urge to scratch that may be most noticeable and bothersome at night or after bowel movements. The most common causes are excessive moisture and eating irritating foods.

Poor hygiene is rarely a cause of Pruritus Ani, but many patients start cleaning the anal region excessively to try and stop the itching. This usually makes the condition worse by damaging the skin and washing away protective natural oils. Pinworms can cause sever anal itching and should be thought of if several members of the family have this problem. One can see the worms by putting scotch tape over the area than looking at the tape.  This problem requires treatment by a physician. Pruritus ani is frequently stubborn and requires months of local medication and gentle skin care. If the cause is not found, some people need to continue their medication indefinitely, as the itching returns whenever they stop. The key to treatment is self care and the avoidance of predisposing factors. Keep the area clean, cool, and dry. You may use over-the-counter cortisone ointment or cream to control the itch. You should apply it three times a day and rub in gently until the medication disappears.

Causes of Pruritus ani

The root cause can be a condition such as haemorrhoids, a fissure, fistula or skin disease. Often, however, there is no obvious cause. Pruritus ani can be caused by irritating chemicals in the foods we eat, such as are found in spices, hot sauces, and peppers. It also can be caused by the irritation of frequent liquid stools, diarrhea, or escape of small amounts of stool. Other problems that can cause anal itching include pinworms, hemorrhoids, tears of the anal skin, and skin tags.

Common causes and risk factors of Pruritus ani:

  • Anal disease.
  • Vigorous use of toilet tissue.
  • Alcohol, coffee, tea and spicy foods make pruritus ani worse.
  • Scratching.
  • An allergy to something in contact with the skin.

Signs and Symptoms of Pruritus ani

The hallmark symptom is itching. On physical examination, the perianal area may appear normal, but excoriations from involuntary scratching can often be seen. Sometimes the skin becomes sore after scratching, making it uncomfortable to open your bowels. The skin around the anus may look inflamed and thickened, and show scratch marks. Small cracks may occur and these may feel painful and sensitive, and bleed.

Sign and symptoms may include the following :

  • Anal itching.
  • Redness of skin around the anus.
  • The itching is often intense and worse at night.
  • Chronic inflammation can occur.

Treatment for Pruritus ani

The key to treatment is self care and the avoidance of predisposing factors. Keep the area clean, cool, and dry. You may use over-the-counter cortisone ointment or cream to control the itch. Irritation of the anal skin needs to be reduced. It is impossible to eliminate it altogether because the stool continues to be in contact with the inflamed skin. Eat plenty of high fibre foods. Straining at stool causes cracks in the anus which are irritable and harbour bacteria. Antifungal creams can be used, but they promote excess moisture, which can cause itching. Oral antibiotics should be discontinued, if possible. Patients should not wear synthetic underwear or use perfumes or deodorizers on the perineum.

Treatment may include:

  • Eat plenty of high fibre foods (cereals, fruit and vegetables). Straining at stool causes cracks in the anus which are irritable and harbour bacteria.
  • Wash the anus in a bidet or a bucket of lukewarm water. Moistened tissues or soft toilet paper are next best. Use aqueous cream, mineral oil or other soap-free cleanser.
  • Applying topical remedies such as zinc oxide or hydrocortisone ointment on a regular schedule, or as needed, to help you avoid scratching.
  • The most effective local therapy is hydrocortisone cream. Usually, it is applied only at night, when itching occurs. Severe cases may require application several times a day.