PRURITUS ANI

 Basic information

description

Pruritus ani is chronic itching around the anus (opening of the rectum). It results in a compelling need to scratch the area. It is common and can affect all ages.

FREQUENT SIGNS & SYMPTOMS

• Itching, which can be intense. It often occurs at night or after a bowel movement.
• Scratching makes the itch worse (scratch-itch cycle).
• May have burning and soreness.
• Itching may worsen with heat, moisture, leaking, wearing certain clothing, stress, or anxiety.

causes

• The itching can be a symptom of many conditions. Often the cause is not clear (called idiopathic pruritus ani). The skin can become sensitized from a variety of causes that can't readily be pinpointed.
• Vicious cycles can develop. For example, a person has a mild anal itch and cleans the area with a scented soap (which can sensitize the skin). A worse itch occurs, so you clean again which makes itching even more severe.

risk increases with

• Contact dermatitis caused by soaps, contraceptive foam or jelly, perfumed toilet paper, deodorant sprays, douches, or underwear made of synthetic fabric.
• Skin disorders (e.g., psoriasis, seborrheic dermatitis, atopic dermatitis, neurodermatitis, and others).
• Fissures, fistulas, proctitis, prolapsing hemorrhoids, skin tags, and dysfunction of the sphincter muscle.
• Chronic diarrhea or constipation.
• Fecal incontinence.
• Chronic disorders (e.g., diabetes or thyroid disease).
• Food irritants (e.g., caffeine, tomatoes, beer or wine, citrus, carbonated drinks, spices, hot peppers, milk, chocolate, cheese, or nuts).
• Pinworms, scabies, lice, or yeast infections.
• Excess sweating.
• Excessive or abrasive cleaning of the anal area.
• Use of certain drugs.

PREVENTIVE MEASURES

• Avoid risk factors where possible.
• Follow steps listed in Diagnosis & Treatment section.

expected outcomes

Treating the cause may provide a cure. Symptoms can be controlled with treatment, even if the cause cannot be found. It may take weeks for the itching to stop.

possible complications

• Skin damage or secondary bacterial infection.
• Recurrence is common.
• Complications may occur from an underlying cause.

 diagnosis & treatment

general measures

• Your health care provider will do an exam of the affected area. Medical tests may include blood, urine, stool studies, and others.
• Treatment will be provided for any specific infection or problem that is diagnosed and for the itching.
• Keep showers or baths brief to reduce dryness and soap irritation. Don't overclean the anal area by rubbing or using too much soap. Use plain, unscented soap, or avoid soap entirely.
• Keep the rectal area clean, dry, and cool. Clean carefully after bowel movements. Use moist wipes or moistened toilet paper. Dry toilet paper can be irritating.
• Avoid contact with substances to which you may be sensitive (colored toilet tissue, soaps, or skin products).
• Wear loose clothing and underclothing. Wear underwear with a cotton crotch or underwear made of cotton, rather than nylon or other synthetics.
• Try not to scratch. Wear mittens or cotton gloves on your hands at night, if you are scratching while asleep.
• Get medical advice if stress or anxiety are problems.

medications

• Use a bland, soothing ointment on the affected area.
• You may use nonprescription cortisone ointment or cream. Apply as directed.
• Stronger topical cortisone drugs may be prescribed.
• Drugs to treat an infection or other medical problem may be prescribed.
• An injection of a drug under the skin may be given.

activity

Avoid activities that cause excess sweating.

diet

Try avoiding the food irritants listed in Risk Factors to see if symptoms improve. Drink plenty of fluids.

 notify our office if

• You or a family member has symptoms of pruritus ani that persist.
• The skin area seems infected or bleeding occurs.
• Symptoms don't improve with treatment.

Special Notes: