What Are The Causes Of Anal Itching (Pruritis Ani)
Anal itching or pruritis ani is severe itching of the anus as well as the immediate area surrounding the anus.
Causes Of Anal Itching
Itching may result from the lack of proper hygiene. However, more often than not, the cause may not be identifiable. Some of the probable reasons for anal itching are:-
- Pinworms
- Fungal infections
- Food allergy
- Lack of hygiene
- Inflammatory bowel disease
- Cancer (rarely)
Itching may appear suddenly without any apparent reason and may disappear without any particular treatment. Lack of hygiene being the most common reason for anal itching, doctors may advise measures to be taken to maintain proper hygiene. If pinworm infestation or fungal infection is suspected, appropriate drug treatments can be initiated. Itching due to cancer is rare but it is a serious issue requiring immediate medical attention. Inflammatory bowel disease also is a cause of concern. For all other unidentified causes, a wait and watch approach is taken initially, with medication to reduce itching. Only if the condition does not clear up in a week, further investigations are initiated.
Lack of hygiene as well as too much hygiene can result in anal itching. Particles of stool left behind by insufficient cleaning of the anal area after bowel movements, and sweat accumulating in the area, can cause irritation to the delicate skin in and around the anus. On the other hand, vigorous rubbing and repeated cleaning with wipes and soap can irritate the skin, making it tender and sore. Allergic reaction to certain ingredients in the soaps and other cleansing solutions can also result in itching. Presence of hemorrhoids poses additional hindrance to proper cleaning after passing stools. Hemorrhoids leaking mucus, blood or stool can cause severe itching in the area.
Anal itching often sets off a vicious cycle of itching and scratching, and then more itching and more scratching until the area becomes too tender and sore, eventually resulting in a burning sensation and pain. It can invite infections which may make matters worse. Allergic reaction to the very ointments used for relieving itching, may precipitate more itching.
Self evaluation
More often than not, anal itching may not have a serious underlying disorder that requires medical intervention. Self evaluation based on the pointers provided here may help a person assess the seriousness of the condition and decide on the next course of action.
- Pinworms, usually found in children, cause severe itching especially at night – de-worming should be done.
- Allergy from certain foods and chemicals like soaps can cause anal itching – avoid them.
- Extremes of hygiene – have good hygiene practices and avoid severe rubbing and cleaning with harsh soaps.
Warning signs: If the following symptoms appear along with itching, it should be investigated.
- A draining fistula which causes pus to exude from the anus.
- Diarrhea with traces of blood in the stool
- Hemorrhoids protruding out of anus.
- Particles of stool spontaneously appearing in the anal area.
- Thickened and hard skin around the anus
Medical intervention may be required in the first two instances i.e., if there is pus formation or if stools are bloody. For the rest of the cases, doctors can be consulted, if the itching and other symptoms do not resolve in a few days with proper measures of hygiene, keeping the area dry and avoiding irritation.
On a visit to the doctor, the symptoms should be described in detail. A physical examination of the anus and the surrounding area may be done and previous medical history may be studied before reaching a diagnosis. Doctor may check for thickening and hardness of the perianal area, the presence of abnormalities such as fistula, hemorrhoids, fissures and lesions during the physical examination. Information about the following may be required by the doctor.
- Food habits, especially regarding foods which are spicy and acidic in nature.
- Level of hygiene, frequency of wash and use of cleansing agents.
- Presence of disorders such as psoriasis, diabetes, hemorrhoids and infections like scabies and pinworm infestation.
- Medications used, including antibiotics and creams for topical application to relieve itching.
- Frequency and condition of bowel movements, including the use of suppositories and other stool softeners.
Testing
In the absence of abnormalities and infections in the anal area, treatment may be initiated to relieve itching. A sample from the anal area is collected using a transparent sticky tape, to examine under the microscope, to detect the presence of pinworm eggs. A scraping may be sent for culture to detect fungal infection. Rarely, a skin biopsy may be done under local anesthesia. Anoscopy may be done, during which doctors can detect the presence of hemorrhoids inside the rectum and anal canal by looking inside, using a short viewing tube.
Treatment
To treat the anal itching successfully, its cause should be treated first. De-worming treatments appropriate for pinworm infestation should be done. Measures to avoid re-infestation should also be taken. Anti-fungal ointments or dusting powder should be used to clear fungal infections. Foods suspected or identified, to be causing irritation or allergic reaction, should be avoided. Antibiotics which produce irritation should be substituted with suitable alternatives.
Soft tissue or cotton dipped in warm water should be used to clean the anal area after every bowel movement. Mild cleansing agents specially designed for hemorrhoids may be used, but soaps and pre-moistened wipes should be avoided. Non-medicated talcum powder or plain cornstarch may be used to keep the area dry. In case of severe symptoms, topical application of ointments containing 1% hydrocortisone may bring relief. Tight fitting clothing should be avoided, especially at night.
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Yasser Elnahas
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