Introduction
Pruritus ani is a common medical condition that affects both men and women. Pruritus ani is most common in adults, affecting 1 to 5 % of the general population. Men are four times more likely to be affected than women. The condition is most prevalent in people between 40 and 60 years. There are numerous causes of pruritus ani, and an appropriate diagnosis is required to treat the underlying cause. Medical management of pruritus ani frequently relieves symptoms and improves patients' quality of life.
What Is Pruritus Ani?
Pruritus ani, which means itchy anus, is an uncomfortable sensation of the skin around the anus that causes the desire to scratch. Pruritus ani, also known as anal itch, is a symptom, not a disease, and it can have a variety of causes. Pruritus ani can be classified as either primary or secondary. The classic syndrome has no identifiable cause (referred to as "idiopathic"), whereas the secondary form has an identifiable, but often specifically treatable, cause. Itching may result from minor skin stimulation. The subsequent scratching may cause skin injury, resulting in a larger area of irritated skin. In addition, scratching repeatedly increases the need to scratch, exacerbating the problem.
What Causes Pruritus Ani?
This pruritus or itching symptom is common in many anorectal conditions. Possible causative agents include hemorrhoids, excessive skin tags, fecal soiling or incontinence, anal fissures (painful clefts or grooves), anal fistula (abnormal passageways between the bowel and an organ or skin surface), and anal warts. It is sometimes unclear what causes a long history of primary pruritus ani. It is thought that the itching is caused by an irritating secretion from the anal canal. With repeated trauma or scratching for extended periods, the local nerve fibers in the skin may become chronically active. Itching can also be caused by nerve pathway disorders or a central nervous system stimulus such as medications. In addition, itching can occasionally be psychogenic. The itchy sensation indicates either of the following factors has irritated the skin in the affected area:
-
Stool Left on the Skin Around the Anus - If the anal area is not properly cleaned after a bowel movement, some amount of stool may be left on the skin, causing itching. In addition, watery stools may occasionally leak out of the anal opening, causing itching. This can happen in otherwise healthy people whose diets include a lot of liquids.
-
A Diet That Irritates the Anal Skin - A variety of foods and beverages can irritate the anus, like spices and spicy foods, tea, coffee (both caffeinated and decaffeinated), milk, alcoholic beverages (especially beer and wine), citrus fruits, vitamin C tablets, chocolate, and tomatoes. It usually takes 24 to 36 hours after eating or drinking something that can irritate the anus before anal itching begins. That is the duration for food to pass through the digestive tract.
-
Antibiotic Treatment - Some powerful antibiotics that work against a wide range of bacterial species can cause anal itch by disrupting the normal ecology of the intestines. Tetracyclines and Erythromycin are two examples of broad-spectrum antibiotics (both sold under several brand names).
-
Local Irritation or Skin Allergy in the Anal Area - Chemicals and medications applied to the anal area can lead to local irritation or allergic reactions in sensitive people. Some of the most common culprits are dyes and perfumes used in feminine hygiene sprays and other deodorants for the region around the anus or genitals, toilet paper, medicated skin cleansers and soaps, particularly perfumed soaps, and medicated talcum powders. In addition, over-the-counter (OTC) medications (suppositories, creams, and ointments) intended to treat anal problems can also cause anal itching.
-
Intense Cleaning After a Bowel Movement - While the anal area needs to be cleaned after every bowel movement, it must be done gently. Rubbing and scrubbing aggressively, especially with soaps or other skin cleansers, can cause skin irritation and cause an anal itch.
Infectious diseases can also cause pruritus ani. Bacterial skin infections, fungal infections (although one common fungus, Candida albicans, appears to be normal flora of the perianal skin), parasitic infections with pinworms or scabies, and viral infections with anal warts are all examples.
-
A variety of skin conditions can cause secondary pruritus ani. Psoriasis, atopic dermatitis, seborrheic dermatitis, contact dermatitis, lichen simplex, lichen planus, and lichen sclerosis are all potential causes of pruritus ani. Pruritus ani can also be caused by local cancers such as Bowen's disease or extramammary Paget's disease.
-
Pruritus ani can be caused by medical conditions that affect the entire body. Diabetes, leukemia and lymphoma, liver diseases (obstructive jaundice), kidney failure, iron deficiency anemia, and hyperthyroidism are a few examples.
While there are numerous potential causes, it is important to note that the itching has no identifiable cause in many cases.
What Are the Clinical Features of Pruritus Ani?
Pruritus ani symptoms may include:
-
Itchiness.
-
Irritation.
-
Burning.
-
Soreness.
-
Scratches (excoriations).
-
Skin that is thick or leathery on or around the anus (perianal area).
How Is Pruritus Ani Diagnosed?
The healthcare provider will conduct a physical exam to rule out any underlying causes of the itchy anus, such as dermatological conditions or illnesses. They will examine the perianal area and note changes in skin color, texture, rashes, or lesions.
Investigations may be required to determine the root cause.
-
Bacteriology skin swab.
-
Mycology skin scraping.
-
Sticky tape test for pinworm ova.
-
Patch testing to diagnose allergic contact dermatitis.
-
A skin biopsy is performed to diagnose inflammatory disorders or skin cancer.
How Is Pruritus Ani Treated?
-
The treatment of anal itching is determined by the cause of the problem. Self-care measures may include using an anti-itch cream or treating an infection or fecal incontinence.
-
If the symptoms worsen at night, an antihistamine may be prescribed. This medication is taken orally. It can provide temporary relief until an anti-itch cream takes effect.
-
Most people find relief from anal itching with proper care. However, if the itching persists, medical attention is needed.
How to Prevent Pruritus Ani?
The mainstay of anal itching prevention is a careful washing routine that keeps the area clean, cool, and dry while avoiding irritating the skin. The following self-care measures can alleviate symptoms:
-
Gently Cleansing: The area around the anus must be cleaned when it is soiled or after each bowel movement. This could include a quick shower, a bidet, a sitz bath, or the use of a squeeze bottle. Toilet tissue that is moist can be useful. Scrubbing and rough clothes should be avoided. Pat dry with a cloth or use a hair dryer on the fan setting to dry the area. Using the heat setting could aggravate this sensitive area even more.
-
Do Not Scratch: Scratching only provides temporary relief from itchy skin. It aggravates the skin even more. Applying a damp, room-temperature compress to the area or taking a lukewarm oatmeal bath may provide relief. To avoid scratching while sleeping, the nails must be short, and cotton gloves can be worn before bed.
-
Wear Non-Binding White Cotton Underwear: This keeps the area dry. Pantyhose and other tight-fitting garments should be avoided because they can trap moisture.
-
Irritants Should Be Avoided: Genital deodorants, personal cleansing wipes, scented toilet paper, bubble baths, and harsh or perfumed soaps must be avoided. Cleaning with gentle soap, water, and no other products is usually the best option.
-
Alterations in the Diet: Tea, coffee, alcohol, citrus fruits, dairy products, pepper, spicy foods, tomato sauce, and tomatoes should be limited or avoided until the symptoms improve. Avoiding excess use of laxatives.
-
Apply Ointments, Creams, or Gels as Needed. Apply a thin layer of zinc oxide ointment (Desitin, Balmex) or petroleum jelly to the affected skin to keep it moist (Vaseline). Apply hydrocortisone 1 % cream twice to three times daily for a week or two to relieve inflammation and itching.
-
Increase Intake of Vegetables, Whole Grains, and Noncitrus Fruits. This will aid in the maintenance of regular bowel movements. Beans, nuts, and seeds are also high in fiber. Fiber supplements like psyllium (Metamucil) and methylcellulose (Citrucel) may be beneficial.
Conclusion
Anal itching is a bothersome condition. It is irritating and embarrassing and may become so unbearable in some situations. It can occur due to various causes. An itchy anus can be relieved with proper hygiene, medications, and gentle care. If the symptoms do not improve even after self-care measures, a doctor must be contacted immediately.