Anal Itching – Pruritus Ani

This is itching or irritation of the perianal area and it occurs as a symptom of many conditions. The commonest cause is irritation of the skin caused by moisture of faecal soiling. Also some primary skin diseases or perianal conditions can cause irritation.

Anal itch is an intense itching around your anus – the 1 1/2-inch-long canal that’s the outlet for your rectum. It can be an embarrassing and uncomfortable situation. The itch, located in your anus or on the skin just around your anus, may be accompanied by a strong urge to scratch.

Also called Pruritus ani, anal itch has many causes. Numerous factors may cause anal itch to be more intense – including moisture, the abrasion caused by your clothing, and the pressure of sitting. Anal itch is usually most noticeable and bothersome at night or right after a bowel movement.

Anal itch is a common problem that most people have experienced. Don’t be afraid to talk with your doctor about this condition. With proper treatment and self-care measures, most people can achieve complete relief.

Signs and Symptoms

Anal itch is associated with other similar symptoms in and around the anus, including:

Burning
Soreness
The itching and irritation in and around your anus may be a temporary condition, or it may be a more persistent and bothersome problem. For some people, the irritation is so intense that the urge to scratch is irresistible – and a source of embarrassment.

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Causes

Some of the many possible causes of anal itching are minor. Others involve more serious medical problems. Possible causes include:

Dry Skin : As you age, skin in and around your anus is more prone to dryness. Dry skin can cause a persistent, intense anal itch.
Too much moisture. Moisture around your anus from excessive sweating or from moist, sticky stools can be irritating. Anal itch especially can be caused by frequent diarrhea or the escape of small amounts of stool (fecal incontinence), particularly if you don’t practice good anal hygiene.
Excessive Washing : Excessive wiping with dry, harsh toilet paper or excessive scrubbing with harsh soaps and a washcloth can cause or aggravate anal itch. Failure to rinse soap completely may also cause irritation.
Chemical Irritants : Certain laundry soaps, colognes, douches and birth control products contain chemicals that can irritate skin in and around your anus. Scented or colored toilet paper can be irritating to people with sensitive skin.
Food Irritants : Anal itch may be due to irritating chemicals in some foods, such as are found in spices and hot sauces. Similarly, some foods may directly or indirectly irritate your anus as they exit your digestive system. Common culprits include chocolate, fruits, tomatoes, nuts and popcorn. Consuming certain beverages – possibly milk or caffeinated drinks – may cause some people to experience diarrhea followed by anal itch.
Medications : Anal itch may be a side effect of certain medications, such as some antibiotics, that can cause frequent diarrhea.
Overuse of Laxatives : Excessive or improper use of laxatives can lead to chronic diarrhea and the risk of anal irritation and itch.
Hemorrhoids : Hemorrhoids (also called piles) are clusters of veins located just under the membrane that lines the lowest part of your rectum and anus. Sometimes, often as a result of straining during a bowel movement, these veins may become swollen and form hemorrhoids. Anal itch can be a symptom of hemorrhoids. However, most hemorrhoids don’t itch.
Bacteria : Faeces in contact with the perianal skin causes irritation because the bacteria in it produce chemicals that are highly irritant. Moisture from sweat or mucus softens the skin and the chemicals produced by the faecal bacteria irritate. This causes itching which leads to scratching. This breaks the skin surface and encourages more softening and infection. Therefore a vicious circle is set up which is often difficult to break.
Perianal Conditions : Up to 40% of cases of Pruritus ani cases are caused by perianal conditions (such as fistula, Crohn’s disease, hemorrhoids and very rarely cancers) with only 5 % caused by generalized skin diseases. Most cases are therefore caused by the above-mentioned vicious circle.
Inadequate Cleaning : Inadequate cleaning of the perianal region after defaecation is the commonest cause, aggravated by anal skin tags, or prolapsed piles. In some cases no cause can be found
When a doctor sees a patient with this complaint he will want to know if there is any itching, skin irritation or rashes anywhere else, or any mucus discharge, prolapsing piles, perianal pain, or any diarrhoea.
Worms : It is also important to know whether any other members of the family are affected as worms that can cause this symptom often affect more than one member of the family.
Pinworms : In children, a common cause of persistent anal itching is infestation with the parasite that causes pinworms. Other parasites may cause similar itching.
Skin Disorders : Common skin problems – such as psoriasis, seborrhea and eczema – can involve and irritate the area in and around your anus. The doctor will want to look at the skin of the whole body and will then examine the anus, both with a gloved finger and with a telescope to see if he can find any obvious cause of the irritation. It may be necessary to send some scrapings of the skin around the anus to a microbiologist to look for infection with fungus
Yeast Infections : Certain diseases, such as diabetes or human immunodeficiency virus (HIV) infection, as well as treatment with antibiotics can lead to a yeast infection that irritates your genital and anal areas.
Anal Abrasions and Fissures : An anal abrasion is a small tear in your anus, usually caused by forced bowel movements though a tight anus. An anal fissure is a deeper tear. Both conditions can cause anal itch, as well as painful bowel movements and bleeding.
Anal Tumors : Rarely, benign or cancerous tumors in or around the anus may be a cause of anal itch.
Anal itch may be related to anxiety or stress. Sometimes, the cause is unknown.

Your own actions may be to blame, in part, for anal itch. Whatever the cause of anal itch, your natural reaction is to scratch the area. But scratching compounds the problem by removing superficial layers of skin. In addition, the natural tendency in response to an irritation is to wash the area frequently with soap and a washcloth. However, excessive washing almost always makes the problem worse by further damaging your skin and removing protective oils.

When to seek Medical Advice ?

Most itching doesn’t require medical care. However, if anal itching is severe or prolonged or if it can’t be easily explained, see your doctor. Persistent anal itching may be related to a skin condition or other health problem that requires medical treatment.

Screening and Diagnosis

Your doctor may be able to pinpoint the cause of your itching simply by asking you questions about your symptoms.

If the cause of your itch isn’t obvious, your doctor may refer you to a doctor who specializes in treating rectal and anal problems (proctologist) or a dermatologist for further evaluation. A rectal exam may be all that’s required for you to get an answer – and a solution – to a very uncomfortable problem.
Sometimes other tests, such as a colonoscopy to view more of the digestive tract, are needed in addition to a physical exam to identify an underlying cause of anal itch. It may be that the precise cause of the itch is never identified.

Treatment

Treatment of anal itch may include self-care measures, changes to your diet, treatment of infections or, rarely, surgery to correct an underlying problem. Your doctor can recommend the best treatment to eliminate your specific problem.

Your doctor may also recommend medications to treat anal itch. An over-the-counter (OTC) cream or ointment containing hydrocortisone (Cortaid, Hytone), applied sparingly to the affected area once or twice a day, for up to 2 to 3 weeks, may reduce inflammation and itching. Doctors treat pinworm infection and other parasitic infections with prescription oral medications to relieve anal itch.

With proper treatment, most people experience complete relief from anal itch.

Self-Care

Prevention of anal itch mainly involves washing properly and avoiding irritants. If you already have anal itch, try these self-care measures

Cleanse Gently : Wash the area in the morning, at night and immediately after bowel movements. But don’t scrub and avoid using soap. Instead, use a wet washcloth, wet bathroom tissue, cotton balls moistened with water, unscented baby wipes or a small squeeze bottle of water to cleanse the area.
Dry Thoroughly : After cleansing, pat the area dry with toilet paper or a towel. Or dry thoroughly with a hair dryer. Once dry, place a dry cotton ball or a piece of cotton gauze against the anus. Replace the cotton as necessary.
Use over-the-counter treatments sparingly : An OTC cream or ointment containing hydrocortisone (Cortaid, Hytone) applied sparingly to the affected area once or twice a day may reduce inflammation and itching. However, don’t use these treatments unless directed by your doctor. For some people, the creams or ointments may cause more irritation, and they may mask a persistent problem.
Don’t Scratch : Scratching further irritates your skin and leads to persistent inflammation. If you can’t tolerate the itch, apply a cold compress to the area or take a lukewarm bath to find some immediate relief. Keep busy to distract yourself from scratching.
Switch Tissue : The skin around your anus may be sensitive to bathroom tissue that contains dyes or perfumes. Use unbleached, unscented tissue. You may want to use tissue that’s moistened or made extra soft for comfort.
Wear Cotton Underwear : This helps keep the area dry. Avoid wearing pantyhose, which can trap moisture. Change your underwear daily and whenever it’s soiled.
Avoid Irritants : Avoid bubble baths and genital deodorants. Cut back or avoid beverages or foods that you know irritate your anal area. Avoid overuse of laxatives that increase diarrhea and the risk of anal irritation and itch.