What is pruritus ani?

Anal itching is an intense discomfort that affects the skin around a person's anus, which is the canal at the end of the rectum from which feces is expelled from the body. Also known as pruritus ani, anal itching can result from many different factors. It occurs more commonly in men than women, although the reason for the difference is unknown.

Pruritus ani is often associated with other similar symptoms that appear around the anus, such as burning and soreness. In many cases, the itching and irritation in and around the anus may be either temporary or more persistent. Some people may have an overwhelming urge to scratch the anus when these symptoms appear. For this reason, symptoms associated with anal itching can be a source of embarrassment.

There are many causes for pruritus ani, which can be worsened by certain factors. Moisture, irritation from clothing, and pressure from sitting can make symptoms of anal itching worse. The symptoms tend to increase at night or right after a bowel movement. Patients who experience anal itch may worsen the problem with excessive scratching, which removes layers of skin.

How is it diagnosed?

Most people will experience symptoms related to pruritus ani at some point. In most cases, patients who experience pruritus ani will not need to seek medical care. However, symptoms that persist or fail to respond to treatment may require a visit to a physician. Nonetheless, the potentially embarrassing nature of the condition makes some patients reluctant to seek medical care. Those who do seek care will find that proper treatment and self-care measures can result in complete relief from symptoms for most people.

To identify the source of pruritus ani, a physician will perform a complete medical examination and compile a thorough medical history. In some cases, questions about the nature of a patient's symptoms will help reveal the potential cause of the anal itching. Females should also undergo a gynecological exam to rule out any underlying disease process, such as vaginitis.

If the cause of the itching cannot be determined, the patient may be referred to a dermatologist (physician specializing in disorders of the skin, mouth, external genitalia, hair and nails) or proctologist (physician specializing in rectal and anal disorders). The physician may perform diagnostic procedures, such as:

How is pruritus ani treated?

In many cases, pruritus ani can be prevented or successfully treated by taking proper self-care measures. These may include:

• Gentle cleansing. Wash the anal area immediately after bowel movements, as well as upon waking in the morning and before going to bed at night. Soap should not be used, and the area should not be scrubbed. When cleaning, use a soft, wet washcloth, wet bathroom tissue, cotton balls moistened with water, unscented baby wipes or a small squeeze bottle of water. A bidet (sit-down basin resembling a toilet) may be used to help gently cleanse the anal area.
• Thorough drying. Pat the anal area dry with toilet paper or a towel, or use a hair dryer to gently but thoroughly dry the area. A dry cotton ball or a piece of cotton gauze can be placed against the anus following drying and replaced as necessary. Nonmedicated talcum powder or cornstarch also can help keep the area dry.
• Proper use of over-the-counter (OTC) treatments. Over-the-counter creams should be used sparingly. Some people will find that these medicines actually increase irritation. Patients should not use any medicine without first consulting a physician.
• Not scratching. Although the temptation to scratch is often strong in those with an anal itch, it should be avoided. Scratching further irritates the skin and causes persistent inflammation. Applying a cold compress to the anal area or taking a lukewarm bath can provide relief from itching. A sitz bath also may provide relief from itching and can be done in a basin or bidet. In a sitz bath, the individual soaks the hips and buttocks in water or a salt solution. It can be used to provide relief from pain or itching in the rectal area caused by various conditions.
• Avoiding tissues that irritate the skin. Bathroom tissue that has dyes or perfumes can irritate the skin around the anus. Unbleached, unscented tissue is the preferred alternative.
• Wearing cotton underwear. Cotton helps to keep the genital and anal areas dry. People should change underwear daily or whenever it becomes soiled, and women should avoid wearing pantyhose, which can trap moisture. Other clothing should also be lightweight and loose, particularly clothing that is worn overnight.
• Avoiding irritants. Bubble baths and genital deodorants can irritate the anal area, as can certain foods and beverages. People should not overuse laxatives that increase diarrhea and the risk of anal irritation and itching.

Several medications are available to help relieve symptoms of anal itching. Over-the-counter (OTC) creams or ointments containing hydrocortisone can reduce inflammation and itching. A protective ointment that contains zinc oxide also may help. Patients who experience worsening of symptoms at night may benefit from a prescription antihistamine that can reduce itching.

In some cases, additional medications or surgery are necessary to treat the underlying problem that is causing the anal itching.

Medications

Zofran (Ondansetron), Periactin (Cyproheptadine), Phenergan (Promethazine), Clarinex (Desloratadine), Atarax (Hydroxyzine), Revia (Naltrexone)

What might complicate it?

Severe excoriation, ulceration and secondary infection of the perineum are complications. The presence of hemorrhoids, an anal fistula, incompetent anal sphincter, or an underlying disease process might complicate pruritus ani.

Predicted outcome

If the cause can be determined and effectively treated, pruritus ani can be eliminated. Symptoms can be lessened or eliminated in idiopathic cases through use of injected medication.

Alternatives

Hemorrhoids, fistula, fissures, tumors of the anorectum, infections, contact dermatitis, psoriasis, Bowen's disease or Paget's disease are other possibilities.

Appropriate specialists

Proctologist, gastroenterologist, gynecologist, and dermatologist.

Last updated 11 July 2015