What is pruritus ani (proo-ri-tus a-ni)?
Pruritus ani is a Latin phrase that means “itchy anus”. Pruritus ani is the medical term for a persistent (chronic) itching of the anus or the skin around it.
What are the symptoms pruritus ani?
The main symptom of pruritus ani is itching. People feel an unpleasant sensation that produces an urge to scratch their anal area in a way that is hard to resist. Anal itching may occur at any time of the day. However, it’s more in the evenings, at night, and after bowel movements. Moisture around the anus, stools in the anus, heat, wool, stress, and anxiety may also tend to aggravate the itching. Scratching the anal area can damage the skin and make it easy a bacterial infection to occur.
What causes pruritus ani?
Pruritus ani (or itching anus) is a symptom, not a disease. Many things can cause it. Most of the time, there is no known cause of pruritis ani. This type of anal itching without an identifiable cause is called primary (or idiopathic). Sometimes, a cause can be identified. We call that secondary pruritus. Below are some causes of secondary pruritus ani.
- Irritation by fecal matter on the anus. E.g. From poor hygiene; also when you have diarrhea or soft bowel movements.
- Irritants in food: Certain foods can irritate the anus, such as coffee (caffeine), tea, beer, chili peppers, chocolate, tomatoes, milk, citrus fruits like oranges or grapefruit, etc.
- Certain medications: Steroids, Colchicine, Peppermint oil, some antibiotics (e.g. metronidazole or tetracycline) and immunosuppresant drugs.
- Infections:
- Bacterial infections
- Viral infections like herpes simplex and condyloma from HPV.
- Fungal infections like candida etc.
- Parasitic infections like threadworms, pinworms, scabies, etc. Threadworms are the most common cause of anal itching in children.
- Sexually transmitted infections (STI) – gonorrhea, chlamydia, syphilis, etc. STI’s may cause anal itching especially in people who have had anal sex in the past. Women without anal sex may still transfer a vaginal infection when the wipe.
- Skin disorders: E.g. Dermatitis – Atopic dermatitis; contact dermatitis; seborrheic dermatitis. Also psoriasis, lichen simplex or sclerosus, lichen planus, hidradenitis suppurativa, skin tags, etc.
- Systemic diseases: Diabetes, chronic renal failure, iron deficiency anemia, aplastic anemia, leukemia, lymphoma, thyroid disease (myxedema, thyrotoxicosis), and liver disease may cause itching. If necessary, your doctor may draw labs to check for these diseases.
- Diseases of the anus and rectum: Fecal incontinence and fecal soiling, anal or colorectal cancer, hemorrhoids, anal fissure, anal fistula, anal abscess, perianal clefts.
Chronic diarrhea or constipation.
How is pruritus ani treated?
If there is a specific or secondary cause to your pruritus ani, your doctor will treat it. The following will be helpful for all types of pruritus ani whether the cause is known or not.
To prevent anal itching, you need to wash the area properly, keeping the area clean, cool and dry (avoid moisture), avoiding irritants, modify your diet to prevent diarrhea, and protect the skin with ointment when needed.
Personal hygiene or self-care and preventive measures:
-Don’t scratch: Even though it will itch, avoid scratching because it can damage the skin and promote infection. Scratching will further irritate the skin and may lead to inflammation. Keep your nails short. If it itches a lot and you are at risk of scratching at night, wear gloves before going to sleep. You may apply a cold compress or take a lukewarm bath.
-Keep the area clean and don’t irritate the skin: After a bowel movement, use plain water to clean the area. You may use a mild soap. Don’t scrub. Avoid irritants like strong soaps, bubble baths, genital deodorants, moist wipes, or other products that may irritate the anus. Avoid dietary irritants like Coffee, Cola, Beer, Tomatoes, Chocolate, Tea, Citrus, and fruits that may cause diarrhea. Avoid laxatives.
-Balneol (Main ingredients: Water, mineral oil, propylene glycol, and lanolin oil.) cleanser. Use this for cleansing as needed.
-Keep the skin dry: After washing the area, pat the area dry with toilet paper or a dryer set on cool setting. Wear cotton underwear (it absorbs moisture), loose clothing, and avoiding tight-fitting clothing. because they can trap moisture. Don’t use cornstarch powder because it can allow bacteria to grow in the area. Unmedicated talcum powder may be used to keep the area dry.
-Have regular, soft but firm bowel movements: Eat more high-fiber foods like whole grains, fruits, and vegetables. The goal is to get stools that are soft, but well formed, and easy to clean with one wipe. If stools are still soft or too frequent, use a fiber supplement like Psyllium husk – Metamucil or other fiber types. The goal is 20 to 35 grams of fiber each day.
-Drink lots of water with the fiber supplement. At least 2 liters or 67 oz. That is eight 8 ounce glasses.
Treatment of symptoms:
-Barrier protection: Apply a barrier cream like zinc oxide ointment (Desitin, Balmex) or Calmoseptine (Menthol and Zinc Oxide topical) cream BID to protect the skin. Petroleum jelly may also be used. This also helps with itching.
-Itching meditation: Use 1% hydrocortisone cream (Preparation H Anti-Itch Cream) two times a day for itching. Don’t use hydrocortisone more than two weeks because of side effects like thinning of the skin.
-Sleep medication: If the itching is significantly affecting your sleep, you may use an over the counter sleep medication to help you sleep. Use this only short-term. Talk to your doctor about it.