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| Pruritus Ani |
Last updated: Apr 28, 2008 |
Contributing risk factors | Other conditions that may be present | Recommendations
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Pruritus ani is a chronic itching of the skin around the anus. Anal itch is a symptom, not an illness, and it can have many different causes. In most cases, a person with anal itch has no underlying disease of the anus or rectum. Instead, the itchy sensation is merely a sign that the anal skin has been irritated. The skin of the perirectal area is exposed to irritating digestive products in the stool; this may lead to an itchy rash, especially when stools are frequent. Often the rash is worsened by vigorous use of toilet tissue or scrubbing with soap and water.
Anal itch is a very common problem that occurs in up to 45% of people at some time during their lives. While men are affected 2 - 4 times more often than women, both sexes have an increased risk for this problem if they are overweight, perspire heavily or routinely wear tight-fitting underwear.
Anal itching is usually an isolated skin complaint in otherwise healthy people, but in some it's part of a disorder involving other areas of the skin. Whether pruritus ani is an isolated problem or part of another skin disorder, irritation from stools and from cleansing after bowel movements keeps the rash going.
Treatment is intended to reduce irritation of the anal skin. Gentle cleansing after bowel movements is important. Moisten the toilet paper with lukewarm water, as dry toilet paper doesn't cleanse as well as wet and also irritates your skin. Never use soap on the anal area. Cleansing with plain water, in either the shower or bathtub can be helpful..
Applying topical remedies such as zinc oxide or hydrocortisone ointment (1%) on a regular schedule, or as needed, to help you avoid scratching.
Pruritus ani is frequently stubborn and requires months of local medication and gentle skin care. If the cause is not found, some people need to continue their medication indefinitely, as the itching returns whenever they stop.
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Risk factors for Pruritus Ani:
Pruritus Ani suggests the following may be present: | |  | | | | Digestion | Hemorrhoids | Sometimes hemorrhoids will cause anal itching. Skin tags, rectal fistulas, rectal fissures or anorectal cancer (rarely) can do so also. |
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Recommendations for Pruritus Ani: | |  | | | | Botanical | Not recommended:
Coffee (Coffea genus) | Diet |
Dairy Products Avoidance
Alcohol Avoidance
Spicy Foods Avoidance | You may find that alcohol, coffee, tea and spicy foods make pruritus ani worse. These foods irritate the digestive tract and increase the number of stools or amount of mucus secreted from the rectum.
Other items that can irritate include chocolate, citrus fruits, vitamin C tablets and tomatoes. Once a person eats or drinks something that can irritate the anus, it usually takes 24 to 36 hours before anal itching begins. |
| Drug |
Conventional Drugs / Information | The OTC medication Lotrimin cream mixed with hydrocortisone 1% cream can be applied daily. A mild alphahydroxyacid cream can help, as can plain vaseline applied each day to the anal area. |
| Environmental |
Chemical Avoidance | In sensitive individuals, chemicals and medications that are applied to the anal area can cause local irritation or allergic reactions. These include dyes and perfumes used in toilet paper, feminine hygiene sprays and deodorants used in the area around the anus or genitals, medicated talcum powders, and medicated skin cleansers and soaps, especially perfumed soap.
You have to be careful not to set up a cycle of worsening. For example, you may have a mild anal itch. You then clean your anus with a scented soap. This may contain an ingredient which sensitises your skin. You then get a worse itch. You may think the itch means the anus needs more cleaning, and so you clean it even more with the scented soap - which makes things worse, and so on. |
| Habits |
Personal Hygiene Changes | Here are some things you can do to help keep the area clean. Wash the anus after going to the toilet to pass feces. The aim is to clear any remnant of feces which may irritate the skin. Using a bidet or a handheld sprayer which attaches to a faucet at home will help rinse the areaDab the area dry, don't wipe.When washing around the anus it is best to use water only. If you use soap, use bland non-scented soap. All natural skin and bath products have helped some.When you are not at home, use a moistened cloth or a special moistened tissue to clean the anus. You can buy moistened tissues from pharmacies.Bath or shower daily. If possible, wash the anus with water only. If you use soap around the anus, rinse well.Change your underwear daily. |
| Homeopathy |
Homeopathic Remedies / Vaccines | Here are a few homeopathic remedies that you could consider:
Aloe: itching after stool; itching and burning in anus preventing sleep; compelled to bore with finger into anus; itching is so violent patient cannot let it alone; cold applications. Graphites: smarting, sore anus, violent itching. Kali carbonicum: itching, ulcerated pimples around anus. Sulphur: itching and burning; redness around anus; voluptuous itching; scratching, in bed at night, warmth of bed; after discharge of moisture; cannot bear any applications. |
| Lab Tests/Rule-Outs |
Elimination Diet | Drinks such as milk, citrus fruit juices and those containing caffeine, such as coffee, tea and cola, may aggravate pruritis ani for some people. Similarly, foods that may be a problem include chocolate, fruits, tomatoes, nuts and popcorn. |
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KEY |  | Weak or unproven link |  |  | Strong or generally accepted link |  |  | Very strongly or absolutely counter-indicative |  |  | May do some good |  |  | Likely to help |  |  | Highly recommended |  |  | May have adverse consequences |
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