Pruritus Ani: The Embarrassing Itch

Itching of the skin around the anus can be agonizing especially if one is stranded in a public place with no escape in view. More often than not the cause behind this itch is easily addressed. Occasionally, however, persistent severe itching can cause psychological stress to the sufferer and needs in-depth evaluation. What is Pruritus ani? Pruritus ani is defined as chronic, moderate to intense itching of the skin around the anal opening. rnIt affects 1-5% of the population and is more commonly found in men. Once itching occurs, it can lead to a vicious itch-scratch-itch cycle. Causes of Pruritus ani• Fecal Contamination Prolonged contact of the skin with fecal matter can cause irritation with resultant pruritus. Inadequate cleansing can leave stool and sweat residue which acts as an irritant. Most of these individuals have loose stools or mucous seepage. Abnormal anal sphincter relaxation can also cause soiling. This kind of itch is usually relieved by washing the area. However, underlying pathology, if any, needs to be addressed. • Anorectal disorders Anorectal conditions like Hemorrhoids (Piles) and Fissure can precipitate peri-anal itch. External hemorrhoids that are large can interfere with post-defecation cleansing. Internal hemorrhoids, on the other hand, can cause mucus seepage or fecal soiling and resultant pruritus. Anal Fissures can also cause itching due to inflammation. Anal Fistula or Fistula-in-ano with an external opening in the region, can lead to the discharge of pus or fecal matter and consequent itching. • Infections Fungal infections are common in the area, especially among diabetics who are prone to Candidiasis. Infection with threadworms/pinworms is also common, especially among children. Viral infections can also cause pruritus. • Allergy Chemicals found in creams, wet wipes, soaps, etc. can cause Allergic Contact Dermatitis. • Skin conditions Psoriasis, lichen sclerosis, Paget’s disease, peri-anal Bowen’s disease, etc. can also can pruritus ani. • Other factors

• Certain foods like caffeinated drinks, spices, peanuts, tomatoes, etc. can cause peri-anal itching. Relief is attained within 2 weeks of stopping the causative food.
• Aggressive cleaning can cause dryness of the skin and thus itching.
• Psychological factors like anxiety, stress or depression may be associated with pruritus ani.

Dealing with Pruritus ani To get rid of peri-anal itching, the underlying cause needs to be addressed. One should wear loose, cotton clothing, especially at night, which gives an opportunity for ventilation. Following a bowel movement, the area should be gently cleaned with water or simple tissue moistened with water or with peri-anal wipes. One should avoid the use of soaps in the area. Associated symptoms, if any, point to an underlying pathology. Anorectal conditions like piles, fissure and fistula are treated by a Proctologist. Peri-anal skin conditions, infections, and allergies are treated by a Dermatologist.