Pruritus ani is not a disease as such but a symptom of an underlying condition. Pruritus ani is seen more often in middle class, middle-aged white males. In females it occurs less frequently and most of the time is associated with itching of the vulva as well.
The causes of pruritus ani are many and it is associated with many diseases affecting the anal canal and the perianal skin. Mechanical irritation, infections, inflammatory reactions, chemical irritation, skin diseases like eczema or psoriasis and psychological disturbances all can cause itching of the perianal skin.
Fecal contamination and persistent moisture are the main culprits in causing and sustaining the anal itching.
Clinical presentation depends upon the underlying cause and is due to constant rubbing, secondary infection, contact dermatitis or an underlying skin disease.
Diagnosis of Pruritus Ani
Diagnosis of perianal pruritus involves the following:
- Detailed history
- Skin examination
- Systemic examination to rule out systemic diseases like lymphoma, pellagra, hypovitaminosis A and D and diabetes mellitus.
- PR (per rectal) examination and proctoscopy and sigmoidoscopy to rule out/include rectal or colon diseases.
- Stool examination and Sellotape test in children to rule out/confirm pinworms
- Patch testing to diagnose sensitivity to lanolin, topical medicaments, rubber, perfumed paper etc.
How to Get Rid of Pruritus Ani
Treatment of perianal itching consists of general measures and specific measures.
- Treatment of Pruritus Ani: General Measures
- Avoid wiping with dry toilet papers. Wash with water in a bidet and dab dry with soft toilet paper.
- Avoid pre-moistened toilet papers as these may cause sensitization.
- Immediately afterwards, apply a moisturizing cream
- Avoid using soap in the area. If you must, use a soap substitute.
- Underwear should be loose and made of cotton.
- Spicy foods, alcohol, coffee, nuts, prawns and shell fish etc should be avoided
- High fiber diet preferred
- Treatment of Pruritus Ani: Specific Measures
- Avoid strong steroids in the perianal area.
- A mild soothing topical steroid/antibiotic/antifungal cream provide instant relief in most cases.
- A gauze pad impregnated with 1% Hydrocortisone and 10% silicone kept in the perianal cleft gives good results.
- If the area is wet and oozing, 1-2% phenol, half strength Castellani's paint or a weak (0.05-0.25%) silver nitrate solution will help.
- A short acting antihistamine like benadryl at night will reduce the itching at night.
- If a specific diagnosis has been made, treatment of the cause of the pruritus ani should be carried out, for example, hemorrhoids, fistulae, fissures or anal sphincter spasm will respond well to surgery. Flexural psoriasis responds well to moderate strength topical corticosteroids, which should not be used for prolonged periods in this area. Bacterial infections call for antibacterial topical applications and yeast infection will respond well to anti-yeast solutions. Both may be preceded by a short application of the mild steroid/antifungal/antibiotic combination creams for a couple of days.
- Pinworm infestations should be treated with a course of mebendazole or thiabendazole.
- In some patients, anxiolytics and antidepressants may be required to control the incessant pruritus ani.
Reference
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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