Pruritus Ani

What is pruritus ani

Pruritus ani is a Latin phrase meaning "itchy anus." It is an unpleasant sensation resulting in a strong urge to scratch the anal area.

What causes this to happen?

While there are several potential causes of pruritus ani, one of the more common causes is excessive moisture in the anal area. Moisture can come from perspiration or a small amount of residual stool or mucus. Pruritus ani may be a symptom of other common anal conditions such as hemorrhoids, anal fissures (painful clefts or grooves), or anal fistulas (abnormal passageways between the bowel and an organ or skin surface). The initial condition may be made worse by repeated scratching.

In some individuals, pruritus ani may be caused by eating certain food products, smoking, and drinking alcoholic beverages, especially beer and wine. Food and beverage items that have been associated with pruritus ani include:

• Coffee, tea
• Carbonated beverages
• Milk products
• Tomatoes and tomato-based products such as ketchup
• Cheese
• Chocolate
• Nuts

Does pruritus ani result from lack of cleanliness?

While stool on the perianal skin has been shown to cause itching, inadequate hygiene is seldom the cause of pruritus ani. More often, the natural tendency of a patient with significant itching is to wash the area vigorously and frequently with soap and a washcloth. Soaps and lotions and scents can be irritating, and the trauma to the anal skin from aggressive cleaning can destroy natural barriers and make the problem worse.

What can be done to make the itching go away?

A careful examination by a colon and rectal surgeon may identify a cause for your itching. The physician can recommend treatment to eliminate the specific problem if one is found. Many times, however, no specific problem is found to be causing the symptoms of itching and burning. In this case, the problem is referred to as “idiopathic" (from unknown cause).

Treatment of pruritus ani involves the following principles:

• Avoid further trauma to the affected area:
• Do not use soap on the anal area.
• Do not scrub the anal area, not even with toilet paper.
• For hygiene, it is best to rinse with warm water and pat the area dry or use a hairdryer set on "cool." Use baby wipes or a wet washcloth to blot the area clean. Do not aggressively scrub the area.
• Avoid scratching the itchy area.
• Scratching produces more damage to the skin, making the itching worse. It may be necessary to wear cotton gloves or socks on the hands when sleeping to avoid itching during sleep.
• Avoid moisture in the anal area and achieve clean and dry skin:
• Apply either wisps of cotton or a 4 x 4 gauze to keep the area dry.
• Avoid all medicated, perfumed, and scented powders.
• Only use medications as directed by your physician:
• Apply prescription medications sparingly to the anal area. This may include topical steroids.
• Prolonged use of prescription or over the-counter topical medications may result in irritation or skin dryness that can make the condition worse.

How long does treatment usually take?

Most people experience some relief from itching within a week. If symptoms do not resolve after 6 weeks, a follow-up appointment with your colon and rectal surgeon may be needed. Recurrent symptoms are not uncommon and patients may need to make long-term lifestyle changes to remain symptom-free.