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.
Signs, symptoms & indicators of Pruritus Ani
Anal itching at night or anal itching
Risk factors for Pruritus Ani
Counter Indicators
Hemorrhoids
Sometimes hemorrhoids will cause anal itching. Skin tags, rectal fistulas, rectal fissures or anorectal cancer (rarely) can do so also.
Dysbiosis, Bacterial
Tetracyclines, erythromycin and other broad-spectrum antibiotics can trigger anal itch by disturbing the normal ecology of the intestines.
Eczema
Skin conditions such as psoriasis, eczema and seborrhea can cause symptoms in several different areas of the skin surface, including around the anus.
Pruritus Ani suggests the following may be present
Hemorrhoids
Sometimes hemorrhoids will cause anal itching. Skin tags, rectal fistulas, rectal fissures or anorectal cancer (rarely) can do so also.
Recommendations for Pruritus Ani
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.
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.
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.
Personal Hygiene Changes
Here are some things you can do to help keep the area clean.
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.
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.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
Glossary
Pruritus
Severe itching, often of undamaged skin.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Topical
Most commonly 'topical application': Administration to the skin.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Hemorrhoids
Varicose disorder causing painful swellings at the anus; piles.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Psoriasis
An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.
Eczema
Swelling of the outer skin of unknown cause. In the early stage it may be itchy, red, have small blisters, and be swollen, and weeping. Later it becomes crusted, scaly, and thickened.
Seborrhea
Skin disease characterized by dry or moist, greasy, yellow crusts or scales.