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Anal Itch
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Anal itch - pruritus ani

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WOMEN'S HEALTH

Hair/Nails/Skin

Anal itching can be just an annoyance. It is usually made worse bywarmth, and is often most troublesome in bed. The skin round the anus easily becomes irritated and inflamed. This is because it is difficult to keep the area round the anus clean and dry. the skin is crinkly and traps tiny faecal particles. It is also sweaty and airless, and it may be moist from an anal or vaginal discharge. When it becomes irritated, scratching is a natural reaction, but this damages the skin further – the itch/scratch cycle. 

Also called pruritus ani, anal itch has many causes. Numerous factors may cause anal itch to be more intense - including moisture, the abrasion caused by your clothing, and the pressure of sitting. Anal itch is usually most noticeable and bothersome at night or right after a bowel movement.

Anal itch is a common problem that most people have experienced. Don't be afraid to talk with your doctor about this condition. With proper treatment and self-care measures, most people can achieve complete relief.

Signs and symptoms

Anal itch is associated with other similar symptoms in and around the anus, including:

  • Burning

  • Soreness

The itching and irritation in and around your anus may be a temporary condition, or it may be a more persistent and bothersome problem. For some people, the irritation is so intense that the urge to scratch is irresistible — and a source of embarrassment.

Causes

Most cases of anal itch are caused by a harmless problem. But anal itch can be a sign of more serious medical issues. Possible causes include:

  • Dry skin. As you age, skin in and around your anus is more prone to dryness. Dry skin can cause a persistent, intense anal itch.

  • Too much moisture. Moisture around your anus from excessive sweating or from moist, sticky stools can be irritating. Anal itch can also be caused by frequent diarrhea or the escape of small amounts of stool (fecal incontinence).

  • Excessive washing. Excessive wiping with dry, harsh toilet paper or excessive scrubbing with harsh soaps and a washcloth can cause or aggravate anal itch. Failure to rinse away the soap completely also may cause irritation.

  • Chemical irritants. Certain laundry soaps, colognes, douches and birth control products contain chemicals that can irritate skin in and around your anus. Scented or colored toilet paper can be irritating to people with sensitive skin.

  • Food irritants. Anal itch may be the result of irritating chemicals in some foods, such as those found in spices and hot sauces. Similarly, some foods may directly or indirectly irritate your anus as they exit your digestive system. Common culprits include chocolate, fruits, tomatoes, nuts and popcorn. Consuming certain beverages — possibly milk or caffeinated drinks — may cause some people to experience diarrhea followed by anal itch.

  • Medications. Anal itch may be a side effect of certain medications, such as some antibiotics, that can cause frequent diarrhea.

  • Overuse of laxatives. Excessive or improper use of laxatives can lead to chronic diarrhea and the risk of anal irritation and itch.

  • Hemorrhoids. Hemorrhoids are engorged veins located just under the membrane that lines the lowest part of your rectum and anus. They often occur as a result of straining during a bowel movement. Anal itch can be a symptom of hemorrhoids. However, most hemorrhoids don't itch.

  • Infections. In children, the parasite that causes pinworms can cause persistent anal itching. Other parasites may cause similar itching.

  • Skin disorders. Common skin problems — such as psoriasis, seborrhea and eczema — can involve and irritate the area in and around your anus.

  • Yeast infections. This common infection, which usually affects women, can irritate your genital and anal areas.

  • Anal abrasions and fissures. An anal abrasion is a small tear in your anus, usually caused by forced bowel movements through a tight anus. An anal fissure is a deeper tear. Both conditions can cause anal itch, as well as painful bowel movements and bleeding.

  • Anal tumors. Rarely, benign or cancerous tumors in or around the anus may be a cause of anal itch.

  • Other causes. Anal itch may be related to anxiety or stress. Sometimes, the cause is unknown.

Anal itch is almost never a problem of cleanliness. But your own actions may be partially to blame. Whatever the cause of anal itch, your natural reaction is to scratch the area. But scratching worsens the problem by removing superficial layers of skin. In addition, the natural tendency in response to an irritation is to wash the area frequently with soap and a washcloth. However, excessive washing almost always makes the problem worse by further damaging your skin and removing protective oils. Overmedication also can aggravate the problem.

When to seek medical advice

Most itching doesn't require medical care. However, if anal itching is severe or prolonged or if it can't be easily explained, see your doctor. Persistent anal itching may be related to a skin condition or other health problem that requires medical treatment.

Screening and diagnosis

Your doctor may be able to pinpoint the cause of your itching simply by asking you questions about your symptoms.

If the cause of your itch isn't obvious, your doctor may refer you to a dermatologist or a doctor who specializes in treating rectal and anal problems (proctologist) for further evaluation. A rectal exam may be all that's required for you to get an answer — and a solution — to a very uncomfortable problem.

Other tests, such as a colonoscopy to view more of the digestive tract, are sometimes needed to identify an underlying cause of anal itch. However, the precise cause of the itch may never be identified.

Treatment

Treatment of anal itch depends on the cause of the problem. It may include self-care measures, changes to your diet, treatment of infections or, rarely, surgery to correct an underlying problem.

Medications also may be part of your treatment plan. An over-the-counter (OTC) cream or ointment containing hydrocortisone (Cortaid, Preparation H), applied sparingly to the affected area twice a day for up to two weeks, may reduce inflammation and itching. A protective ointment that contains zinc oxide (Desitin, Balmex) also may help. If your symptoms are worse at night, your doctor may also prescribe an antihistamine to reduce itching until topical treatments take effect. With proper treatment, most people experience complete relief from anal itch.

Self-care

Prevention of anal itch mainly involves washing properly and avoiding irritants. If you already have anal itch, try these self-care measures:

  • Cleanse gently. Wash the area in the morning, at night and immediately after bowel movements. But don't scrub and avoid using soap. Instead, use a wet washcloth, wet bathroom tissue, cotton balls moistened with water, unscented baby wipes or a small squeeze bottle of water to cleanse the area.

  • Dry thoroughly. After cleansing, pat the area dry with toilet paper or a towel. Or dry thoroughly with a hair dryer. Once dry, place a dry cotton ball or a piece of cotton gauze against the anus. Replace the cotton as necessary. Nonmedicated talcum powder also can help keep the area dry.

  • Use over-the-counter (OTC) treatments correctly. Apply OTC creams sparingly. Don't use these treatments unless directed by your doctor. For some people, creams or ointments may cause more irritation, and they may mask a persistent problem.

  • Don't scratch. Scratching further irritates your skin and leads to persistent inflammation. If you can't tolerate the itch, apply a cold compress to the area or take a lukewarm bath to find some immediate relief. Keep busy to distract yourself from scratching.

  • Switch tissue. The skin around your anus may be sensitive to bathroom tissue that contains dyes or perfumes. Use unbleached, unscented tissue. You may want to use tissue that's moistened or made extra soft for comfort.

  • Wear cotton underwear. This helps keep the area dry. Avoid wearing pantyhose, which can trap moisture. Change your underwear daily and whenever it's soiled.

  • Avoid irritants. Avoid bubble baths and genital deodorants. Cut back or avoid beverages or foods that you know irritate your anal area. Avoid overuse of laxatives that increase diarrhea and the risk of anal irritation and itch.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 05/14/08 07:37 AM