Category Archives: Anal itching

The Many Causes of Anal Skin Tags | Minnesota

While anal skin tags are extremely common, they’re very rarely cause for alarm. These non-cancerous, benign small bumps or raised areas around the anus are essentially excess skin growths that develop for various reasons. They’re usually sensitive to the touch and can be quite itchy, but aren’t usually painful. While some individuals seem to be genetically prone to developing skin tags, a variety of causes ranging from skin friction to hemorrhoids may be linked to skin tag formation.
 

Who gets anal skin tags?

Anal skin tags can affect anyone, but they’re much more prevalent in obese individuals and individuals who suffer from chronic bowel problems, especially Crohn’s disease. Additionally, pregnant women tend to develop skin tags more easily due to hormone fluctuations and increased skin friction around the anal region. Those who suffer from hemorrhoids or inflamed lesions and anal injury are also at a higher risk of having anal skin tags.
 

How do anal skin tags develop?

Although the exact causes of skin tags are unclear, they usually result from one or more of the following:

  • Hemorrhoids – When swollen hemorrhoids begin to shrink and eventually heal, excess skin may remain and form into a skin tag.
  • Diarrhea – Also related to friction, having recurrent bowel movements can irritate the skin around the anus, especially if combined with excess wiping.
  • Constipation – Too many bowel movements can lead to skin tags, as can too few bowel movements. When you overstrain, the anal blood vessels can swell and bulge; skin near the anus must also stretch to accommodate large or hard stools. Skin tags form when the skin fails to snap back to its original position.
  • Friction/irritation – Increased friction between surfaces of the skin, such as from exercising or prolonged sitting, can lead to anal skin tags.
  • Crohn’s disease – Sufferers of this chronic bowel disorder experience inflamed intestines and bouts of diarrhea and constipation, all of which contribute to a higher risk of skin tags.
  •  

    How can I prevent anal skin tags from forming?

  • Decrease the chances of constipation and diarrhea by eating plenty of fiber and keeping your bowel movements regular.
  • Do not excessively wipe after a bowel movement to avoid excess friction and irritation.
  • Do not wear overly tight underwear, which can cause skin irritation and unnecessary friction while moving or sitting.
  • Aim for a healthy body weight and avoid a sedentary lifestyle. Overweight and obese individuals are more prone to developing skin tags, so eating a balanced diet and regularly exercising can significantly lower your risk.
  •  

    Here’s Why Your Anus May Be Itching at Night | Minnesota

    If you’ve ever experienced an itchy bum in the middle of the night, it’s quite an unpleasant sensation. Scratching the area may provide temporary relief, but the harshness of your nails ends up causing further irritation and damage to the already sensitive anal region.

    Known as pruritis ani, this condition literally translates to “itchy anus” and occurs on an intense, cyclical basis where an unpleasant burning sensation around the anus produces the urge to scratch. This feeling typically intensifies at night or after a bowel movement, when even minimal stimulation of the anal skin can cause extreme itching.

    So what causes anal itching? The exact reason for pruritis ani is unclear, but it is often linked to anorectal diseases, lifestyle habits and skin conditions. Below are a few of the more common reasons your bum may be keeping you up at night:
     

    Hemorrhoids

    Anal itching is both a symptom and complication of hemorrhoids that can escalate into pruritis ani. When a patient experiences hemorrhoid flare-ups, blood vessels in the walls of their anus and lower rectum swell and bulge, often causing inflammation and bleeding. This irritation around the anus causes sporadic itching, and continuous scratching of the area can further harm the sensitive tissues and worsen symptoms.

    More specifically, itching can occur when overstraining during bowel movements pushes an internal hemorrhoid outside the anus, otherwise known as a prolapsed internal hemorrhoid. Internal mucus then comes into contact with the anal tissues and prolongs the itching.
     

    Pinworms

    Pinworms are tiny parasites that infect the colon and rectum via ingestion of their eggs through contamination. Once the eggs hatch in your intestines, the pinworms wiggle out from the anus (especially at night) and lay eggs on the surrounding anal skin. The primary symptom is intense anal itching that causes restless sleep. However, treating pinworms is usually a simple and straightforward process of oral medication and topical creams.
     

    Skin Conditions

    Chronic skin disorders around the anal region, such as eczema and idiopathic dermatitis, can cause itching and dry, flaky skin for no apparent reason. Allergic dermatitis, however, results from the skin coming into contact with an allergen via creams, lotions, soap, powders, etc. and having a negative reaction. At times, excessive cleaning using one of the aforementioned products ends up worsening one’s anal itching. While chronic skin conditions are untreatable, allergen-based conditions can be managed by avoiding the triggering products.
     

    Hygiene Habits

    Both excessive cleaning and lack of cleaning of the anal region can irritate the skin. Over-wiping after bowel movements, especially with rough toilet paper or soap/topical products, can lead to dryness and itching.
     
    For more information on pruritis ani and its causes and treatment methods, check out our earlier blog post here.

     

    Comparing Anal Abscesses and Anal Fistulas | Minnesota

    Hemorrhoids, abscesses, fistulas, fissures, anal itching, rectal prolapse—with so many anorectal disorders out there, it’s hard to keep track of which is which. Two of these conditions, anal abscesses and anal fistulas, are closely linked to one another but can be easily distinguished via the guidelines below.
     

    Defining Each Disorder

    Anal Abscess – This is a pus-filled, infected cavity near the opening of the anus or deep in the rectum. Most abscesses result from infection of anal glands in the lining of the anal canal near the anus opening. When bacteria from the gut passes the anal sphincter barrier and into the surrounding tissue of the rectum, an abscess of varying severity and depth forms. When an abscess fails to fully heal, an anal fistula may form.

    Anal Fistula – As mentioned above, fistulas usually occur due to a previous anal abscess. A fistula is an inflamed tunnel under the skin, connecting the anal canal and the surface of the surrounding skin. The majority result from an anorectal infection, wherein the anal crypts are infected and cause pus-filled cysts to form near the anal canal.
     

    Symptoms

    Anal Abscess – The most common symptoms are pain around the anal area, swelling, redness, and fever. Rectal bleeding and urinary complications (difficult or painful urination) may also occur.

    Anal Fistula – In addition to most likely having a history of anal abscesses, patients may also experience skin irritation around the anus, a throbbing pain when sitting, anal discharge, swelling and redness, and fever.

     

    Causes

    Anal Abscess – This usually occurs from infection of anal glands in the lining of the anal canal near the anus opening. Other causes include an anal fissure and sexually transmitted infections (STIs).

    Anal Fistula – As previously mentioned, fistulas typically result from an abscess that did not fully heal. They may also, though less frequently, be caused by Crohn’s disease, STDs, trauma, tuberculosis, cancer or diverticulitis.
     

    Treatments

    Anal Abscess – Surgical incision and drainage should be performed ASAP, as antibiotics are ineffective at this stage of the infection. Delaying surgery can result in tissue destruction, fibrosis (scar tissue formation), and impaired anal continence. Drainage involves making a small incision above the abscess as close to the anus as possible, then removing the gauze after 24 hours. Sitz baths and stool softeners can help with post-surgery discomfort.

    Anal Fistula – Surgery is generally needed to treat fistulas and involves cutting a small part of the anal sphincter muscle away. By doing so, the tunnel/fistula is opened up to form a trench that heals from the bottom outwards. After a few weeks, the trench ideally fills up with scar tissue and heals. Post-surgery discomfort is mild and can usually be addressed with painkillers.
     

    Recurrence Rates

    Anal Abscess – Nearly half of abscesses may recur, either in the form of a new abscess or as a frank fistula.

    Anal Fistula – Fistulas can also potentially recur, with recurrence rates dependent upon the particular surgical technique utilized.

     

    Four Cardinal Symptoms of Hemorrhoids | Minnesota

    Although hemorrhoidal symptoms and complaints are common and typically not a serious concern, all patients should be examined for signs of possible cancer and other associated diseases. There are four cardinal symptoms of hemorrhoids, including rectal pain, bleeding, anal itching, and rectal mass or lump.

    Anal Itching
    Anal itching is the most common complaint in the hemorrhoid patients. It often comes and goes. The initial relief of the itching does not necessarily mean the problem goes away. Continuous scratching or excessive cleaning of the anal area may further harm the sensitive tissues and worsen symptoms. In addition, the area can be highly sensitive to perfumes, soaps, fabrics, dietary intake and superficial trauma. When chronic itching occurs, the perianal area becomes white with fine fissures.

    Treatments for anal itching include taking antihistamine as a sedative prior to sleeping to prevent the patient from unconsciously scratching, or using a topical corticosteroid to alleviate the itching. Underlying hemorrhoids and other rectal diseases must be considered and treated when diagnosing and treating anal itching.

    Anal pain
    Anal pain is a common sign of hemorrhoids. The patients with hemorrhodis often complain the aching pain, irritating pain, and spasmodic pain. If the hemorrhoid patient also has anal fissure, sharp pain may occur during intense, forced bowel movements that are often accompanied by rectal bleeding. Immediate onsets of intense pain accompanied by a palpable mass are usually a result of an external thrombosed hemorrhoid, which may last a few days to a couple of weeks. Internal hemorrhoids, however, are not very painful due to being located above the dentate line of the rectum.

    Proctalgia fugax is a more serious anal pain condition that involves short spasms of intense pain at night. Hemorrhoids could be its trigger or cause.

    Rectal Lump
    A palpable anal lumps can be caused by a variety of conditions including anal warts, hemorrhoids, polyps, fissures, or cancer.

    Hemorrhoids are probably the most common reason for having a rectal lump. It can be caused by internal hemorrhoids, but more commonly by external hemorrhoids. If a rectal lump is related to internal hemorrhoids, it usually gets bigger and more prolapsed right after the bowel movement; it could be spontaneously reduced in the early stage of internal hemorrhoids. But it could be non-reducible in the late stage of hemorrhoids.

    The thrombosed external hemorrhoids often cause very painful, bluish anal lumps when the hemorrhoidal veins rupture and the blood clots develop.

    Rectal bleeding
    Rectal bleeding can be caused by hemorrhoids and other conditions, but even the slightest amount of bleeding should be taken seriously. Common causes of bleeding are internal hemorrhoids, ruptured thrombosed external hemorrhoids, fissures, diverticulosis, colon cancer, colitis, polyps and angiodysplasias. Patients of older age or with significant family history of bowel disease or cancer should consider further examination. In addition, patients who were previously treated for rectal bleeding but continued to experience bleeding must be further examined.

    The source of rectal bleeding is determined by history, physical examination and blood tests, assisted with anoscopy, sigmoidoscopy, colonoscopy, radionuclide scans, and angiograms.

    The Unfortunate Condition of Anal Itching | Minnesota

    When you watch hospital dramas on TV you get this impression of the medical world being this dramatic place where love and life are in constant peril. This is not the case in reality. If they made a TV show about the mundane things most people go to the doctor for no one would want to watch it. In fact, it’s part of the joke in shows like House where Dr. House is punished by clinic duty.

    That being said, let’s talk about pruritus ani, a rare and exotic disease caused by a river parasite in the Himalayas. OK, so that’s a lie. It’s just a fancy term for anal itching. If that’s not obvious enough, anal itching is when the skin around your anus (perianal skin) becomes intensely itchy. And now you have to go to work constantly repressing the urge to scratch your bum. If you’re reading this, you may be one of the 1-5% of the population that anal itching effects, and you’re four times as likely to be a man.

    There are two types of anal itching. Primary, where there is no definitive cause, and secondary, where anal itching is the symptom of an underlying medical issue. Some of the myriad of potential causes include:

    – Hemorrhoids
    – Skin tags
    – Poor hygiene (residual fecal matter)
    – Sweat
    – Diabetes
    – Incontinence
    – Anal fistulas
    – Anal fissures
    – Anal warts
    – Repetitive scratching/trauma/irritation
    – Medication (e.g.antibiotics)
    – Skin conditions like psoriasis
    – Infection
    – Psychosomatic; your own mind tricking you into thinking you have anal itching (i.e. anxiety, schizophrenia, etc)
    – Diet

    Here are some ways to manage the symptoms. Just keep in mind that, if anal itching is a symptom of an underlying disease, merely treating the symptoms may not actually fix the cause of anal itching.
    – Cleaning the anus by using a wet unscented wipe or toilet paper or washcloth.

    – Avoid scrubbing.

    – Avoid medicated powders, lotion, soaps, and sprays.

    – Do not wear clothing that is too tight, too often.

    – DO NOT ITCH. Just don’t. Wear mitten to sleep.

    – Do Sitz Bath with warm water

    – May take Benedry for a few nights

    Most of the time, as long as you follow these steps itching should go away on it’s own, unless of course, you have an underlying condition that is causing the itching such as hemorrhoids or a fistula.

    If the anal itching is associated with any type of rash, lump, discharge, bleeding, or fever, call your doctor.

    Hemorrhoid Disease and its Anatomy | Minnesota

    Hemorrhoids are swollen clumps of vessels, smooth muscle and connective tissue in the anus and lower rectum. They are similar to varicose veins, but they are not considered the same. Hemorrhoids are quite common; about 75% of adults will have hemorrhoids in their life. Sometimes they are very benign; other times they may cause significant symptoms, such as itching, pain, prolapse and rectal bleeding.

    Hemorrhoid cushions are a normal part of the body and only pose an issue when become engorged, prolapsed and inflamed. In their normal state, they have an important role in continence, and make up 15-20% of anal pressure at rest. When bearing down, the cushions expand to maintain anal closure as intra-abdominal pressure grows. Increased sphincter pressure may result due to hemorrhoid inflammation because of this effect.

    Hemorrhoids are classified into internal and external hemorrhoids. Internal hemorrhoids develop deeper in the rectum, above the dentate line, from the embryonic endoderm and are covered by columnar epithelium. There are few somatic sensory nerves in this area, and as a result are not painful. Patients often only notice the blood after a bowel movement as a result of internal bleeding. External hemorrhoids are located around the anus, below the dentate line, derived from the ectoderm and covered in squamous epithelium. There are many sensory nerves here, so external hemorrhoids can be quite painful when the complication of thrombosis happens.

    Hemorrhoid inflammation is often caused by excess pressure in the region. This can be exacerbated by straining when defecating, constipation/diarrhea, low-fiber content in diet, lack of fluid, sitting too long, weight, and lack of exercise. Proper rectal function and physical fitness are essential in preventing hemorrhoid formation.

    Daily Activities Risk Factors for Causing Your Hemorrhoids | Minnesota

    A hemorrhoid is a common disease that numerous Minnesotans suffer from. Many patients know treatment options such as infrared coagulation (IRC), banding, and surgeries, however far fewer people understand the causes of hemorrhoids and the risk factors contributing to it.

    The normal hemorrhoids structure is clusters of vascular tissue, smooth muscle, and connective tissue lined by the normal epithelium of the anal canal. Most symptoms arise from enlarged internal hemorrhoids. The engorged anal hemorrhoidal mucosa is easily traumatized, leading to rectal bleeding. The prolapse of hemorrhoid tissue leads to soiling, mucus discharge, and trigger pruritus.

    Many people in Minnesota don’t realize that they’re exposing themselves to the causes of hemorrhoids every day. Those activities actually become the risk factors of hemorrhoids. Whether you are currently suffering from hemorrhoids or are looking to avoid them, knowing the hemorrhoid risk factors related to your everyday activities is important. Therefore, you can work to prevent them from developing, worsening, and recurring.

    Some of the most common hemorrhoid risk factors related to your everyday activities are:

    Compromised Bowel Movements
    You should have good bowel habits and maintain smooth stool. Constipation with hard stool and straining can increase abdominal pressure rapidly, as well as expansion of venous plexus, often causing rupture of hemorrhoidal vessels and even anal skin tearing. If you develop chronic constipation, you should treat it aggressively by having a high fiber diet, increasing water intake, walking daily, and taking bulking agents and laxatives. However, frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid vessel complex, too. The toilet time should not be too long, and you should avoid the bad habit of reading newspapers or surfing the Internet on the toilet.

    Sitting and Standing
    Most people’s jobs in Minnesota involve either extended hours sitting or standing. But doing either for too long can result in increased pressure in the lower rectum, leading to develop hemorrhoids. Individuals who are prone to developing hemorrhoids should avoid sitting and standing for extended periods of time.

    Heavy lifting
    Heavy lifting can put pressure on the abdomen and lower rectum rapidly, increasing venous engorgement of the internal hemorrhoids which causes them to swell and enlarge, and also causes the rupture of hemorrhoidal vessels and even thrombosed external hemorrhoids, a common complication of hemorrhoids.

    Weight and Pregnancy
    Being overweight can also put pressure on the abdomen and lower rectum due to carrying too much weight for what body organs can normally withstand. The same goes for pregnancy, as the uterus increases venous pressure.
    .
    Genetics
    Unfortunately, hemorrhoids do run in some families. Although hemorrhoids are a very common disease, it is not a disease that everyone develops. Those who inherit certain genes are more likely to suffer from the condition.

    Solution to Your Hemorrhoids
    You may find that you are exposed to several of these common risk factors after reading this blog, but by knowing what these risk factors are, you can work to minimize their impact on your body.

    Functional Anorectal Pain

    Functional anorectal pain is a relatively common symptom that occurs in the absence of any clinical abnormality although some patients may also have other anorectal diseases, such as hemorrhoids. It is not sure if the local inflammation caused by hemorrhoids contributes to the development of anorectal pain syndromes in those patients. Despite their benign nature of functional anorectal pain, they can cause debilitating to the sufferer.

    There are two functional anorectal pain syndromes.
    • Proctalgia fugax (PF) (fugax = fugitive/fleeting in Latin)
    • Levator ani syndrome (LAS)

    Proctalgia Fugax is an anorectal pain syndrome that occurs as a result of cramping of the levator ani muscle. It occurs in episodes lasting seconds or minutes, typically in the middle of the night, though it is very possible to experience it during the day as well. Patients may feel spasm-like, sharp pain in the anus that is often mistaken for a sign that they must defecate. This may also be accompanied by an involuntary erection in men. Attacks, and typically start at the age of 45. An estimated 8-18% of people in the developed world are affected by proctalgia fugax, but true figures are not clear because many people do not seek professional diagnosis. It is estimated that only 20-30% of people with this condition seek out professional diagnosis.

    The condition is recurrent, and while not curable, treatments are available.

    Traditional ways to manage pain include warm baths, warn/hot enemas, relaxation techniques. Applying ice or some similar cold pack to the afflicted area can help pain as well. Severe attacks can be mitigated a bit using salbutamol. For most cases, reassurance, and topical calcium-channel blockers, salbutamol inhalers, and sublingual nitroglycerine are used for treatment. Botulinum toxin A injection is a new way to effectively reduce the tone of anal sphincters and reduce anorectal pain. Co-existent psychological issues should be addressed with behavioral and/or pharmacological therapies. Increased fiber intake and withdrawing gut-affecting medication can also help with pain. High-voltage pulsed galvanic stimulation has been shown to reduce short-term frequency of the attacks.

    Levator ani syndrome presents the symptoms with vague, aching or pressure feeling high in the rectum. It could be worsened by sitting and relieved by walking. The pain tends to be constant and lasts from hours to days. It recurs regularly.

    The diagnostic criteria of levator ani syndrome is that the symptoms must be present for three months with symptom onset at least six months prior to diagnosis, and other causes of similar anorectal pain must have been excluded.

    Management of levator ani syndrome is similar to that of proctalgia fugax, including biofeedback treatment, Inhaled salbutamol, Botulinum toxin A, electrogalvanic stimulation and nerve stimulation.

    Self Management in Relieving the Symptoms of Hemorrhoids | Minneapolis & St Paul

    Studies suggest that an estimated more than 50% of Americans will develop a hemorrhoid condition by the age of 50- yet, only a small percentage of people seek treatment until it is impossible to ignore. While not a replacement for professional treatment, conservative treatments are available that can manage the symptoms and prevent recurrence.

    For grade I internal and nonthrombosed external hemorrhoids, warm baths, a high-fiber diet, high fluid intake, stool softeners, topical analgesics, topical steroids, and proper hygiene can improve hemorrhoids. Warm baths increases blood flow and relaxes the sphincter, easing perianal pain caused by a hemorrhoid. Ice can be used in cases of acute thrombosis. The key to conservative management of hemorrhoids is reducing constipation and hard stool. This, in turn, reduces pressure in the lower rectum. Increasing dietary fiber increases fluid retained in the stool, which, combined with increased water intake, can greatly relieve pressure on hemorrhoids. Good sources of fiber include beans, fruit, veggies, and whole grains. Fiber supplements, such as psyllium husk powder, are effective and can make fiber intake more convenient. Another important consideration is time spent on the toilet- with so many ways to distractions available it is easy to linger in the bathroom, but one should only stay on the toilet long enough to evacuate the bowels.

    Topical agents are available, but only a few are marginally effective. Topical hydrocortisone can relieve the rectal irritation and itching and decrease internal hemorrhoidal bleeding. However, it should not be used longer than two weeks due to mucosal atrophy.

    Hemorrhoids can be a hassle, but luckily there are ways to manage it independently. Conservative treatment aims to reduce constipation and stool hardness, by adjusting diet or through supplements, reduce strain by changing toilet habits, and medicate in some circumstances with topical medication. However, if bleeding is persistent or if pain is present or if the irritation with itching affects your quality of life, it is best to see a medical professional.

    Learn about Pruritis Ani | Minneapolis & St Paul

    What is pruritis ani?
    Pruritis ani is a Latin term meaning “itchy anus” and it is an unpleasant, intense, cyclic itching or burning sensation of the skin around the anus (rectal opening) that produces the urge to scratch. Minimal stimulation or irritation of the skin in the anal area may cause itching. The subsequent scratching may cause damage to the skin which leads to more itching and scratching, which is a vicious cycle.

    Pruritis ani is classified as either primary or secondary. The primary form is idiopathic, which may not have an identifiable cause, while the secondary form has an identifiable cause. It affects up to 5% of the population in Minnesota.

    The symptom of itching is common to many anorectal diseases, such as internal and external hemorrhoids, anal tags, anal fissures and fistulae, anal warts. But the difference is that itching in pruritis ani is more intense and cyclic, having an irresistible urge to scratch, and it happens more often at night or after a bowel movement.

    What causes pruritis ani?

    The exact mechanism of developing pruritis ani is not clear. There are many risk factors that contribute the disease.

  • Excessive Cleanliness
  • Prolonged exposure to moisture
  • Dietary factors
  • Skin Irritants
  • Infectious processes
  • Anal skin diseases.
  • How is pruritis ani diagnosed?
    The diagnosis of pruritis ani is clinically diagnosed by history, physical examination, and anoscopy. There is no test for it. In the initial office visit, your doctor may inspect the anus visually to look for skin changes or growth in the anus, followed by a digital rectal examination with a gloved, lubricated finger and then anoscopy to look for abnormalities in the lower rectum and anal canal. If indicated, your doctor may also perform a biopsy (a small piece of skin removed for microscopic examination).
    Anoscopy is a rectal exam with a very short (3 to 4 inch) rigid metal tube to examine the lower rectum and anal canal. It is very useful when your doctor suspects hemorrhoids, anal fissures and other anorectal diseases.

    How is pruritis ani treated?
    The goal of therapy is to reduce or eliminate the itching symptom and cure the disease by restoring clean, dry, and intact skin.

  • Avoid injury to the skin. This is one of the most important, but often most difficult, part treatment of pruritis ani. This means no scratching with hands or dry toilet paper, which is often very difficult to achieve, due to the intense desire to scratch. The patients should cut their nails and wear a pair of mittens at night so they are not able to scratch.
  • Thicken stool and create a formed bowel movement to minimize leakage. Most people can benefit from taking a fiber supplement. If stools still remain loose, additional medications, such as Imodium and Lomotil, may be helpful.
  • Make dietary changes. Avoiding overuse of several common foods and beverages may improve symptoms. These foods and include coffee, colas, tea, chocolate, tomatoes and beer.
  • Improve bowel hygiene or modify cleaning habits. It is important to clean the anus gently. Cleaning with plain water rinses is quite helpful. Anything containing deodorants, alcohol and witch hazel agents should be avoided. You may use diluted white vinegar.
  • Make sure the skin is dry. You may use a hair dryer on a low setting and place a wisp of rolled cotton between the buttocks and against the anus to absorb moisture.
  • Try skin barriers or short course of steroid cream in the initial stage of treatment.
  • Treat the underlying diseases such as hemorrhoids, anal tags, anal fissures, and anal warts.
    • Sign Up for Our E-Newsletter
    blog icon facebook icon
    Click for the BBB Business Review of this Health & Medical - General in Edina MN   Click for the Patients' Choice award   ASLMS logo   American Board of Laser Surgery logo
    Click for the IMQ accreditation in Minneapolis, MN American Association for Primary Care Endoscopy logo