Pruritus Ani

 

Pruritis ani is a Latin term meaning “itchy anus” and is a condition that causes an intense, cyclic itching or burning sensation of the rectal opening. Even the most minimal stimulation or irritation of the anal skin can cause severe itching. The subsequent scratching then causes damage to the skin, which leads to more itching and scratching.
rectal-itching
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. The condition affects up to 5 percent of Minnesotans and occurs more frequently in men.
 

Symptoms

While itching is common to many anorectal diseases, the itching associated with pruritis ani is more intense and cyclic, causing an irresistible urge to scratch. Symptoms manifest more often at night or after a bowel movement.
 

Causes

The exact mechanism of developing pruritis ani is not clear, but there are many risk factors that contribute to the disease, such as:

  • Excessive cleanliness
  • Prolonged exposure to moisture
  • Dietary factors
  • Skin irritants
  • Infectious processes
  • Anal skin diseases
  •  

    Diagnosis

    Pruritis ani is clinically diagnosed by history, a physical examination and an anoscopy. There is no specific test for its diagnosis. During your initial office visit, your doctor may inspect the anus for skin changes or growth in the anus before doing a digital rectal examination with a gloved, lubricated finger, followed by an 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 is removed for microscopic examination).

    An anoscopy is a rectal exam with a very short (3-4 inch), rigid, metal tube used to examine the lower rectum and anal canal. It’s extremely useful in locating hemorrhoids, anal fissures and other anorectal diseases.
     

    Treatment

    The goal of therapy is to reduce or eliminate itching and restore clean, dry and intact skin. To promote healing, the following steps are recommended:

  • Avoid injury to the skin. This is one of the most important, but often most difficult, parts of treating pruritis ani. This means no scratching with your hands or dry toilet paper. The patient should clip their nails and wear mittens at night to prevent themselves from scratching.
  • 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 certain foods and beverages may improve symptoms. This can include coffee, sodas, tea, chocolate, tomatoes and beer.
  • Improve bowel hygiene, or modify cleaning habits. It’s important to clean the anus gently. Rinsing the area with plain water or diluted white vinegar can be helpful, while anything containing deodorants, alcohol and witch hazel agents should be avoided.
  • Make sure the skin is dry. It might help to use a hair dryer, set to a low setting, and to place a wisp of rolled cotton between the buttocks (against the anus) to absorb moisture.

  • Try skin barriers or steroid cream in the initial stage of treatment.
  • Address underlying diseases such as hemorrhoids, anal tags, anal fissures and anal warts.
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