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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.

Hemorrhoids are a varicose vein disease. More than 10 million people in the United States suffer from hemorrhoids. Three out of four people will develop hemorrhoids at some time in their lives. Although they can be extremely unpleasant and painful sometimes, they can be easily treated with non-surgical therapy and they are preventable. Moreover, if patients don’t take preventive measures, it is possible to relapse after hemorrhoid care, especially in advanced hemorrhoids.

There are many ways to prevent hemorrhoids for patients in Minnesota.

1. One of the best things you can do to prevent hemorrhoids is to make important dietary changes to keep your stools soft and prevent constipation. Why is fiber so very important? People in Minnesota who do not get enough fiber in their diet tend to have constipation with hard stool and strain when going to the bathroom. In turn, this pressure constitutes one of the greatest risk factors to those who are vulnerable to developing hemorrhoids. Constipation with hard stool and straining often causes the rupture of hemorrhoidal veins and anal skin tearing.
Eating a diet that is high in fiber such as fruits, vegetables, beans, and whole grains is recommended. Taking a fiber supplement every day, such as Citrucel or Metamucil, can help keep bowel movements regular. Drinking enough fluids is equally as important so that these bulking agents work better (6-8 glasses of water daily).

Frequent diarrhea does not help, either. Straining related to diarrhea also can rapidly increase the pressure in the abdomen and hemorrhoid venous complex, too.

2. Daily exercise is also great to help the bowel move through your digestive system and prevent you from becoming constipated. Moderate activity of at least 30 minutes 3-4 times per week is recommended.

3. Obese patients are 2-4 times more likely to develop hemorrhoids than the average patient, so weight loss may help to reduce the recurrence.

4. Individuals who are prone to developing hemorrhoids should also avoid standing for extended periods of time and constant heavy lifting.

5. You should have a good toilet habit. The toilet time should not be too long; you should avoid the bad habit of reading newspapers or surfing on the Internet on the toilet. Scheduling time each day for a bowel movement and keeping it a daily routine may help. Take your time and do not strain when having a bowel movement, because it is the straining that causes hemorrhoids. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum. Lastly, once you feel the urge, it is important to go because if you wait to pass a bowel movement, the urge goes away and your stool could become dry and harder to pass.

6. You may program your bowel movement in the way that you always try to have bowel movements right before your regular shower. For example, if you are a morning person, you go to the toilet first before you take a shower, so the anus is always clean without residual feces. Residual feces are irritable to the skin around anus. If you starting having recurrent symptoms, then a daily Sitz bath helps a lot to relieve the symptoms.

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Learn about Pruritis Ani | Minneapolis & St Paul

How to Prevent the Hemorrhoids | Minneapolis & St Paul