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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.

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