Pruritis ani is a dermatological condition characterized by itching in the anal area. The itching may become worse at night or after a bowel movement. Scratching the area results in further irritation and makes the itching worse instead of relieving it. Scratching with the fingernails may result in skin damage or an infection. If the itch-scratch cycle persists, it can lead to extreme discomfort, soreness, and burning.
The anal area may become dry and irritated due to the use of harsh soaps, sanitary wipes, or rough toilet paper to clean the area after a bowel movement. A hypersensitivity reaction may occur if perfumed powders, lotions, creams, ointments, or other products are applied in the anal region. Excess perspiration or small amounts of fecal matter can cause irritation and itching.
There are two main types of pruritis ani—primary and secondary.
It is estimated that 1-5% of the population is affected. Pruritis ani is about 4 times more likely to occur in men than in women. Primary or idiopathic pruritis ani accounts for the majority (about 50-90%) of cases.
Pruritis ani is usually not caused by poor hygiene. Rather, the overuse of soaps and other topical products to clean the anal region or vigorous scrubbing with a washcloth or rough toilet paper can cause irritation. Excess perspiration or moisture may become trapped in the anal area if constricting or tight-fitting underwear is worn. Some foods and beverages, such as carbonated drinks, caffeinated beverages (coffee, tea, colas) and spicy or acidic foods (tomatoes, citrus fruits) have been linked to the condition. Having frequent bowel movements (diarrhea) or infrequent ones (constipation) may play a role.
Other causes of pruritis ani include:
The doctor will obtain a full medical history and perform a physical examination to identify possible underlying causes, such as dermatological conditions and other illnesses. He or she will visually inspect the area to look for changes in skin color or texture, rashes, or lesions. The doctor will ask about any medications that you take and the type and frequency of bowel movements.
The doctor may obtain skin specimens and perform tests to screen for bacterial or other infections.
Parents of children who may have pinworms can place a small piece of surgical tape near the child’s anus before bedtime. The worms are more likely to emerge at night. In the morning, when the child awakens, the tape can be removed to see if the worms or their eggs are present.
Usually treatment focuses on establishing and maintaining a routine for proper anal hygiene. If a secondary or underlying cause is found, the treatment will depend on the specific condition.
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