Anal Itching (Pruritus Ani)

Definition:
Anal itching is itching around your anus — the canal that’s the outlet for your rectum. The itch, located in your anus or on the skin just around your anus, is often intense and may be accompanied by a strong urge to scratch. You may find anal itching to be an embarrassing and uncomfortable situation.

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Anal itching, also known as itchy bottom, pruritus ani or anusitis, is irritation and sometimes inflammation of the anus – located at the exit of the rectum.

Itching severity varies and is usually exacerbated by such factors as type of clothing worn, whether the patient is seated or upright, moisture levels, pressure and general rubbing of the anal area. Anal itching can become so severe that some people find it intolerable, describing the sensation as one of incredible burning and soreness.

Numerous factors may cause anal itching to be more intense — including moisture, abrasion caused by your clothing and the pressure of sitting.

Anal itching is a common problem that many people have experienced. Don’t be afraid to talk with your doctor about this condition. With proper treatment and self-care measures, most people can achieve complete relief from anal itching.

Anal itching is not a disease in itself, but rather a sign or symptom. In the majority of cases, there is an underlying cause or condition which causes the anal itching. However, sometimes the underlying cause is never found.

Regardless of the cause, virtually every type of anal itching sign or symptom can be successfully treated.

Most humans and other animals sometimes scratch their bottoms. For a person with pruritus ani (anal itching) the urge to scratch around the anus is very strong and persistent. Although the urge may occur at any time of day or night, it is more common after going to the toilet; especially if stools are liquidy. Some patients say the itching becomes more intense just prior to falling asleep in bed at night.

Things that set off anal itching or exacerbate it are:
#Anxiety
#Heat
#Mental stress
Moisture
#Soiling (defecating or pooing in one’s clothing)
#Some clothing or bedding materials, such as wool
#Having nowhere private to go into nearby

According to Medilexicon’s medical dictionary, pruritus ani is “itching of varying intensity at the anus; may be paroxysmal or constant, associated with seborrheic candidiasis or moniliasis, with irritated and enlarged hemorrhoidal veins, or may occur independently of any cutaneous lesions in association with systemic disease.”

Symptoms:-

The symptoms of anal itching are self explanatory – “itching of the anus and the anal area”. The patient generally experiences:
#Burning
#Intense itching
#Soreness
#Pain (sometimes)

Symptoms may be short-term or persistent. Some individuals may experience irritation that is so intense that the desire to scratch must be satisfied there and then – this can be bothersome problem. For some people, the irritation is so intense that the urge to scratch is both irresistible and embarrassing.

Causes:-

Most cases of anal itching are caused by a harmless problem. Occasionally, however, anal itching can also be a sign of more-serious medical issues. Possible causes of anal itching include:

#Skin type – if the skin around the anal area is too dry there is a significantly greater risk of developing persistent and sometimes severe anal itching.

#Moisture levels – if moisture levels around the anal area are high, the chances of having anal itching are raised. High moisture levels can be the result of several different factors, including over-sweating, allergies, diarrhea, very wet and sticky stools, inappropriate clothing, fecal incontinence, and not having access to toilet paper or any means of cleaning oneself.

#Abrasive rubbing – cleaning your bottom with toilet paper can aggravate anal itching if the sensitive skin area is rubbed too hard, for too long, or too often.

#Excessive washing. Excessive wiping with dry, harsh toilet paper or excessive scrubbing with harsh soaps can cause or aggravate anal itching. Failure to rinse away the soap completely also may cause irritation.

#Some chemicals
– some substances found in some soaps, douches, laundry detergents and body sprays may irritate the skin and cause anal itching.

#Type of toilet paper – the texture and substances added to toilet paper may irritate and inflame the skin in the anal area, resulting in itching.

#Some foods some people may develop anal itching after consuming certain types of hot sauces or spices. The irritation may occur when the food is anywhere in the digestive system, even when stools are exiting through the anus.
.

#Some medicines – some medications, such as antibiotics can cause diarrhea, which can cause anal itching.

#Laxative abuse – if laxatives are used inappropriately and the patient has diarrhea or very liquidy stools, the probability of anal itching occurring  becomes much greater.

#Hemorrhoids – when the veins around the anus or in the rectum are swollen or inflamed the patient has hemorrhoids . Hemorrhoids can occur both inside and above the inside of the anus. They can also appear externally, under the skin of the anus. People with hemorrhoids commonly suffer from anal itching.

#STDs (sexually transmitted diseases) – also known as STIs (sexually transmitted infections) cause anal as well as genital itching.

#Parasites- some parasites may cause anal itching. Parasites are more commonly a cause of anal itching in tropical countries, or tropical regions of countries.


#Some yeast infections –
this generally affects women. Yeast infections which affect the genital area, may spread to the anus, causing intense irritation.

#Forced bowel movement – if the stool is dry and large and the individual heaves and still pushes it through, there is a risk of an anal abrasion (small tear in the anus). A deeper tear is called an anal fissure, which may also cause itching.

#Food irritants.
Anal itching may be the result of irritating chemicals in some foods, such as those found in spices and hot sauces. Similarly, some foods may directly or indirectly irritate your anus as they exit your colon. Common culprits include chocolate, alcohol, tomatoes, nuts and popcorn. Consuming certain beverages, including milk or caffeinated drinks, may cause some people to experience diarrhea followed by anal itching.

#Medications. Anal itching may be a side effect of certain medications, including some antibiotics, that can cause frequent diarrhea.

#Overuse of laxatives. Excessive or improper use of laxatives can lead to chronic diarrhea and the risk of anal irritation and itching.

#Skin disorders.
Common skin problems — such as psoriasis, seborrhea and eczema — can involve and irritate the area in and around your anus.

#Yeast infections.
This common infection, which usually affects women, can irritate your genital and anal areas.

#Anal abrasions and fissures. An anal abrasion is a small tear in your anus, usually caused by forced bowel movements through a tight anus. An anal fissure

is a deeper tear. Both conditions can cause anal itching, as well as painful bowel movements and bleeding.

#Anal tumors. Rarely, benign or cancerous tumors in or around the anus may be a cause of anal itching.

#Other causes. Anal itching may be related to anxiety or stress. Sometimes, the cause remains undetermined.

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Although anal itching is almost never a problem of cleanliness, your own actions may contribute to the problem. Whatever the cause of anal itching, your natural reaction is to scratch the area. But scratching worsens the problem by removing superficial layers of skin. In addition, the natural tendency in response to an irritation is to wash the area frequently with soap and a washcloth. However, excessive washing can aggravate the condition by removing your skin’s natural protective oils.


Diagnosis:

Doctor may be able to diagnose the cause of your itching simply by asking you questions about your symptoms.

Click for Anal eatching Diagnosis Throgh question & answer:

If the cause of your itching isn’t obvious, your doctor may refer you to a skin specialist (dermatologist) or a doctor who specializes in treating rectal and anal problems (proctologist) for further evaluation. A rectal exam may be all that’s required for you to get an answer — and a solution — to a very uncomfortable problem.

Diagnosis can also be made just from a rectal exam. This will involve the doctor checking the anal area for any skin that is inflamed, cracked or bleeding. An internal exam may then be required; the doctor inserts his/her finger into the patient’s anus. Doing this can help determine what is causing the anal itching as well as eliminating more serious conditions, such as colorectal cancer. Sometimes a more detailed exam of the digestive system, such as a colonoscopy or a proctoscopy may be required.

Other tests, such as proctoscopy or colonoscopy to view more of the digestive tract, are sometimes needed to identify an underlying cause of anal itching. However, the precise cause of the itching may never be identified.


Treatment:

Treatment of anal itching depends on the cause of the problem. It may include self-care measures, changes to your diet, treatment of infections or, rarely, surgery to correct an underlying problem.

Most of the time it is easy to  treat  Anal itching  and   treatment responds very well. However, this may not stop it from recurring in the future. The type of treatment chosen is dependent on the cause of the anal itching. The various methods of treatment may include:

#Anal cleanliness/dryness – When suffering from anal itching, keeping your anus clean and dry is very important. Each time you pass a stool and before going to bed it is advised that the skin around the anus is carefully cleaned using water and then dried thoroughly.

#When drying, be gentle,
avoid vigorous rubbing as this could further irritate the area. Another option is using a hair dryer on low heat or patting with a dry pad.

#Be careful when washing with soap
– When washing the skin around the anus avoid perfumed soap, try using one which is mild and unscented, and be sure to rinse away all the soap with water.

#When trav elling
-The above options may not be possible when on the move or away from home. In this case try using damp toilet tissues to clean yourself.

#If the area keeps getting moist due to sweat – Putting a cotton tissue in your underwear will absorb the sweat/moisture and reduce itching.

#Avoiding consumption of certain foods
– There are a number of food types that can make the anal itching worse. If you notice the urge to itch getting worse after eating a particular kind of food, you should try to cut down on it.

Below is a list of foods that are known to make anal itching worse:

*Chocolate
*Citrus fruits
*Coffee
*Dairy Products
*Nuts
*Spicy food
*Tomatoes
*Too much liquid consumption


#Things you can do yourself – There are some other ways you can keep control of your anal itching symptoms. These are as follows:

*Use colorless plain toilet paper
*Make sure you have a shower every day
*Wear underwear that is made of cotton and not too tight.
*Be sure to wear clean underwear every day.
*Trim your fingernails regularly; scratching the anal area with long fingernails can damage the skin. Ideally scratching the area should be avoided altogether, as it can make the itching worse.


#Prescription Medication
– Doctors can prescribe medication to help relieve the symptoms.

*Creams – Doctors can also prescribe creams or ointments.

*Corticosteroids – Patients with anal itching where the anal area is tender and inflamed may be prescribed a short course of corticosteroids (less than 7 days). It is applied onto the skin around the anus and will relieve the itching impulse and inflammation. It is known on occasion to make the itching worse, if this is the case it you should stop taking it and contact your doctor.

*Antihistamines – This is to be taken at night and can alleviate your itching and help you sleep.

*Treating the underlying cause – If the anal itching is the result of an underlying cause, the doctor will nead to treat that first. In most cases, if that underlying cause is effectively treated, the anal itching will resolve itself.

With proper treatment, most people experience relief from anal itching in less than a week. Anal itching that continues for more than six weeks needs to be evaluated carefully  by your doctor.

Prevention:
Prevention of anal itching mainly involves washing properly and avoiding irritants. If you already have anal itching, try these self-care measures:

#Cleanse gently. Wash the area in the morning, at night and immediately after bowel movements. But don’t scrub and avoid using soap. Instead, use a wet washcloth, wet bathroom tissue, unscented flushable bathroom wipes, cotton balls moistened with water, unscented baby wipes or a small squeeze bottle of water to cleanse the area.

#Dry thoroughly. After cleansing, pat the area dry with toilet paper or a towel. Or dry thoroughly with a hair dryer. Once dry, place a piece of cotton gauze against the anus to help keep the area dry. Replace the cotton as necessary. Nonmedicated talcum or cornstarch powder also can help keep the area dry.

#Use over-the-counter treatments correctly. Apply OTC creams sparingly. Don’t use these treatments unless directed by your doctor. For some people, creams or ointments may cause more irritation, and they may mask a persistent problem.

#Don’t scratch.
Scratching further irritates your skin and leads to persistent inflammation. If you can’t tolerate the itching, apply a cold compress to the area or take a lukewarm bath to find some immediate relief. Keep busy to distract yourself from scratching.

#Switch tissue. The skin around your anus may be sensitive to bathroom tissue that contains dyes or perfumes. Use unbleached, unscented tissue. You may want to use tissue that’s moistened or made extra soft for comfort, or unscented flushable bathroom wipes.

#Wear cotton underwear and loose clothing. This helps keep the area dry. Avoid wearing pantyhose and other tightfitting garments because these can trap moisture. Change your underwear daily and whenever it’s soiled.

#Avoid irritants. Avoid bubble baths and genital deodorants. Cut back or avoid beverages or foods that you know irritate your anal area. Avoid overuse of laxatives that increase diarrhea and the risk of anal irritation and itching.

Click to see->Home Remedies for Anal Itch and Rectal Burning.

Related articles:

Seeing someone scratch an itch ‘makes you itchy too’

Itching study ‘finds chemical that makes us scratch’

Itching and scratching a ‘vicious cycle’, say researchers

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/anal-itching/DS00453
http://www.medicalnewstoday.com/articles/168728.php

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2 thoughts on “Anal Itching (Pruritus Ani)”

  1. So, depending on how you look at it, I’ve suffered from pruritus ani most of my life (now 44 years old, white male). At the start of 2013, I decided finally to go to the doctor to seek relief. I had been assuming for years my troubles (consistently finding blood on the toilet paper, swelling, itching in the middle of the night) had to do with two internal hemorrhoids that were confirmed in a colonoscopy in 2009. I had been a piano mover in my early twenties and knew heavy lifting is commonly associated with hemorrhoids. So, the colon & rectal doctor laser-treated the two hemorrhoids and prescribed me some prescription cream (containing steroids, I do not recall the name). He also instructed me to use an elaborate daily treatment of the area with cotton balls and corn starch “to keep the area as dry as possible.” He also recommended I avoid spicy foods, fruit with citrus and caffeinated drinks. This is when my troubles REALLY began. I followed his instructions TO THE LETTER and used the cream for several months (not realizing long-term use is contra-indicated with creams containing steroids) with the cotton ball/corn starch treatments (which were messy and humiliating) and tried to forgo coffee (which was miserable in itself). To my absolute horror, after about four months of this I developed anal warts!! At this point I went to a dermatologist, who prescribed imiquimod cream, which cleared up the anal warts (and was rather excruciating in the process, but I was glad it worked). Once the warts were gone, the next several months were ‘so-so’ with the pruritus ani. I began to get depressed and even sought relief via pain medication. Finally, I went to another, more experienced dermatologist, who examined the area and prescribed Pramasone, which was a big help in relieving the pain and itching. More importantly, however, the dermatologist said he “has seen (this condition) before (something NO medical professional/MD had said up to that point)” and said that “for some reason (he) has seen this condition only in men.” With the Pramasone he instructed that I buy a skin cleanser/moisturizer called CeraVe (available in any pharmacy) and use it to clean myself after a bowel movement. MOST IMPORTANTLY the dermatologist advised me my condition was likely a contact allergy to toilet paper! Specifically, he said most toilet paper manufacturers use some amount of chlorine to dye the toilet tissue white. I found some toilet paper made without chlorine, but, decided to take this information further, by NO LONGER USING TOILET PAPER AT ALL. So, my practice has been, after a bowel movement, to clean the area with CeraVe using a latex glove. This necessitates a private restroom with a sink. Finally, I bought a portable bidet at amazon.com and use it daily after the cleansing with water as cold as possible. Basically it’s a three-step process: bowel movement, cleaning the area, then rinsing the area. Really, it involves only one additional step to ‘normal’ people’s bathroom activities.
    All this sounds disgusting, odd and downright crazy, right? If you’ve read this I’m assuming you are suffering and desperate for help. I’ve heard that those in other countries think Americans are crazy for using toilet tissue in the way we do, hence the use of bidets in other cultures. Sure seems like the right assessment to me! If you are a person unaffected by this problem, count your blessings and go read something else. As I indicated, after suffering off and on my entire life and moreso the past TWO YEARS after seeking help from the medical community I am only too happy to have to go through the routine I’ve described to keep the symptoms nearly 100% gone. I have yet to endure a hot summer since using the CeraVe and portable bidet but I’m pretty confident. I have a tiny area of psoriasis on my right knee, and this further confounded my efforts to find an answer for my problem, since much medical literature describes ‘inverse psoriasis’ which can affect the anal area. I also realize the appearance of warts probably indicates the presence of something in my system, but I’ve had no recurrence (knock knock) thus far. As I’ve indicated, the past six months have been the most symptom-free of my entire life. I’ve only realized how much depression and lowering of general functionality was affecting me since the symptoms have dropped to their current levels. I truly hope I can make it to one year; in the meantime, I hope this narrative can be helpful to anyone who is experiencing my type of problem. Hang in there. J in ABQ, NM

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