Anal itching, also known as pruritus ani, is a common condition. Some studies have shown that it can affect as much as 1-5% of the population.
The reason why cases of anal itching are not always relieved with scratching is because of a self-propagating itch-scratch cycle: the scratching exacerbates the inflammation, causing an irresistible urge to scratch even more.
There are many causes of anal itching.
Here are 7 broad groups of conditions that can present with anal itch.
1. Dermatologic conditions
Topical irritants such as Deodorants, Detergent/fabric softener, Hemorrhoid remedies, Soaps, Suppositories, Talcum powder, Tight clothing and Toilet paper dyes and perfumes can cause Irritant dermatitis leading to itching. Atopic dermatitis, Hidradenitis suppurativa, Lichen planus, Lichen sclerosis, Psoriasis and Seborrheic dermatitis are all conditions that can cause anal itch.
2. Dietary irritants
Certain types of foods, when ingested, can become dietary irritants when passed out from the other end. They include foods such as Beer, Caffeine, Chili peppers, Citrus foods, Milk and Tomatoes.
3. Anal conditions
Such as Anal fissures, Chronic constipation, Chronic diarrhoea, Fistula, Incontinence, Prolapsed haemorrhoids, Rectal prolapse, Irritable bowel syndrome, Inflammatory bowel conditions and Skin tags.
Abscesses, Candidal infections (intertrigo), Corynebacterium minutissimum (erythrasma), Molluscum contagiosum, Parasites (e.g., pinworms, scabies), Staphylococcus aureus infections can cause anal itch. A big group of infections are sexually transmitted infections. These infections have to be considered especially in people who partake in anal intercourse. Some of the infections include Chlamydia, Gonorrhoea, Herpes and Human papillomavirus to name a few.
Such as Bowen disease, Extramammary Paget disease, Squamous cell carcinoma can present with itch.
Such as Chemotherapy, Colchicine, Neomycin and Quinidine can trigger itch too.
7. Systemic diseases
Aplastic anaemia, Diabetes mellitus, Inflammatory bowel disease, Jaundice, Leukemia, Lymphoma and Thyroid disease can have anal itch as a symptom.
In many instances, we may not actually identify any specific cause and label the itch as idiopathic pruritus ani. The itch could also be due to psychological disorders.
While many people worry that anal itch is due to a sexually transmitted infection, as you can see above, there are so many reasons why a person may develop an anal itch.
The most important thing is to seek medical attention so your doctor can assess you and come to a diagnosis.
The doctor will take a detailed medical history from you and do a physical examination, including an examination of your perineal area and possibly do a proctoscopy. If need be, we may do some swabs to send off for investigation. The doctor may advise for further investigations such as a colonoscopy depending on what is found and your age group.
Treatment & Prevention
Treatment of pruritus ani should address the underlying cause. The goal of treatment is also to prevent further irritation and moisture in the affected area and avoiding scratching. Patients should be aware of proper hygiene and avoidance of perfumes, dyes, dietary irritants (especially caffeine), and tight clothing.
Patients should also keep the area dry and be aware of the itch-scratch cycle. A sedating antihistamine can reduce scratching during sleep. If the itch is very bad, wear cotton gloves or socks on the hands at night to prevent scratching. Patients with hemorrhoidal skin tags that make hygiene difficult can clean the area using a handheld showerhead, squirt bottle, sitz bath, or a bidet. After which, pat the area dry or use a hairdryer set on “cool.” Avoid using soap on the anal area as the skin there is sensitive and can dry out easily. Do not scrub the perineal area with anything including toilet paper.
Besides the conservative measures above, low-potency topical steroids can be used for a short duration of time. If the itch persists after treatment, a biopsy can be considered. If you wish to speak to our doctors about the following symptoms, please call us or email us for an appointment at firstname.lastname@example.org .