Pruritus Ani

What is Pruritus Ani?
Itching around the anal area is called Pruritus Ani. This condition results in a compelling urge to scratch.

What are the causes of Pruritus Ani?
There are various possible causes which may include the following:

• Excessive Moisture in the anal area. Moisture may be due to excessive perspiration or a small amount of residual stool around the anal area. This can be caused by passive faecal leakage, particularly if the stools are loose.
• Skin Conditions may affect the skin around the anus and cause itch - for example, eczema, psoriasis, lichen sclerosus. Some soaps, perfumes, creams, ointments, or the dye in some toilet tissue may sensitise (irritate) the skin around the anus in some people. You may be allergic to one or more of the ingredients in these products
• Infections such as thrush and other fungal infections. Scabies, herpes and anal warts can cause itch around the anus. Threadworms are a common cause in children. Consider this cause particularly if there is more than one person in the home with an itchy bottom. Also, with threadworms, the itch is mainly at night.
• Certain Foods are not fully digested and may sensitise the skin around the anus. These include citrus fruits, tomatoes, spices and drinking large amounts of beer, milk, tea, coffee or fizzy drinks.
• Medicines such as some antibiotics can lead to diarrhoea which can irritate the anal skin
• Anal Fissure
• Haemorrhoids
• Anal Tumours are a rare cause of itching

What can be done to make the itching go away?
Careful examination may identify a definite cause for the itching. Any underlying cause should be treated, but in general the principles of treatment are:

1. AVOID MOISTURE IN THE ANAL AREA.
After washing, dry around your anus by patting gently (rather than rubbing) with a soft towel. Even better, use a hairdryer on a low heat setting. Do not put on underwear until your anus is fully dry. Wear loose cotton underwear (not nylon). Avoid wearing tight-fitting trousers. If possible, do not sit for long periods, and try not to get too hot. The aim is to allow air to get to your anus as much as possible, and not to get too sweaty. If you sweat and moisture gathers around your anus, use a cotton ball to absorb the moisture. Avoid all medicated, perfumed and deodorant powders. When you are not at home, use a cotton make up removal pad and plain water to clean your anus. Have a bath or shower daily. If possible, wash your anus with water only. If you use soap around your anus, rinse well. Change your underwear daily.

2. AVOID FURTHER TRAUMA TO THE ANAL AREA.
Do not use soap of any kind on the anal area. If you must use soap, use a bland non-scented soap. The natural tendency once a person develops this itching is to wash the area vigorously and frequently with soap and a washcloth. This almost always makes the problem worse by damaging the skin and washing away protective natural oils. Do not scrub the anal area with anything – even toilet paper. It is best to clean with just water and pat the area dry. Use wet toilet paper, baby wipes or a wet flannel to blot the area clean. Never rub. Try not to scratch the itchy area. Keep your fingernails short. Scratching produces more damage, which in turn makes the itching worse. You may also scratch in your sleep without realising. For individuals that experience irresistible itching at night, wearing cotton mitts or socks on the hands may be helpful to prevent scratching with fingernails.

3. AVOID PROLONGED USE OF TOPICAL MEDICATIONS.
Apply prescription medications sparingly to the skin around the anal area and avoid rubbing. Prolonged use (over one week) of prescribed or over the counter topical medications may result in irritation or skin dryness that can make the condition worse.