The following are possible causes for the development of this condition.
- Certain skin conditions - issues such as contact dermatitis (which could be caused by products that cause a reaction when they come into contact with the skin) or psoriasis can cause this.
- Hygiene and personal care habits - skin care routines could include behaviours and the use of products that irritate the skin. This can include cleaning too little or too much around the anus and using certain soaps, toilet paper and wipes which contain perfumes and dyes.
- Infections - issues such as certain sexually transmitted diseases (STD), parasite infections (such as pinworms) and fungal/yeast infections (especially in women) are all causes which would need to be excluded.
- Haemorrhoids - these occur when the veins around the anus or inside the rectum become swollen and these can cause an itchy anus.
Symptoms and signs
The following are signs and symptoms of pruritus ani.
- Soreness or burning sensation in or around the anal area.
- Redness or the affected area.
- Anal itching which is persistent or severe.
- The anal area may seem to be infected.
- There's no clear cause for the itching.
- There may be anal bleeding.
If the cause of the problem can't be determined through history taking and an examination, then the patient may be referred to a specialist such as a dermatologist (skin specialist) or a proctologist (specialist in rectal and anal conditions). They would then assess the patients further and perform applicable investigations to determine the possible cause.
The treatment of pruritus ani will depend on what is causing the condition.
- Skin conditions will be prescribed medication which will help resolve the symptoms. Steroid ointments usually help for contact dermatitis, as well as avoiding contact with potential products or materials which irritate the skin.
- Patients may want to stop using hygiene products which irritate the anus and use ones which are more suitable for sensitive skin.
- Infections are treated by prescribing antibiotics, anti-parasitic and anti-fungal medications.
- Haemorrhoids can be managed conservatively by using a topical ointment to relieve pain and itching. If the haemorrhoids are severe and persistent, then surgical intervention may be necessary.
- For patients who experience severe itching, that it wakes them up at night or they need to be at work and can't be seen scratching, oral antihistamines can be prescribed for them.
Self-care measures can help to allow irritation to resolve on its own, if this is the cause. Suggestions would include the following:
- Cleaning gently around the anus - using water or gentle soaps with soft cotton balls helps to clean the area without irritating it further.
- Dry the area properly - instead of scrubbing clean, rather gently pat the area dry with toilet paper which doesn't have any dye or prints on it.
- Use cotton underwear and loose clothing - this will allow the area to remain dry as moisture can't be trapped.
- Use protective barriers - applying zinc containing ointments on the affected area can help keep it dry and free from irritation from moisture.
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