What is Pruritus Ani?
Pruritus ani is a bothersome and sometimes intense itching or burning sensation of the skin around the anus (rectal opening). It is most noticeable at night or after a bowel movement. The most common complaint is an irresistable urge to scratch. Some people will note occasional bleeding when wiping after a bowel movement. This is a common problem that affects up to 5% of the population. It affects men and women equally and may occur at any age.
Diagnosing Pruritus Ani
It is diagnosed by an examination of the skin around the anal area. The appearance of the skin will vary, depending on the severity and the length of time the condition has been present. It may start with redness of the skin and can progress to thickening of the skin. It may also lead to cracks and open sores which may result in small amounts of blood on the toilet tissue. Sometimes a biopsy (a small piece of skin removed for microscopic examination) is necessary.
Causes of Pruritus Ani
The causes of pruritus ani fall into four categories:
- Excessive cleanliness: Excessive washing, rubbing, cleansing with soap, face cloths, and brushes which lead to chronic skin irritation.
- Moisture: Prolonged exposures to moisture from vaginal discharge, perspiration, loose stools or mucus discharge from other rectal problems.
- Diet: Certain foods can produce irritation to the skin when stool is passed. The most common ones are products containing caffeine (coffee, tea, colas, and chocolate), spicy foods, dairy products, beer, acidic foods like citrus fruits, tomatoes, and nuts.
- Skin Irritants: Dyed or scented toilet paper, soaps, and laundry detergent may cause the irritation. Stool left on the skin from leakage or incomplete hygiene may be another cause. Occasionally, once the itching starts, some people may respond with excessive wiping of the area which can increase symptoms.
Other rare causes are pinworms and various skin conditions such as fungal infections or skin burns from radiation.
Treating Pruritus Ani
Treatment is determined by focusing on skin care and the underlying cause of the pruritus ani. After gently cleansing and drying the skin apply the recommended ointment.
To help with healing:
- Wipe gently- never rub harshly.
- Use plain white toilet paper or moist wipes to cleanse after bowel movements.
- Gently dry skin thoroughly.
- Use mild soap or don't use soap at all.
- Wear cotton rather than nylon underwear.
- Wear loose clothing or underclothing.
- Watch your diet and eliminate foods that seem to make your condition worse. When your symptoms disappear you may be able to resume these foods in moderation.