Anal Pruritus

Index

1. What is anal itching?
2. What are the symptoms?
3. Causes of anal itching or why does it occur?
4. Can it be prevented?
5. What is the treatment?

What is anal itching?

Anal itching is a skin condition characterized by itching and irritation of the skin around the anus. The itching may be worse at night or after defecation. It is advisable not to scratch, as this causes further irritation and worsening of the itching. In addition, scratching with fingernails may result in skin damage and even infection of the area.

It is estimated that anal itching usually affects 1-15% of the population, being up to 4 times more likely in men than in women.

There are two main types of anal itching:

• Primary (idiopathic) anal pruritus. It has no underlying cause, and is the most common type (about 50-90% of cases).
• Secondary anal itching. It may be due to many underlying causes: infections, contact dermatitis or dermatological problems, systemic diseases, etc.

What are the symptoms?

There are certain typical symptoms of anal itching:

• Constant anal itching or anal itching
• Irritation in the anal area
• Burning sensation in the anus
• Obsessive sensation, in severe and persistent cases
• Sleep disturbances, in patients with advanced cases

Causes of anal itching or why it occurs

Some causes of anal itching may be:

• Excessive use of soaps and other intimate hygiene products.
• Rubbing the area with wet wipes or rough toilet paper
• Excessive sweating or wetness
• Underwear that is too tight or constricting
• Certain foods or drinks: carbonated beverages, caffeinated beverages (coffee, tea or cola), and spicy or acidic foods (tomato and citrus fruits)
• Diarrhea or constipation

Other underlying causes also include:

• Infections. Some bacteria, fungi or parasites can cause such itching or irritation. Some of these are airborne staphylococcus or streptococcus pyogenes, Candida albicans (a type of yeast), roundworms and Sarcoptes scabiei (scabies mites). It should be noted that roundworms are more typical in children than in adults.
• Dermatological conditions. Psoriasis, contact dermatitis (allergens or other irritants) or atopic dermatitis can cause rashes in the anal area as well.
• Crohn’s disease
• Stress or anxiety
• Systemic diseases: Diabetes Mellitus, Leukemia, Lymphoma, Thyroid disease and liver disease (obstructive jaundice).
• Colorectal and anal diseases: rectal prolapse, internal and external hemorrhoids, anal fissures (ulcers) or fistulas.
• Systemic or topical medications, such as quinine, colchicine and mineral oils.
• Fecal or urinary incontinence, due to the fact that the area is much more humidified.

Can it be prevented?

Some tips that prevent anal itching from appearing and, in case of suffering it, from worsening, are:

• Resist the urge to scratch and wear cotton gloves at night to avoid being able to injure yourself with your fingernails.
• Keep the perianal area clean and dry. In people with anal itching it is recommended to wash with clear water (without soap), after defecation, and dry with a hairdryer, as towels or paper can irritate the area. In case of using it, it should be done in small touches.
• Do not use soap when cleaning the anal area and, much less, rubbing with paper or wipes.
• Avoid using perfumed creams, lotions, bubbles or bath salts.
• Eat high-fiber foods to avoid diarrhea and constipation.
• Avoid spicy or acidic foods and caffeinated beverages.
• Avoid wearing tight underwear.

What is the treatment?

Treatment of anal itching usually focuses on maintaining a proper routine for proper hygiene. If there is a secondary cause it will be treated and treatment will vary.

In general, the basic treatments for anal itching include:

• Topical medication. These are topical steroids in cream form that contain 1% hydrocortisone and will help relieve itching and irritation. Topical capsaicin will be an alternative for patients with chronic anal pruritus.
• Oral medication. Antibiotics or antifungals, which will be prescribed only if infection is present.
• Methylene blue injection (anal tattooing). It is used in advanced cases that do not respond to topical medication. Methylene blue is a dye that is injected into the perianal area, believed to relieve itching by killing nerve endings.