Pruritus ani

Pruritus ani is the medical term for severe itching around the anus. It is a common condition that causes an overwhelming urge to scratch, often worsening at night or after a bowel movement. It is more frequently seen in men than in women or children.

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Causes of pruritus ani

There are several potential causes of pruritus ani, including:

 

Anal conditions

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• Haemorrhoids (piles) and anal fissures can cause tiny amounts of leakage, leading to skin irritation and itching

• External anal skin tags can make hygiene difficult, contributing to irritation

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Hygiene and moisture-related factors

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• Sweating around the anal area is a common trigger

• Residual stool or excess moisture left after bowel movements can cause skin irritation

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Underlying skin conditions

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• Anal intraepithelial neoplasia (AIN) and other dermatological conditions may contribute to itching

• Fungal infections of the anal skin can cause persistent itching and discomfort

 

Dietary triggers

 

Certain foods and drinks may irritate the anal skin after a bowel movement, including:

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• Tea, coffee, and carbonated drinks

• Milk and dairy products

• Tomatoes, citrus fruits, and spices

• Alcohol (especially beer and wine)

• Chocolate and cheese

 

Irritants from soaps and hygiene products

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• Perfumed soaps, wipes, and lotions can trigger local irritation

 

Parasitic infections

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• Threadworms, a common cause of anal itching in children, can spread to other family members if not treated

 

How is pruritus ani investigated?

A detailed clinical history and a thorough examination of the anal skin, anus, and rectum are required to determine the underlying cause.

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Diagnostic tests may include:

• Proctoscopy or rigid sigmoidoscopy – Used to inspect the lower bowel and identify any contributing conditions

• Skin biopsy – May be required to diagnose underlying skin conditions such as AIN or fungal infections

 

Treatment for pruritus ani

 

Addressing underlying causes

• If haemorrhoids, anal fissures, or skin tags are present, treatment is recommended to relieve symptoms.

• AIN and other skin conditions may require surgery or close monitoring.

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Antifungal treatments

• Fungal infections usually respond well to antifungal creams.

• Overuse of creams containing steroids can damage the skin and worsen symptoms, so it is essential to follow medical advice.

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Treatment for threadworms

• Family-wide treatment is often necessary to prevent reinfection.

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Lifestyle and hygiene measures

• Thorough but gentle cleaning of the anal area after bowel movements is recommended.

• Avoiding dietary triggers may help reduce irritation.

• Avoiding perfumed soaps and wipes can prevent further skin sensitivity.