Pruritus ani, commonly referred as anal itching, perianal itching or itchy buttocks hole can cause severe distress and sleep disturbance due to persistent itching. One may even frighten to go to social events due to intense anal itching. It can really ruin one’s professional career as well as personal life. Anal itching actually is not a disease, but rather a symptom or sign and every type of anal itching sign or symptom can be successfully treated regardless of the cause.
Pruritus ani can be due to several factors; it can just be due to common skin dermatoses or could be the skin manifestation of systemic illness. In pruritus ani, itching is often localized in the anal region with little or no itching elsewhere. Pruritus ani is more commonly seen in males then females. Although serious systemic illness is rare in pruritus ani, it is very necessary to do a thorough examination for any malignancies like squamous cell carcinoma and extramammary paget’s disease, so you don’t have to regret later. Below are some of the causes on anal itching
Anal neurodermatitis is one of the causes of pruritus ani and is so intense during night that patients may tear the affected area until it bleeds.
Allergic Contact Dermatitis (ACD)
ACD is another common cause of anal itching. ACD could be due to various agents like fragrances in toilet paper, detergents, bubble baths, preservatives or anything that come in contact with the area.
Irritant Contact Dermatitis (ICD)
ICD may also cause anal itching. Irritant contact dermatitis may result from repetitive exposure to irritants from gastrointestinal contents, like hot spices or inadequate cleaning of the anal area after bowel moments. Anatomical abnormalities of the anal area or fecal incontinence can also leak rectal irritant to the skin causing irritant contact dermatitis.
Certain foods can cause pruritus ani in some individuals. These may include Tea, coffee, milk products, cheese, chocolates, nuts, popcorn,seeds, carbonated beverages, citrus fruits and drinks, tomatoes and tomato products etc. Smoking and alcohol has also been associated with pruritus ani.
Fungal infection is another cause of pruritus ani, it may be associated with red/white swollen rash with fissuring around the anal region. Patients with diabetes are more susceptible for perianal candidiasis. In case of female, candidosis is an important cause and should always prompt screening for diabetes mellitus.
When itching is present in female gonorrhea is also suspected, however it is almost ignored in men, especially when itching is the only symptom.
Although itching is less common, erythrasma involving groin and perianal region may also cause occasional itching.
Seborrheic dermatitis of the anal area may also cause pruritus ani. However, it may also be evident on other areas like inguinal region, scalp, chest and face.
Lichen Planus and Psoriasis
Sometimes lichen planus and psoriasis can also cause perianal itching but lesion are usually not limited to perianal region, other areas of the body may also be involved.
Pediculosis and Scabies
Pediculosis also causes anal itch, but patient main focus may be on pubic itching. Scabies also can cause anal itching; however itching is not limited to anal area. Itchy lesion in scabies usually involves finger web-space, wrist, axillae and genitals.
Intestinal Parasites Infestation
Pinworm infestation may also cause pruritus ani, especially in children. Night anal itching is very common in pinworm infestation in children. Other intestinal parasites may also cause anal itching.
Other miscellaneous causes:
Hemorrhoids, anal fissure and fistula may also cause or aggravate the itching of anal area.
Although rare, anal warts and condyloma lata (syphilis lesion) may also sometimes cause itching
Persons chronically infected with Strongyloides may also experience pruritus ani
Pruritus ani Treatment
The mainstay of treatment of anal itching is to find out the causative factor responsible for pruritus ani, once the cause has been identified, treatment can tailored accordingly. Avoid scratching or rubbing the anal area. Also, avoid excessive cleaning which can actually make symptoms worse.
Good toilet hygiene should be strictly followed no matter what is the cause of itching. The anal area should always be cleaned with plain water and dried with soft tissue paper when possible. Contact allergy to preservatives in the products are the main concern, so it is wise to avoid all perfumed products or any other products that contains preservatives, just using plain water is better option. A good moisturizer may be applied if there is dryness around the anal region.
If you are obese or you sweat much, you may use cotton ball on the anal area so it will protect from repetitive friction and keep moisture away. Increase your fluid intake. Drink atleast 6-8 glasses of non-caffeine, non-alcohol drinks each day.
Diet can play an important role in the management of anal itching. Avoid foods that aggravate the itching. Avoid foods that causes constipation or diarrhea. Increase fiber intake eat lots of fruits and vegetables.
Topical steroids are effective in case of noninfectious cause of pruritus ani especially non fungal etiology. Use of newer agents like tacrolimus is safer and effective than topical steroids. Use of topical Capsaiein 0.006% is also effective in some cases. When there is inflammation and pain, topical anti-inflammatory and anesthetic lotions (Pramoxine hydrochloride) can be applied alone or in combination with hydrocortisone.