Pruritis Ani
What is pruritis ani?
Pruritis ani is Latin for “itchy anus”.
What causes Pruritis ani?
There are many different causes of pruritis ani. The skin around the anus is sensitive and difficult to keep clean. Moisture and small amounts of residual stool or mucous are the most common factors that cause this problem. Hair can aggravate the problem. A number of other common anal conditions such as haemorrhoids, fissures or fistulas can also lead to itch.
Other causes can include diabetes, inflammatory bowel disease or various skin conditions as well as allergies. In children, threadworm is a common cause. The skin becomes itchy. Scratching the skin temporally relieves the itch but can lead to skin damage and further irritation, thus setting up a persistent cycle.
Does poor anal hygiene cause pruritis ani?
While stool on the skin can cause itching, inadequate hygiene is not usually the major cause. Often, patients with a tendency for pruritis more vigorously and frequently wash the perianal skin. The soaps/lotions and minor damage from excessive cleaning can in itself be irritating and make the problem worse.
How is the cause of pruritis ani diagnosed?
Many patients are reluctant to seek help for fear of embarrassment. Pruritis is very common and a doctor can help with the diagnosis and management. The doctor will need to examine the anus to see if there is any pathology causing the problem.
What is the treatment for pruritis ani?
Surgery is not usually necessary unless an obvious cause such as a fissure is found. The most important thing to do is to keep the anal skin clean and dry without excessive cleaning. Treatment involves the following principles:
- Avoid further trauma to the skin
- Avoid soap on the anus.
- Do not scrub the anus, even with toilet paper after a bowel motion.
- Following a bowel action, only use soft toilet tissue to clean the anus. It is often best to rinse with warm water and pat dry (or hairdryer on low setting) rather than scrubbing clean. Baby wipes or wet washcloth are suitable alternatives.
- Avoid scratching, this causes more damage and inflammation and can worsen the problem.
- Avoid moisture and maintain clean and dry skin
- Dry skin at all times.
- Avoid ointments (unless prescribed) or any medicated, perfumed or scented powders. A simple drying powder or baby powder may be used.
- Choose loose fitting clothes, cotton underwear.
- Only use medications recommended by your doctor
- Only use an ointment if directed by your doctor.
- An ointment containing steroid may be recommended for a short period to reduce the inflammation and help to break the itch-scratch cycle.
If strict adherence to these measures do not solve the problem, you may need to have your local doctor refer you to a skin specialist.
What is a colorectal surgeon?
A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.