This is not a popular topic for many people despite it being very common.
Pruritis ani (proo-RIE-tus A-nie) or Anal itching is very common and a very disturbing condition which many people have to deal with alone due to embarrassment. Imagine having a meeting or giving a presentation while having an irresistible urge to scratch. The feeling can become un-tolerable and will lead to a lot of distress, anxiety and may even lead to depression if not sorted out early. The itching may be predictable.
It affects men more than women. It is caused by irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch. The irritants are many and can be difficult to identify.
Usually, the condition results from seepage from haemorrhoids or over activity of sweat glands around the anus. The intensity of itching usually increases with moisture, sitting and clothes worn. The scratching many be so bad that so causes Perianal excoriation (damage to the skin around the anus). Exposing the patient to infection of the area.
It does not mean you are dirty
Uncleanliness is almost never the cause of the itching. However, there is a natural tendency once a person develops itching to wash the area vigorously and frequently with soap. This almost always makes it worse by damaging the skin around the anus and washing away protective natural oils normally on the skin, making it more vulnerable to irritants.
When to seek Medical help
Most Pruritus - Ani doesn't require medical care, but seek medical care if:
- It's severe or lasts longer than one to two months
- There's bleeding from the rectum
- You can't figure out what's causing a persistent itch
- Adversely affecting your daily activities
Always try to remember if there is anything new in terms of food, clothes or soap that may give a clue to what is causing. The cause may require a bit of detective work.
There are many causes and in many patients a cause is never found..
- A very common cause is seepage of feces from the anus that causes irritation and itching of the skin around the anus.
- Other common irritants include rough toilet paper
- Dietary items such as spices, caffeine, and carbonated drinks.
- Pin-worms also have to be ruled out and treatment for this may take weeks to months due to high re-infection and the need for disinfection of a lot of home items.
- Infections such as sexually transmitted infections may also involve the anus and can cause anal itching.
- Skin disease such as psoriasis or contact dermatitis
- Anal tumors; benign or cancerous tumors around the anus
- Anal warts
- Anal fissures (usually painful too)
This condition is also common in Diabetics and individuals who have reduced immune systems (HIV and transplant patients). In these people, the main cause is a fungal infection due to a fungus called candida Albicans(usually causes thrush).
The Itching can be made worse by;
- Frequent motions
- Straining at stool
- Vigorous use of toilet tissue
- Scrubbing with soap and water
- Acidic foods
The best thing you can do is not to scratch as difficult as it may sound. If you scratch it makes you want to scratch more, it a vicious cycle of unhappiness. This is especially difficult at night when the itch tends to be worse.
- Keep your fingernails short to limit any damage done by scratching.
- Consider wearing cotton gloves at night
Initial treatment is removal of the irritant, of which can be identified almost instant relief will be attained. For instance with fungal infections, a topical anti-fungal would be enough, but the cause of the fungal infection may have to be searched for.
The area should be kept dry and clean and over-hygiene should be avoided, because it may aggravate the situation. The anus may be kept dry with acid-free toilet paper that may be placed in the anus(not in) to act as a wick to keep the area dry. Also the use of gentle toilet paper, even baby wipes may be of use.
If there are hemorrhoids then a doctor should be consulted for appropriate treatment.
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