Pruritus ani is manifested by an anus that scratches, stings and burns. Different causes can explain this itching of the anus. What are the treatments ?
The anus that scratches, burns and stings is a symptom that affects between 1 and 4% of the general adult population and 18% of proctology consulting patients. Moreover, itching of the anus is much more common in men up to 4 times more than in women. What can cause anal itching? How to cure itchy anus? How to prevent pruritus ani? Causes, Symptoms and Treatments itching of the anus.
Definition: what is itchy anus?
Pruritus ani is defined as all of the skin sensations (itching or burning) perianal resulting in the need to scratch the anus, or even the anal canal. “Pruritus ani is common because the anus is a region prone to pruritus. The anus is the external opening of the digestive tract, located at the level of the perineum between the external genitalia and the furrow inter-gluteal“, describes Dr. Higuero, proctologist. Before continuing: “It follows the anal canal (area from the lower rectum to the anal margin) and is bordered by the anal margin (skin area with a wrinkled appearance and pigmented in a darker color than the surrounding skin).”
Causes: what can cause anal itching?
The cause is unknown half the time. This is called the essential pruritus. However, two types of disease should be sought during a clinical examination: those of the anus and those of the skin. But there are other main causes:
- hemorrhoidal disease (hemorrhoids),
- THE marisques,
- there anal fissure and fistula,
- sexually transmitted infections or STI (especially warts, which are growths of the skin or anal mucosa),
- THE parasitosis (responsible for pinworms: small white worms that cause itching at the anal margin), anal incontinence and anal cancer,
- There are also dermatological causes : eczema, erosive dermatitis, psoriasis, candidiasis, lichen planus, Bowen’s disease.
- Illnesses must systematically be mentioned during the consultation, such as diabetes
- Some medications (colchicine, nicorandil, etc.)
What are the symptoms of itchy anus?
Pruritus ani is manifested by specific symptoms which are a feeling of irritation, burning and itching which will lead to scratching. “The sensation of pruritus will be triggered by the aggression of diseased skin or in contact with oozing or discharge (pus, stools, vaginal mucus, etc.). It will lead to scratching causing skin lesions that can become infectedirritating the skin which becomes more sensitive to itching“, explains Dr. Higuero. And then to add: “a vicious circle sets in with a self-sustaining mechanism. We sometimes end up scratching because it itches when the initial cause has disappeared“.
What are the risk factors for pruritus ani?
The anus has a highly developed sensory innervation. Its immediate environment exposes it to local irritant factors: defecation, default or excess toilet care, skin folds in the neighborhood. In addition, urological and gynecological problems like urinary incontinence and vaginal discharge, wearing unsuitable underwear favoring maceration are also favoring factors.
Dr. Higuero has some tips for relieving pruritus ani. The important thing is to treat the cause if it has been found, then the consequence. These two elements are essential to eliminate pruritus because of the self-sustaining mechanism of itching. “The proctologic treatment will be adapted to the anatomical presentation. The dermatological treatment will be of the type anti-infectives or topical corticosteroids depending on the diagnosis“, details Dr. Higuero. In addition, if a drug is responsible for this itching, it will be discontinued. To relieve itching, the treatment calls on common sense: have a clean and dry anus in case of moist and hydrated anus in case of skin dryness and certain medications (from topical corticosteroids). “In the event of failure, recourse is sometimes had to anti histamines, anti-depressants, capsaicin, hypnosis“, recommends the specialist.
To limit the risk of appearance of pruritus ani, it is recommended to take care of this area. The anus can be “attacked” in the period surrounding defecation as well as outside of it. Dr. Higuero lists some simple rules of hygiene to remember:
► The anal toilet must be twice daily, with water and a gentle cleansing base (surgras soap, dermatological bread) in a squatting position with a hand shower to remove any residue of faecal matter.
► Washing is done by hand with a careful rinsing followed by gentle drying. This same toilet must of course be carried out after any sporting activity.
► Wearing preferred cotton underwear. Avoid antiseptics (Betadine®, alcohol, Dakin®, etc.) and solutions with an acid pH.
► “After defecation it is necessary choose quality toilet paper, by dabbing then washing as specified above. The use of toilets or so-called Japanese toilet seats, which very effectively allow washing with water followed by air-drying of the anus, are also a solution, even if expensive. Occasionally, it is also possible to use intimate hygiene wipes sold in pharmacies“, concludes Dr. Higuero.
Thanks to Dr. Higuero, proctologist and member of the Board of Directors of the French National Society of Gastroenterology.