Itching around the anus ( pruritus ani ) is common (affecting 1-5% of the population) and is usually accompanied by eczema around the anus ( perianal eczema ). It is often caused by irritation from feces. It is more common in men (60% men, 40% women) and in overweight individuals. Pruritus ani is most commonly seen between the ages of 45 and 64.WHAT CAUSES PRURITUS ANI?There are several possible causes, such as irritation from feces, contact dermatitis, infections, and anal abnormalities. In a quarter of patients, no cause for the itching is found.
Irritation from feces:
Irritation from feces is a significant cause. Feces contain enzymes and are acidic, which can irritate the skin, leading to eczema. This causes itching, followed by scratching. Scratching causes wounds, which become itchy again as they heal. This creates an itch-scratch-healing-itching cycle.
Feces can remain due to inadequate anal hygiene and improper cleaning of the skin around the anus. Dry toilet paper is also only possible to a limited extent. Proper cleaning is virtually only possible with water (shower hose, washcloth, bidet, bottle). Cleaning the anal area is also difficult if the anus is deeply located (which can occur with obesity, among other things) or if there is a lot of hair. Other causes include diarrhea, leakage of stool from the anus (soiling), fecal incontinence, and anal abnormalities such as hemorrhoids, skin tags (mariscae), and fistulas.
Contact dermatitis
In addition to eczema caused by irritation from stool, allergic contact dermatitis can also be a factor. An allergy to products used on the perianal skin, such as moist wipes, soaps, ointments, and creams.
Infections
A fungal infection caused by the yeast Candida albicans is also a known cause of perianal itching.
Infections with bacteria ( Staphylococcus aureus and streptococci) can also cause irritation and itching.
Itching around the anus can also be a symptom of sexually transmitted diseases accompanied by ulcers ( herpes , syphilis ), or inflammation of the anus (proctitis) caused by chlamydia or gonorrhea , or genital warts .
In children, pinworms (Enterobius vermicularis) can be the cause of itching.
Anal abnormalities
Perianal itching can also be caused by hemorrhoids , skin tags (mariscae), fissures (ani fissures), fistulas, intestinal diseases such as Crohn's disease, urinary incontinence, increased discharge, and by skin conditions such as atopic eczema , seborrheic dermatitis , psoriasis , lichen planus , sore spots, erythrasma , Bowen's disease, and Paget's disease.WHAT ARE THE SYMPTOMS OF PRURITUS ANI?The main complaint is severe itching. Other symptoms include pain, skin irritation, eczema, and bleeding wounds from scratching.HOW IS THE DIAGNOSIS MADE?The diagnosis is based on the clinical picture and its appearance. Sometimes additional testing is necessary, such as a culture for bacteria, fungi, or viruses, a skin biopsy, or an internal examination of the anus (proctoscopy). If contact dermatitis is suspected, an allergic test is performed.HOW ARE PRURITUS ANI AND PERIANAL ECZEMA TREATED?There are ointments and creams that can alleviate the symptoms, but the most important thing is to address the underlying causes. Infections, skin conditions, and anal problems should be treated. If irritation from feces is the cause, follow the advice below:
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After a bowel movement, clean the anus with lukewarm water, using the showerhead, a washcloth, or a bidet if you have one. Pat it dry, don't rub. Frequent use of rough, dry toilet paper often only makes matters worse. At work, you can use a bottle or a wet washcloth in a plastic bag. Or rinse thoroughly as soon as possible when you get home. |
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It is best to avoid using moist wipes, as they often contain perfume and preservatives and can cause contact dermatitis. |
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Do not use your own care products, ointments or creams, but only those prescribed by your doctor. |
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Wear soft, loose-fitting, clean, dry cotton underwear. |
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Try not to scratch, as that will only make it worse. Trim the nails short. |
Nourishing creams
Good creams for the perianal skin are:
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Vaselinecetomacrogol cream FNA |
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Zinc sulphate Vaseline cream 0.5% FNA |
Anti-inflammatory creams
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Hydrocortisone Vaseline Cream 1% FNA (hydrocortisone 1% in Vaseline Cetomacrogol Cream FNA) |
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Triamcinolone Vaseline Cream 0.1% FNA (triamcinolone 0.1% in Vaseline Cetomacrogol Cream FNA) |
In persistent cases, or with skin conditions such as psoriasis, it may be necessary to temporarily use stronger corticosteroids. Protopic (tacrolimus) ointment or Elidel (pimecrolimus) cream are also options. These can, however, cause a burning sensation initially.
CAN PRURITUS ANALYSIS BE CURE? Pruritus ani and perianal eczema are usually curable if the underlying cause is addressed and the above advice is followed. However, the symptoms may return. |
