ANAL ITCH OR PRURITUS ANI:
Anal Itch or Pruritus ani is an extremely common and annoying symptom, which is associated with a wide range of mechanical, dermatological, infectious, systemic, and other conditions. Regardless of the etiology, the itch/scratch cycle becomes self-propagating and results in chronic pathologic changes that persist even if the initiating factor is removed.
Many patients believe pruritus ani is caused by poor hygiene and are overzealous in their attempt to clean the perianal area. Excessive cleaning, and particularly the use of brushes and caustic soaps, aggravate the sensitive tissues and exacerbate the condition. The perianal area can be highly sensitive to perfumes, soaps, clothes, fabrics, dietary intake, and superficial trauma.
CAUSES OF ANAL ITCH:
1) Infections:
- Parasites (Pinworm, scabies)
- Bacterial infections (Group A, Beta-hemolytic Streptococus, staphylococcus aureus),Fungal infections (particularly candida)
- Sexually transmitted diseases (condyloma, herpes, syphilis, gonorrhea)
2) Fecal Soiling:
- Encopresis,Incontinence (usually post anorectal and bowel surgeries)
- Chronic diarrhea,Poor hygiene
- Transient internal relaxation of the internal anal sphincter
- Anatomic abnormalities (eg. prolapsed internal hemorrhoids, rectal prolapse)
3) Local irritation:
- Excessive use of soap and detergents
- Use of local creams and medications
4) Dietary agents:
- Coffee
- Cola
- Beer
- Tomatoes
- Chocolate
- Tea
- Citrus fruits milk
5) Anorectal diseases:
- Abscesses
- Fissures
- Fistulas
6) Dermatologic diseases:
- Psoriasis
- Contact dermatitis
- Atopic dermatitis
- Hidradenitis suppurativa
- Paget’s disease
7) Systemic diseases:
- Diabetes mellitus
- Hepatic diseases (hyperbilirubinemia)
- Leukemia
- Thyroid disorders
8) Post operative conditions:
- Psychological causes
- Other
- Chemotherapy
TREATMENT OF PRURITUS ANI:
Keep the area clean, cool, and dry. The most effective local therapy is ANAPROCT OINT ( lidocaine 3 %, hydrocortisone acetate 0.25 %, zinc oxide 5 %, allantoin 0.5 % ). Usually, it is applied only at night, when itching occurs. Severe cases may require application several times a day. Irritation of the anal skin needs to be reduced. Eat plenty of high fiber foods.Straining at stool causes cracks in the anus, which are irritable and harbour bacteria. Antifungal creams can be used. Patients should not wear synthetic underwear or use perfumes or deodorizers on the perineum. Wash the anus in a bidet or a bucket of lukewarm water. Moistened tissues or soft toilet paper are next best. Use aqueous cream, mineral oil or other soap-free cleanser.
