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Pruritus ani (anal itching) - causes, diagnosis and treatment

What is pruritus ani?

Pruritus ani, also known as anal itching, is a common and often unpleasant problem that affects many people. It describes the feeling of itching in the skin around the anus. This perianal skin is particularly prone to itching due to the variety of possible causes, which can range from hygiene factors to serious medical conditions.

Causes of pruritus ani

The most common causes of anal itching are:

  • Idiopathic: In most cases, the exact cause remains unknown.
  • Hygienic factors: Both inadequate and excessive cleansing can cause irritation. Insufficient cleansing leaves irritating stool and sweat residue on the skin, while excessive cleansing with strong soaps and wipes can dry out or irritate the skin.

Other less common causes may include:

  • Hemorrhoids: Large external hemorrhoids make cleaning difficult, while large internal hemorrhoids can cause mucus secretions and fecal impurities.
  • Fecal and urinary incontinence: Especially in very young or elderly people, this can lead to local irritation and secondary infections.
  • Systemic skin conditions and infections: These include Candida infections and parasitic diseases such as pinworms.

Symptoms and diagnosis

The symptoms of pruritus ani include intense itching, which often leads to a vicious cycle of itching and scratching. This can lead to skin lesions and secondary infections that further exacerbate the itching.

Medical history and examination

A thorough medical history is crucial to identify the cause of itching. Patients should be asked about their hygiene routines, topical products used and dietary habits. Symptoms such as perianal pain, bleeding or changes in the skin may indicate specific causes.

Physical examination

The physical examination focuses on the anal area to detect signs of skin changes, infection or hemorrhoids. An anoscopy may be necessary to examine the internal anal area in more detail.

Treatment of pruritus ani

General measures

  • Hygiene: Use soft cotton cloths soaked in water to cleanse after a bowel movement. Avoid strong soaps and wet wipes.
  • Clothing: Wear loose clothing, especially at night, to promote air circulation.
  • Reduce moisture: Powdering with regular cornstarch can help reduce moisture in the anal area.

Drug therapy

  • Topical corticosteroids: 1% hydrocortisone acetate ointment may help relieve symptoms in the short term (less than a week). In some cases, stronger corticosteroids may also be required.
  • Specific treatment of infections: Fungal infections and parasitic diseases need to be treated specifically.

Important points

Most cases of pruritus ani are idiopathic, but infectious, neoplastic and other treatable causes should be ruled out.Pinworms in children and hygiene-associated problems in adults are common causes.Appropriate hygiene practices and reducing localized dampness are critical to relieving symptoms.

Our practice offers comprehensive diagnoses and individualized treatment plans for patients with pruritus ani. If you are suffering from anal itching, do not hesitate to contact us for a consultation and examination.