Pruritus ani

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What are the aims of this leaflet?

This leaflet has been written to help you understand more about pruritus ani. It

will tell you what it is, what causes it, what can be done about it, and where

you can find out more about it.

What is pruritus ani?

‘Pruritus’ means itching. Pruritus ani is itching around the opening of the back

passage (the anus). It is a symptom with many causes, but sometimes no

obvious cause can be found. Pruritus ani is common and occurs more often in

men than women. It is seldom due to an underlying serious condition and

those who have pruritus ani are usually otherwise well.

What causes pruritus ani?

Pruritus ani has many possible causes so it is sensible to seek the advice of

your doctor about your own itching.

Some of the more common causes are:

Anal disease. The contents of the bowel contain digestive enzymes

that can irritate the skin and cause itching. Minor leakages of bowel

motions, and a failure to remove them completely from the skin around

the anus, can lead to pruritus ani. One contributory factor may be the

presence of piles (haemorrhoids), which are the result of back pressure

on the blood vessels of the anal area. Constipation (not opening the

bowels regularly) can make the piles and pruritus ani worse. Skin tags

in the anal area can also contribute to itching.

Skin irritation. The skin of the bottom is sensitive and can easily be

irritated by moist wipes, soaps, perfumes, antiseptics (for example,

Dettol). These make the skin sore and itchy and contribute to pruritus

Sweating. The skin around the back passage is often moist with

sweat. If long periods pass without ventilation to the area, for instance

if you sit down for a long time, the skin can be irritated further and

become itchy.
Is pruritus ani hereditary?

What are the symptoms of pruritus ani?

Itching is the main symptom, often occurring after the bowels have opened. It

may be bad enough to interfere with sleep. Sometimes the skin becomes sore

after scratching, making it uncomfortable to open your bowels.
What does pruritus ani look like?

The skin around the anus may look inflamed and thickened, and show scratch

marks. Small cracks may occur and these may feel painful and sensitive, and


How is pruritus ani diagnosed?

It is usually possible to make a diagnosis of pruritus ani by hearing the story

and examining the affected skin. Your doctor will want to find out why you

have pruritus ani, and may need to check you for threadworms, allergies etc.

The tests selected will depend on the clues offered by your story and the

examination of the skin in the area.

Can pruritus ani be cured?

There is no one simple treatment that will cure everyone who has pruritus ani

as it can have so many different causes. It is important to diagnose these

correctly, then the right treatment can be implemented.

How can pruritus ani be treated?

Your doctor may suggest a variety of

ways of helping your pruritus ani:

· A steroid ointment or cream applied every day to the area for a

short course may reduce the itching. It can be used intermittently

as and when needed.

· It is important to remove all irritants such as bowel motions or soap

from the skin creases. A cream, such as Diprobase cream, should be

used instead of soap for washing the area. This avoids the irritating

effect of soap and detergents. Cotton wool balls with warm water

are gentler than toilet paper and more effective in cleaning fissures

and creases. The area also should be rinsed thoroughly after you

have opened your bowels.

· If you have troublesome constipation, you should see your family

doctor for advice.
What can I do?

· You should avoid any of the things listed above that might be

contributing to your pruritus ani. If you notice that a particular food

makes the itching worse, avoid it.

· Scratch as little as possible, as scratching keeps the itch going.

· Open your bowels regularly. Try not to delay going to the toilet when

you have the urge to do so.

· Keep your stools soft so you do not have to strain to open your bowels.

Eat plenty of fruit, vegetables and other roughage, and drink plenty of


· The use of a bidet or a shower jet helps to remove particles of bowel

motion that have become trapped near the anus. Always dry the skin

gently, without rubbing it.

· Keep the area as well ventilated as possible. Clothing should be loose

and not made of synthetic materials. Avoid prolonged sitting.

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