What Is Pruritus Ani?
Pruritus ani is bothersome and sometimes intense itching of the skin around the anus (rectal opening). It is most noticeable at night or after a bowel movement. The most common complaint is an irresistible urge to scratch. Some people will experience a burning sensation or note occasional bleeding when wiping after a bowel movement. This is a common problem that affects up to 5% of the population. It affects men and women and may occur at any age.
What Causes Pruritus Ani?
There are many causes of pruritus ani but most fall into three categories:
Prolonged exposure to moisture from vaginal discharge, perspiration, loose stools or mucus discharge from other rectal problems may lead to pruritus ani. For example, people who perspire when they exercise may find the moisture irritating to the skin around the rectum. Tight clothing, nylon underwear, and skin folds resulting from obesity may trap moisture in the area.
Certain foods can produce enzymes that are irritating to the skin when stool is passed. The more common ones are products containing caffeine (coffee, tea, colas, and chocolate), spicy foods, dairy products, beer, citrus fruits, tomatoes, and nuts.
Dyed or scented toilet paper, soaps, and laundry detergent may cause the irritation. Stool left on the skin from leakage [meaning the sphinter does not close -coffee exacerbates this -therefore put cotton ball folded tissue to capture] or incomplete hygiene may be another cause. Occasionally, once the itching starts, some people may respond with excessive wiping of the area which can increase symptoms.
Other rare causes are pinworms and various skin conditions such as fungal infections or skin burns from radiation.
How Is It Treated?
Treatment of pruritus ani is directed at the care of the skin and determination of the underlying cause. After gently cleansing the skin by patting, it is important to make sure the skin is dry. Some people use a hair dryer. Apply the ointment recommended by your doctor. Place a wisp of rolled cotton between the cheeks to absorb moisture.
What Can I do to Speed Healing and Help Prevent Pruritus Ani?
What I read:
Pruritus ani is a symptom complex consisting of perianal discomfort and itching. It is much more common in men than women, and it is idiopathic. [this means of unknown cause].
Discomfort is exacerbated by friction or a warm, moist perineal environment. Poor anal hygiene or anus itching over-cleansing with soap is often a contributing factor. Diabetes, antibiotic use, vaginal discharge or infection, and other skin disorders.
Patients with idiopathic pruritus often have intermittent seepage from the anal canal.
A decrease in resting anal canal pressure occurs with coffee intake, and exacerbation of itching symptoms can occur with ingestion of caffeine.
Common Conditions Causing Pruritus Ani
Anorectal Disease. Fissures, fistula-in-ano, proctitis, prolapsing hemorrhoids, skin tags, sphincter dysfunction.
Infection. Candida organisms, condyloma acuminata, pinworms, scabies
Dermatologic Disorders. Contact dermatitis, lichen planus, lichen sclerosus, psoriasis, seborrhea.
Physical Exam. Mild pruritus ani manifests as mild erythema and excoriations of the perianal skin. In later stages, the skin may be raw, red, and oozing or pale and lichenified with exaggerated skin folds. Examination of the anus and rectum.
For me, it may be coffee and leakage form the anal canal. Previously I reasoned I did not wipe well. Could be. But maybe there is seepage -aha-and thus now I gently roll tissue in a tad of vasoline or whathever lubricant mix (hydrocortisone, diaperex (though I'm not sure doctor recommended), and stick there to absorb moisture]. I am tyring some vaginal lubricants, too, to help with intenral dryness.
How I personally treat myself should not be considered MD advice.
BUT do NOT let the docs JUST stick you on hormones, or creams or diflucan. It sounds like there could be more goign on, and this is only treating some things.
For now this is like someone rubbed sandpaper on my most private privates. Ouch.
I just want Chris and all to know they are not alone. And thanks so much Chris in 2005 for posting..you have the EXACT symptoms, starting with the leg itch, as I do. I rub sores into the leg skin in a few minutes. This is nuts.
About Your Diagnosis of pruritis ani...
Pruritus ani is a burning or itching of the anus and genitals and the surrounding skin. Numerous conditions cause pruritis ani. Infections caused by yeast, herpes, genital warts, pinworms, scabies, and lice cause the condition. Skin conditions such as contact dermatitis, psoriasis, and seborrheic dermatitis may initially present as pruritis ani. Contact dermatitis may be caused by exposure to soaps, contraceptive jellies and foams, scented toilet paper, deodorant sprays, and douches. Individuals who have chronic diarrhea may have pruritis ani because of the difficulty keeping the area clean and dry. Diseases of the rectum such as hemorrhoids, fissures (tears), fistulas, or rectal prolapse may initially cause symptoms of pruritis ani. Women may have pruritis ani caused by a vaginal discharge or low estrogen levels if perimenopausal or postmenopausal. Excessive coffee drinking is also a known cause. However many times the cause cannot be identified. (ideopathic).
Decreased estrogen leads to vaginal and vulvar dryness and thinning, which may result in inflammation of the vaginal mucosa (atrophic vaginitis). Atrophy may cause irritation, dyspareunia, and dysuria and may increase vaginal pH. The labia minora, clitoris, uterus, and ovaries decrease in size. Intermittent light-headedness, paresthesias, and palpitations may occur. Nausea, constipation, diarrhea, arthralgia, myalgia, and cold hands and feet can occur. For hot flushes, avoiding triggers and wearing clothing in layers that can be removed as needed may help. Black cohosh, which may have estrogenic effects, may have some efficacy, but long-term safety is unknown. Soy protein has been used, but its efficacy has not been confirmed. Other medicinal herbs, vitamin E, and acupuncture do not appear helpful. Regular exercise, stress avoidance, and relaxation techniques may improve sleep and reduce irritability; relaxation techniques can also reduce vasomotor symptoms. Nonhormonal drug treatments for hot flushes include SSRIs (eg, fluoxetine, paxil, sertraline, prozac, zoloft).
OTC over the counter vaginal lubricants and moisturizers help relieve vaginal dryness. Measures to prevent and treat osteoporosis should be considered. Generally the risk of hormone replacement may not be worth it.Hormone therapy: Hormone therapy may be used for moderate to severe menopausal symptoms. For women who have had a hysterectomy, estrogen should be used alone, orally or as a transdermal patch, lotion, or gel. Women who have a uterus, if given any type of estrogen, are also given a progestin (as combination therapy) because unopposed estrogen increases risk of endometrial cancer. For most women, risks of oral hormone therapy outweigh benefits. Benefits include reduction in hot flushes, night sweats (and consequent sleep disturbance), and vaginal dryness. Combination therapy decreases yearly incidence (per 10,000 women treated) of osteoporosis (from 15 to 10) and colorectal cancer (from 16 to 10). For asymptomatic menopausal women, overall effects of hormone replacement therapy [hrt] on quality of life are not very meaningful.
Risks of combination [HRT] therapy are reflected in an increased yearly incidence (per 10,000 women treated) of breast cancer (from 30 to 38), ischemic stroke (from 21 to 29), pulmonary embolism (from 16 to 34), dementia (from 22 to 45), and coronary artery disease (from 30 to 37). Risk of coronary artery disease almost doubles during the 1st year of therapy and is particularly high for women with high pretreatment low density lipoprotein levels; aspirin and statins do not prevent the increase in risk. Also, the breast cancers that develop are larger and more likely to be metastatic, and false-positive mammograms are more common.
Estrogen-only therapy does not affect incidence of coronary artery disease but increases incidence (per 10,000 women treated) of ischemic stroke (from 32 to 44) and decreases incidence of hip fractures (from 17 to 11); effects on breast cancer, dementia, colorectal cancer, and pulmonary embolism are less clear.
For vaginal dryness or atrophy, topical forms of estrogen (eg, creams, vaginal tablets or rings) are as effective as oral forms. When estrogen cream is used, women with a uterus are also given a progestin. Hormone therapy is not recommended for prevention and treatment of osteoporosis because other effective measures (eg, bisphosphonates) are available
Progestins (eg, megestrol acetate 10 to 20 mg po once/day, medroxyprogesterone acetate 10 mg po once/day or depot 150 mg IM once/mo) may relieve hot flushes but not vaginal dryness. Progestins may have adverse effects (eg, abdominal bloating, breast tenderness, increased breast density, headache, increased low density lipoprotein, decreased high density lipoprotein); micronized progesterone appears to have fewer adverse effects. There are no long-term safety data about use of progestins.
Treatment of pruritis ani...
The key to treatment is self care and the avoidance of predisposing factors.
Keep the area clean, cool, and dry. Y
ou may use over-the-counter cortisone ointment or cream to control the itch. You should apply it three times a day and rub in gently until the medication disappears. You should stop using the cortisone when the itching stops. You should not use the cortisone for longer than 5 days because it may cause additional irritation and damage to the skin if used for longer periods.
If you can not control the itch with the over-the-counter cortisone, you should see your doctor. Your doctor may prescribe a more potent topical cortisone drug or other agents to treat the cause of the pruritis.
Conditions such as yeast, herpes, genital warts, pinworms, scabies, and lice, must be specifically treated with the appropriate medications.
Rectal diseases may require additional medical or surgical treatment.
1) Keep the area clean, cool, and dry.
2) Use plain, unscented soaps if you must use soaps.
3) Cleanse the area with moistened unscented tissue or tufts of cotton after bowel movements.
4) Lose weight if overweight BMI>25. Individuals who are overweight are at greater risk of developing pruritis ani.
5) Wear loose clothing and cotton underclothing.
6) Using tampons may be more comfortable than sanitary napkins for menstruating women.
7) If scratching while asleep is an issue, wear soft mittens.
1) Avoid contact with irritating substances that can cause pruritis ani.
2) Avoid tight fitting underclothing.
3) Avoid underclothing made from synthetic material.
4) Avoid overdoing activities that could cause excess wetness or sweating in the area.
5) Avoid spicy or highly seasoned foods that may irritate the area.
6) Avoid excess coffee consumption.
7) Avoid laxatives
When to Call Your Doctor
1) If the area seems to be infected.
2) If fever occurs.
3) If symptoms persist, despite self-care.
1998, Mosby, Inc.
Some of what the MD Dr. Rockoff
on this forum said, in 2005 to Chris..
I would moisturize your skin with any lubricating lotion (Lubriderm, etc.), and you might also try an itch lotion containing camphor or menthol. (No prescription needed.)
I don't think you have anything to worry about; a skin doctor should be able to supply the reassurance and treatment you need.
I think you should see a dermatologist, for starters. Lots of people have itchy legs, usually from dry skin, but I can't think of any direct relationship between the leg itch and the symptoms near the anus or vagina.
MY NONMEDICAL RESPONSE: I HAVE THE EXACT SAME SYMPTOMS..ITCHY LEGS AND LATER ITCHY BUTTOCKS.
THIS IS FROM WEB...ABOUT ITCHINF ASS..
For the last two months, my ANAL AREA has been itching like crazy. I eat a lot of fiber in the form of Metamucil and whole wheat bread, so my STOOL IS generally of a good consistency. I don't have hemmorhoids, and I would like to think that I don't have a parasite, but my ANAL AREA still itches. It's not the o-ring that itches, but rather the area around it. It's almost like I have jock itch of the ass -- is that possible? I exercise a good bit, so it does get sweaty down there. Please help me!
First, you know that I am going to tell you to get it checked out by a competent medical professional, right? It could be just an irritation, or it could be something as disgusting as pinworms or something. So see a doctor.
You COULD briefly try washing with a mild soap such as Ivory, letting the area dry well, wearing loose cotton underpants, not using premoistened wipes, and applying 1% hydrocortisone cream SPARINGLY to the itchy area twice a day. If these suggestions don't help within ten days or so, show your itching ass to a doctor.
Use a natural cure. Search for a natural cure for pruritus ani. Trust me there are lot's of options to choose from. Once I choose mine and it truely works I will surely write back cause living like this just isn't right. Don't give up!