Introduction
After itching, in medical terminology pruritus ani, is the term used to describe regularly occurring or permanent itching in the anal region. It is a phenomenon that affects many people, with a percentage of up to five percent of the population, but is still a taboo subject in society, and is often avoided even during a conversation with a doctor of confidence. Anal itching occurs most frequently between the ages of 30 and 50, although it affects men much more frequently than women.
The unpleasant sensations can be caused by numerous diseases. Although most causes are harmless, prolonged anal itching can be a sign of a chronic disease that requires medical clarification and treatment. Last but not least, anal itching can have a considerable influence on the daily life and thus the quality of life of the person affected and should be addressed during a visit to the doctor because of the often easily treatable causes.
Symptoms
Pruritus ani (anal itching) is a permanent or regularly recurring itchy sensation in the anal region. The itching can occur spontaneously and disappear after some time without treatment. In some cases, however, the problem occurs more frequently at shorter intervals or is even permanent.
The anal itching can be accompanied by a burning sensation or slight pain. If visible redness and skin changes also occur, the medical term for this is eczema or dermatitis (inflammation of the skin). If anal itching occurs in connection with tumor-like excrescences of the skin in the anal region, an infection with human papillomavirus (HPV) is to be considered. A warning sign in connection with anal itching is blood loss during defecation or contact bleeding during cleaning. In this case a thorough examination should be carried out with a view to possible cancer.
Causes of itching of the anus
As already mentioned in the introduction, the causes of anal itching are often harmless. In most cases, the reason for anal itching is due to unbalanced, i.e. inadequate or excessive anal hygiene. The sensitive skin of the anal region maintains a protective mantle of secretions from the skin glands to ward off mechanical and chemical stimuli.
In particular, frequent washing with aggressive soaps and washing lotions can remove this protective mantle, making the skin drier and susceptible to infection and mechanical irritation. Doctors therefore often advise against the use of moist toilet paper. Often the cause of anal itching is also a contact allergy to soaps or detergents.
If, on the other hand, anal hygiene is neglected, faeces can collect in the folds of the anal area and, in combination with sweat and body heat, form irritating substances that attack the skin and cause itching. If the pruritus ani occurs in connection with psoriasis vulgaris, the occurrence of a special form, psoriasis inversa, in the gluteal fold should be considered. The most frequent disease in connection with anal itching is the so-called hemorrhoidal disease, a pathological dilatation of the hemorrhoids (lat.
Plexus), a vascular plexus at the end of the intestinal canal. It has not yet been conclusively clarified how this dilatation of the haemorrhoids, which incidentally occur as an anatomical structure in every human being, occurs. However, it is suspected that in the context of frequent constipation with hard stool consistency, disproportionately long, strong pressing during bowel movement occurs.
This increases the pressure in the abdominal cavity, causing blood to back up into the haemorrhoids, which then expand. Signs of a hemorrhoidal disease are irritation and itching of the bulging, sensitive skin at the bowel outlet, as well as blood loss and a disturbance of fine continence with occasional unintentional mucus discharge. If anal itching occurs in conjunction with frequent diarrhoea, a chronic inflammatory bowel disease must be considered.
In this case, a medical examination should be performed to determine whether Crohn’s disease or ulcerative colitis is present. Another chronic disease that can lead to pruritus ani is the metabolic disease diabetes mellitus. Here, frequent infections of the anal region occur due to a disturbance of the immune system.
If the immune system is weakened due to an infection with HIV or during chemotherapy, frequent infections with bacteria or yeast fungi can occur. If the itching occurs in connection with small elevations in the anal or genital region, an infection with human papilloma viruses (low risk types) must be considered. One speaks of genital warts (condylomata acuminata), which are among the sexually transmitted diseases.
Worm diseases such as infection with Enterobius vermicularis, the pinworm, can also cause anal itching. Rare but nevertheless serious causes of anal itching are anal carcinoma and carcinoma of the anal rim. The anal carcinoma occurs in the anal canal, the anal rim carcinoma at the transition from the anal canal to the outer skin. Both forms are associated with the human papilloma virus (high-risk types), which is also responsible for the development of cervical cancer in women.
