Pruritus ani is the Latin and also the medical name for a partly inflammatory itching in the area of the bowel outlet. Pruritus ani is exclusively a symptom and was given the number L29.9 in the ICD-10 classification
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What is pruritus ani?
Pruritus ani can occur in both the anal and perianal regions. Depending on the severity, it is accompanied by severe redness, inflamed areas of skin, and a burning pain. If left untreated, pruritus ani quickly takes on the form of a chronic condition that severely limits the quality of life of the affected person. However, acute cases are also stressful and unpleasant for the patient due to the usually slow healing process. Although persistent itching is one of the most widespread signs in proctology, which focuses on diseases of the rectum, only about one to five percent of the population is affected. However, a possible bias in view of the body region suggests a higher number of unreported cases. Furthermore, the dermatological symptom is often accepted as insignificant and given. Pruritus ani usually presents between the ages of 30 and 60, with women being significantly less affected.
Causes
In most cases, pruritus ani is caused by a medical condition. In every second person affected, this is hemorrhoidal disease or so-called anal fistulas or abscesses. In addition, cracks in the anal skin (fissures), anal or colon cancer, as well as fungal, viral and bacterial infections can cause the itching. Furthermore, there is the possibility that diseases independent of the intestinal and anal area act as a cause. These include diabetes mellitus, deficiencies in liver and kidney function, leukemia or HIV. Even for patients with psoriasis or taking antibiotics, there is a risk of pruritus ani. In rare cases, the itching has psychological reasons. It then occurs in connection with depression, anxiety or stressful situations. More likely, however, is a causal relationship with an allergic reaction. Perfumed soaps, creams, flavored toilet paper as well as wet wipes increasingly trigger contact allergic anal eczema, which results in pruritus ani. The same applies to a lack of or too intensive hygiene in this area. Frequently, certain foods are also named as the reason for the itching. However, no medical evidence in this regard has been provided to date.
Symptoms, complaints and signs
Of great importance in the case of pruritus ani is the visit to the doctor. A possible feeling of shame should be conquered and the family doctor, dermatologist or proctologist should be visited. Due to the more than one hundred known causes in the meantime and the risk of a previously undiagnosed disease, a thorough diagnosis is essential. The diagnosis, which is usually very complex, is initially made by means of a clarifying discussion in which habits with regard to hygiene and bowel movements, tablet intake and possible allergies are discussed. This is followed by an eye examination, palpation, possible smears, biopsies or blood samples. An allergy test, endoscopy of the rectum or colonoscopy may also be useful. Occasionally, no cause can be determined despite intensive diagnostics. Such idiopathic pruritus ani should nevertheless be taken seriously and is also curable. Not every itch in the area of the rectal opening is a pruritus ani. However, a visit to the doctor is recommended after an appropriate observation period. Only in this way can it be prevented that the pruritus ani becomes chronic and the complaints intensify.
Complications
If the anus itches from time to time, this is normal. Constant itching due to pruritus in the anal region can lead to a sore scratched anal region and subsequently to further complications. This happens especially if the affected person cannot stop the itching and scratches. This could be the case at night while sleeping, for example. To avoid complications, the affected person should have the causes clarified if itching in the anal region persists. The sore scratched skin at the anus makes it easier for bacterial infections to form. In the long term, this can lead to scarring and skin damage around the anus. The skin damage can manifest itself, for example, as fine and painful anal fissures. The fissures deepen as a result of pressing.The itching in the anal region may also become chronic. It is then a recurrent pruritus ani. Chronic pruritus ani multiplies the possibility of infectious and parasitic secondary diseases in the anal region. Due to the warm, moist skin climate, contact with intestinal germs and fecal excretions, and the sore scratched skin areas, skin fungi can easily colonize. In addition, viruses can settle in the irritated skin folds of the anus. Since pruritus ani is usually an accompanying symptom of various diseases, complications can be prevented by a cause-related treatment.
When should you go to the doctor?
Pruritus ani is a phenomenon that can have many different causes, ranging from harmless to cancer. For this reason, it is always advisable to get to the bottom of the cause. For this purpose, a doctor should be consulted. However, there are indications whose occurrence makes an immediate visit to the doctor necessary. These include, for example, palpable changes in the anal region. As soon as those affected by pruritus ani feel lump-like phenomena, a doctor should be consulted immediately. Increased bleeding can also be a warning sign that should not be ignored. It should also be noted whether pruritus ani occurs in combination with other symptomatology. If this is the case, it is always advisable to seek professional advice, as a serious bowel disease or infection could be present. Treatment is also advisable in the case of severely increased itching, which leads to sufferers being severely restricted in their daily lives. Overall, it is true that pruritus ani can often be completely cured in the course of medical treatment, but usually alleviated in any case.
Treatment and therapy
The treatment of pruritus ani is two-pronged. In the foreground is the fight against the actual cause. Accordingly, the cure of the respective underlying disease is carried out first in order to take away the basis of the itching. In general, a rapid alleviation of the symptoms can then be observed. The discomfort caused by the pruritus ani itself can be treated additionally. This is especially the case if the underlying disease is severe and a prompt cure is not to be expected. Usually, medicinal sitz baths and anti-inflammatory, partly anesthetic ointments are prescribed, the application of which should be supervised by the physician. Self-medication is not appropriate for pruritus ani, as certain ointments or applications may further aggravate the itching. The very sensitive skin around the anal area is significantly weakened by pruritus ani. Irritation of any kind should therefore be avoided by the patient. Toilet paper should not be used. Rather, toilet visits should be terminated by thorough rinsing with clear water. Affected individuals are also advised to stay away from spicy foods (high in capsaicin) and perfumed soaps. Heat and perspiration also promote irritation of the skin. Consequently, air-permeable clothing made of a soft, undyed cotton fabric is optimal. If there is a possibility, the area should even be exposed for short periods of time or overnight.
Prevention
Prevention of pruritus ani is in principle possible only if it is not based on any disease. Otherwise, only certain measures can be taken to delay its occurrence or reduce its intensity. Above all, it is advisable to clean the area carefully and at the same time cautiously. Use pH-neutral washing lotions and unscented, soft toilet paper. Skin-irritating wet wipes and vigorous rubbing, on the other hand, should be avoided altogether. To reduce the risk of contact allergies, cleaned underwear should not contain any detergent residues, and attention should also be paid to allergenic substances in body lotions and creams.
Aftercare
Pruritus Ani, severe itching occurring in the anal area, can be triggered by various underlying diseases. After detailed examination and successful medical diagnosis, the causative disease must first be treated consistently. In addition, the affected person can use self-care creams with which he or she creams the anal region several times a day. Wound and healing ointments with calendula or witch hazel additives are particularly suitable for this purpose.If the symptoms cannot be sufficiently reduced despite this treatment, the doctor may prescribe creams containing lidocaine or procaine, which have an anesthetic effect. However, pain-relieving gels containing ibuprofen or diclofena should not be used, as they can irritate the sensitive anal region and make the itching even worse. Patients can also find relief in sitz baths with the addition of sulfonated shale oils, which are available from pharmacies. For regular anal hygiene, pH-neutral care products are recommended. Too much washing should be avoided so as not to further irritate the sensitive anal region. Frequently, no medical cause is found for pruritus ani. The idiopathic condition may also have psychological causes. With psychotherapeutic treatment, the patient can be helped to distract himself from his problem region and to lead a symptom-free life again.
This is what you can do yourself
Since itching can have various causes, the corresponding underlying disease should be treated by a doctor. Here, adherence to therapy and consistent implementation of the prescribed measures ensures success. In addition, nourishing creams that are applied to the anus once or twice a day can help. Baby creams, wound and healing ointments with calendula or witch hazel can be used for this purpose. Gels containing light sulfonated shale oil, which have both antimicrobial and wound-healing properties, are also recommended. If a skin care cream is not sufficient and cannot permanently relieve the itching, the doctor will prescribe an anesthetic cream containing lidocaine or procaine. Pain-relieving gels containing ibuprofen or diclofenac are not indicated because they unnecessarily irritate the inflamed anal region. Regular sitz baths in sulfonated shale oils also bring help. They can relieve inflammation and thus itching even in moist wound conditions. These sitz baths are available in pharmacies. Furthermore, attention should be paid to regular anal hygiene. The care products used are best pH neutral. But hygiene should also not be exaggerated, because too many washes unnecessarily irritate the sensitive anal region. If no cause for the pruritus ani has been found, it is an idiopathic condition, which usually has psychological causes. In this case, in addition to psychotherapy or psychotherapeutic crisis intervention, an altered lifestyle that distracts from the problem region can also help.
