Pruritis ani

Pruritis ani or itchiness around anus is a common condition affecting both men and women. Men are more commonly affected than women.  There are many causes of pruritis ani, and an accurate diagnosis is important in order to treat the specific cause. Pruritis ani may be primary or idiopathic (no cause is identified) or secondary to other pathologies. Itching and the subsequent scratching causes injury to the skin producing a larger area of irritated skin leading to a cycle of itching and discomfort.

Pruritis is often caused by anorectal pathology including hemorrhoids, skin tags, faecal incontinence, anal fistula, fissures, anal warts or anorectal cancer. Idiopathic pruritis ani may be caused by discharge from anal canal leading to hypersensitivity of nerves. Poor perianal hygiene or over- aggressive hygiene can both cause pruritis ani. Prolonged use of topical steroids can also lead to itching. Some dietary agents may cause pruritis ani including coffee, tea, cola, energy drinks, chocolate, citrus fruits, tomatoes, spicy foods, beer, dairy products and nuts. Infections like bacterial, fungal or viral infections are also implicated in some patients. Some skin conditions may result in pruritis. These include psoriasis, saeborrheic dermatitis, atopic dermatitis, contact dermatitis, lichen planus, lichen simplex, and lichen sclerosis. Local cancers such as Bowen’s disease or extra mammary Paget’s disease are also potential causes of pruritis ani. Systemic causes include diabetes mellitus, leukemia and lymphoma, kidney failure, liver diseases, iron deficiency anemia, or hyperthyroidism.

Detailed history and anorectal examination can help in identifying the causes of pruritis ani. Swabs can help identify infections. Endoscopy may be required to rule out other pathology.

Treatment is challenging and includes identification and management of the cause of pruritis. It is important that stools are soft and bulky but not loose and fibre supplements and stool thickening medication may be useful. Maintaining anal hygiene also helps with the symptoms. Cleaning the area with a shower head or by sitting in bath, drying with a soft towel and not using strong agents is helpful. Small amount of powder may be used to keep the area dry. Short course of steroid ointment can help resolve acute symptoms.