Pruritus Ani: Causes and Treatment

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These messages are for mutual support and information sharing only. Always consult your doctor before trying anything you read here.

Pruritus ani (aka. anal itch/itching) is an irritating, itchy sensation around the anus. It may become worse at night or after a bowel movement. Scratching could lead to damages or infections. Many people mistake it for certain disease, while in truth it is just a symptom, not an illness. Basically, there are two main types of pruritus ani-primary and secondary. Moreover, there are a lot to talk about when it comes to its causes. Well, you may assume that poor hygiene must be one of the causes, but actually pruritus ani is usually not caused by poor hygiene. Rather, the overuse of soaps and other topical products to clean the anal region or vigorous scrubbing with rough toilet paper can result in irritation. Other causes may include:

1. Frequent bowel movements or infrequent ones

2. Some foods and beverages that may trigger the irritation

3. Dermatological conditions (contact dermatitis, atopic dermatitis, psoriasis, etc)

4. Psychological factors such as stress or anxiety

5. Systemic or topical medications (quinine, mineral oil or colchicine)

6. Fecal or urinary incontinence

7. Inflammatory bowel disease (Crohn’s disease)

8. Infections (bacteria, fungi, Candida albicans, Sarcoptes scabiei, etc)

9. Systemic diseases (diabetes mellitus, leukemia, thyroid disease, liver disorders, etc)

To treat this condition, most of the options you will be given focus on establishing and maintaining a routine for proper anal hygiene. If there is an underlying cause for your case, your doctor may choose a suitable treatment plan based on your condition. 

Basically, there are three options for treating your condition. They are:

Oral meds: If any kind of infections is found, you may be prescribed antibiotic or antifungal medications.

Topical meds: Topical steroids (e.g. creams or ointments) may help to relieve your symptoms such as itching and irritation. You can treat your condition by simply applying these meds two or three times to the affected area each day. If your pruritus ani is diagnosed as a chronic one, you may be recommended to apply topical capsaicin.

Methylene blue injection (anal tattooing): Methylene blue is injected under the skin in the perianal region. This option is considered useful in relieving pain and itching by deadening the nerve endings where the dye is injected. To put it simply, it is reserved for those who are in a more advanced stage of the condition. 

Are there any tips on how to relieve the symptoms at home? I’ve already seen a dermatologist and he prescribed me some meds. But it seemed of little help!
Oh, poor you! I’m afraid you’ve got the wrong doctor! How about making an appointment with another professional? Sometimes, meds that are not for treating your condition may make things even worse!
There are some tips on self-care. But you’d better first get yourself the right dermatologist and then check it out with him/her. Some tips prove effective in treating this condition. For example, you have to: avoid using perfumed creams, lotions, bubble baths, or other products that may cause irritation to the area; keep the perianal area clean and dry; resist the urge to scratch; eat food high in fiber; avoid wearing tight or constricting underwear; not use soap when cleansing the anal area. And the most important thing is use topical medications as directed.