Anal Itching

Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.

The intensity of anal itching increases from moisture,pressure, and rubbing caused by clothing and sitting.

At worst, anal itching causes intolerable discomfort that often is accompanied by burning and soreness. It is estimated that up to 5% of the population of the United States experiences this type of discomfort daily.

Causes

If a specific cause for pruritus ani is found it is classified as "secondary pruritus ani". If a specific cause is NOT found it is classified as "idiopathic pruritus ani".

The irritation can be caused by intestinal parasites, anal perspiration, frequent liquid stools, diarrhea, residual stool deposits, or the escape of small amounts of stool as a result of incontinence or flatulence.

Another cause is yeast infection or candidiasis. Some diseases increase the possibility of yeast infections, such as diabetes mellitus or HIV infection.

Treatment with antibiotics can bring about a disturbance of the natural balance of intestinal flora, and lead to perianal thrush, a yeast infection affecting the anus. Psoriasis also can be present in the anal area and cause irritation.

Abnormal passageways (fistulas) from the small intestine or colon to the skin surrounding the anus can form as a result of disease (such as Crohn's disease), acting as channels which may allow leakage of irritating fluids to the anal area.

Other problems that can contribute to anal itching include pinworms, hemorrhoids, tears of the anal skin near the mucocutaneous junction (fissures), and skin tags (abnormal local growth of anal skin).

Aside from diseases relative to the condition, a common view suggests that the initial cause of the itch may have passed, and that the illness is in fact prolonged by what is known as an itch-scratch-itch cycle.

It states that scratching the itch encourages the release of inflammatory chemicals, which worsen redness, intensifies itchiness and increases the area covered by dry skin, thereby causing a snowball effect.

Some authorities describe “psychogenic pruritus” or "functional itch disorder",where psychological factors may contribute to awareness of itching.

Ingestion of helminth (worm) Enterobius vermicularis (pinworm, or threadworm) eggs leads to enterobiasis, indicative of severe itching around the anus from migration of gravid females from the bowel.

Severe cases of enterobiasis result in hemorrhage and eczema.

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