Anus, Itchy

Pruritus ani (also known as anusitis and Itchy/Sore Arse Syndrome) 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.

Causes

Anal itching can be caused by irritating chemicals in the foods consumed, such as are found in:

• Spices, hot sauces, and peppers
• Coffee, tea
• Carbonated beverages
• Milk products
• Tomatoes and tomato products, such as Ketchup
• The irritation can also be caused by 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 main 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 lead to a yeast infection and irritation of the anus. Psoriasis also can irritate the anus. 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), and these fistulas bring irritating fluids to the anal area. Other problems that can cause anal itching include pinworms, hemorrhoids, tears of the anal skin (fissures), and skin tags (abnormal local growth of anal skin).

Treatment

Initial treatment of simple itching is directed toward relieving the burning and soreness. It is important to clean and dry the anus thoroughly and avoid leaving soap in the anal area. Cleaning efforts should include gentle showering without direct rubbing or irritation of the skin with either the washcloth or towel. After bowel movements, moist pads should be used for cleaning the anus instead of toilet paper.

Scratching the affected area is to be resisted, as it only aggravates the problem and can lead to bleeding from the anal area.

An effective, if layman's treatment for this condition, helpful when used in conjunction with the medical treatments described below, is to fold a single sheet of acid-free soft toilet paper in half, then to roll it into a cylinder, and place it in the offending area inside one's undergarments. After careful cleaning as described above, this has the effect of drying out any accumulated moisture which is the root cause of the condition. Care should also be given to wearing undergarments free of artificial fibres which can exacerbate itching and discomfort. Washing undergarments in some biological washpowders can also aggravate the problem.

A gauze pad, folded in half and placed between the buttocks so that it contacts the perianal area, is effective at wicking away the moisture that causes irritation. Gauze pads made of rayon/polyester cause the least irritation.

Many over-the-counter products are sold for the treatment of anal itching. These often contain the same drugs that are used for treating hemorrhoids. Products used for the treatment of anal itching are available as ointments, creams, gels, suppositories, foams, and pads. Ointments, creams, and gels–when used around the anus–should be applied as a thin covering. When applied to the anal canal, these products should be inserted with a finger or a "pile pipe." Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion. Suppositories or foams do not have advantages over ointments, creams, and gels.

Most products contain more than one type of active ingredient. Almost all contain a protectant in addition to another ingredient. Only examples of brand-name products containing one ingredient in addition to the protectant are discussed below.

Baby (face/ bottom) wipes should be used only with caution as these keep the area moist and may also contain chemicals to which the skin reacts.

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