Pruritus ani

Itching of the skin about the anus (opening of the rectum) is a common complaint.

Anal itching is usually an isolated skin complaint in otherwise healthy persons, but in some it is part of a disorder involving other areas of the skin, especially the vulva in women and children.

Common conditions affecting the anus include:

• Dermatitis
• Psoriasis
• Bacterial infection including streptococci (streptococcal dermatitis) or Corynebacteria minutissimum (erythrasma)
• Yeast infection especially Candida albicans

The anal skin is exposed to irritating digestive products which may result in a rash (irritant dermatitis). The rash is made worse by:

• Frequent stools (diarrhoea)
• Straining at stool (constipation)
• Scratching
• Vigorous use of toilet tissue
• Scrubbing with soap and water
• Acidic or spicy foods.

Treatment

• Irritation of the anal skin needs to be reduced. It is impossible to eliminate it altogether because the stool continues to be in contact with the inflamed skin.
• Cleanse carefully, thoroughly and gently after bowel movements. If there is faecal leakage, cleanse again after an interval of half an hour.
• Wash the anus using a electronic bidet-toilet, standard bidet, shower or a bucket of lukewarm water. Moistened tissues or soft toilet paper are next best. Use aqueous cream, mineral oil or other soap-free cleanser. Avoid soap and rough toilet paper.
• Apply medicated ointment as directed.
• Ask your doctor to explain your treatment. Various different soothing preparations are suitable, including mild topical steroids and zinc paste. Strong steroid creams should not be applied for more than a few days unless under strict medical supervision.
• Petroleum jelly can be applied frequently to soothe and to act as a barrier preparation and skin protectant.
• Do not apply any other remedy, suppository, or medicine to your rash. They can cause allergic contact dermatitis.
• Avoid constipation.
• Eat plenty of high fibre foods (cereals, fruit and vegetables). Straining at stool causes cracks in the anus which are irritable and harbour bacteria.
• Avoid excessively loose or otherwise irritating motions.
• Don't over-indulge in spicy food, prunes, figs, orange juice, coffee or beer.
• NEVER SCRATCH! Scratching and rubbing is a common reason for the continuing pruritus ani.

Pruritus ani is frequently persistent and recurrent. The above advice should be followed indefinitely.