Peri-anal itchiness (pruritus ani)

Pruritus ani means itchiness around the back passage. When this becomes chronic it can really affect a person’s quality of life. Scratching of the area leads to further itchiness and a vicous cycle. Pruritus ani affects men 4 times more often than women. In up to 75% of cases it is caused by another condition (secondary) and more than 100 different conditions have been linked with it. Even though it may be linked with a condition, permanent changes in the nervous system can take place with time leading to persistence of the symptoms even if the original cause of the itchiness goes way. When a cause is not found pruritus ani is called primary or idiopathic.

The different causes of pruritus ani among others include:

1. skin conditions which may affect the skin such as contact dermitis or psoriasis,
2. different types of food such as coffee, tea, cola, chocolate, citrous fruit, spicy food, tomatos, beer, nuts, dairy products
3. bad hygiene or rigorous hygiene
4. loose stool consistency
5. conditions affecting the back passage such as haemorrhoids, anal fistula, anal fissure, weak anal sphincter, anal cancer or rectal prolapse which may lead to a small leak around the back passage which sometimes even goes unnoticed
6. infections such as fungal infections, sexually transmitted diseases, pinworms
7. systemic conditions such as diabetes

Diagnosis

Your history will be taken carefully and you will be examined in the area to establish the diagnosis and exclude other conditions. A proctoscopy or rigid sigmoidoscopy may need to be performed.  Depending on the findings and your symptoms, your doctor may need to request a flexible sigmoidoscopy or colonoscopy to rule out any other condition further up the bowel which may be contributing to your symptoms or may request some imaging investigations in the form of a special x-ray called defecating proctogram, a MRI, CT scan or anorectal physiology studies. An examination under anaesthesia (EUA) with skin biopsies around the back passage may also be required.

Treatment options

The treatments options will vary and directed towards the primary cause. This includes the eliminations of any irritants, controlled peri-anal hygiene, use of barrier creams and/or cotton wool balls and wearing gloves at night to stop the scratching cycle. Medication such as local steroid preparations can also be used but only in the short term as long term steroid use can make the skin much more sensitive to pain and itchiness. In patients with primary pruritus ani or when the above measures fail, anal tattooing can be performed.