Signs and Symptoms
Etiology and Treatment
Pruritus Ani is so common today that it is known as the "Space-age"
disease. Occasionally, pinworms,
lice, fungus, and hemorrhoids
may be responsible. Rarely, food allergies, and allergies
to drugs such as antibiotics may be the cause. Pruritus ani
is also associated with certain systemic disorders such as
jaundice, diabetes, lymphoma, and uremia. Pruritus ani is
a self-perpetuating disease: scratching causes further irritation,
which becomes a new source of itching. The cause of pruritus
ani may be difficult to determine, thus making pruritus ani
a potentially difficult conditions to treat.
Signs and Symptoms
Itching, particularly at night. Skin changes occur which are
due in part to scratching hyperemia, excoriations, abrasions,
thickening, and lichenification.
Etiology and Treatment
Treatment varies widely, depending on the actual cause of
the pruritic condition. In almost every case, anal hygiene
is reassessed, and careful attention is given cleanliness
and soft gentle wiping after bowel movements. Balneol®
is a product specially formulated with emollients to cleanse
and soothe the perianal and external vaginal areas after wiping.
Topical hydrocortisone medication applied daily is frequently
prescribed, and in most cases the problem gradually dissipates
within a few short weeks.
One of the main problems with treatment is that the disease
is self-perpetuating and made worse by scratching and rubbing.
Intense itching causes the patient to scratch the area. Scratching
and rubbing off superficial layers of skin makes the itching
worse – and causes the patient to scratch more. As the
perianal skin begins to break down, the protective layers
of skin begin to ooze interstitial fluid. The area then becomes
moist, and susceptible to a fungal infection. Open sores made
by scratching, then become susceptible to infection by bacteria.
Using a protective moisture barrier cream or ointment, may
help prevent skin irritation from direct contact with stool.
In the event that there is a fungal component to the skin
irritation, antifungal medications should be added to the
treatment regimen. In the event that there is a bacterial
component to the skin irritation, antibacterial medications
should be prescribed as well. Vytone® is an antifungal,
antibacterial, and corticosteroid combination that may be
useful because it can treat symptoms of itching as well as
many causes of perianal skin irritation.
Warm, moist environments are ideal for allowing the growth
of fungi and bacteria. In the event that the perianal area
is irritated by a constant feeling of wetness, bow dry the
area after a shower, and place some cotton batting in between
the buttocks for dryness. Zeasorb Powder® is a superaborbent
powder that may also be of use. This product does not contain
cornstarch, which is food for bacteria and fungi, and needs
to be avoided. In the event of hyperhidrosis in the perianal
area, a prescription antiperspirant containing aluminum hexahydrate
or aluminum chloride may be helpful.
Dietary indiscretion, the use of antibiotics, or an infection,
may alter the pH (measure of the acidity or alkalinity of
a solution) of the intestinal tract. A simple stool acidity
test can be helpful to diagnose the problem, but lacks specificity
and should not be relied upon. An increase in pH (alkalinity)
allows the intestinal tract’s normal protective mechanism
to depart, and permits the proliferation of minority fungi
and bacteria. To correct this, the diet can be altered to
avoid high alkaline foods and fermentable type of foods such
as citrus juices, beer, wine, and carbonated beverages. Friendly
bacteria in the form of Lactobacillus Acidophilus is reintroduced
into the intestinal tract, taken orally 4 times a day for
7-10 days. And the patient is instructed to bathe the area
with a mild astringent like Domeboro’s® solution,
or a dilute vinegar solution, before bedtime for 7-10 days.
Last but not least, the patient needs to be examined for
food allergies and sensitivities. Blood eosiniphile and RAST
(radioallergosorbent test) testing may be useful to help identify
a wide variety of food allergies, and their levels of sensitivity.
(the inability to digest significant amounts of lactose, the
predominant sugar of milk and cheese) can be a common cause
of pruritus ani. Antihistamines may help neutralize the effect
of some allergens. Foods not well tolerated should be avoided.
Because the cause of pruritus ani may be difficult to determine,
these treatments be tried either empirically or systematically,
until satisfactory results are achieved.
|This author does not endorse
or favor any specific commercial product or company. Trade,
proprietary, or company names appearing in this document
are used only because they are considered necessary in
the context of the information provided. If a product
is not mentioned, this does not mean or imply that the
product is unsatisfactory.