From the Guidelines
Anal itching, or pruritus ani, is most commonly caused by inadequate hygiene, minor incontinence, or perianal dermatitis, rather than solely by hemorrhoids. When considering the causes of anal itching, it's essential to look at the broader picture, including hygiene practices, dietary factors, and underlying medical conditions. According to 1, hemorrhoids are frequently assumed to be the cause of common symptoms such as bleeding, a lump, itching, or pain, but other pathology should not be overlooked. Key factors to consider in the causation of anal itching include:
- Inadequate hygiene after bowel movements, which can leave irritating fecal residue
- Minor incontinence, which can lead to persistent moisture and irritation
- Perianal dermatitis, a skin condition that can cause itching and discomfort
- Dietary triggers, such as spicy foods, coffee, and citrus fruits, which can increase anal irritation
- Skin conditions like psoriasis, eczema, and contact dermatitis, which frequently affect the anal region
- Infections, including pinworms, fungal infections, and sexually transmitted infections, which can cause itching and discomfort
- Medical conditions, such as hemorrhoids, anal fissures, and certain systemic diseases like diabetes, which can contribute to persistent anal itching As stated in 1, symptoms like itching are not specific for hemorrhoids and require a thorough physical examination to rule out other disorders. Given the potential complexity of anal itching, treatment should focus on addressing the underlying cause, maintaining good hygiene, and using gentle, non-irritating products to reduce inflammation and discomfort.
From the FDA Drug Label
temporarily relieves external anal and genital itching other uses of this product should only be under the advice and supervision of a doctor The most common causes of anal itching are not explicitly listed in the drug label.
- The label mentions external anal itching as a condition the product can temporarily relieve, but it does not provide a list of the most common causes of anal itching. 2
From the Research
Common Causes of Anal Itching
- Hemorrhoids: a common source of anorectal symptoms, which are determined by their size 3
- Anal fissures: probably caused by trauma to the anal canal during defecation, may persist because of a cycle of hard stools, pain, and reflex spasm 3
- Perianal abscess: often caused by acute infection of the anal glands; fistula is the result of chronic infection 3
- Pruritus ani: may result from several contributing conditions or may be idiopathic, restoration of dry, intact perianal skin is the treatment goal 3
- Condylomata acuminata: cause bleeding and pain if allowed to progress, biopsy should be considered in patients at risk of dysplasia 3
Treatment Options
- High-fiber diet: a helpful measure in small hemorrhoids and relieving acute fissures 3
- Ligature therapy: effective in moderate hemorrhoidal lesions 3
- Surgery: reserved for large hemorrhoids and chronic anal fissures 3
- Sitz baths: relieve acute fissures 3
- Topical nifedipine and lidocaine ointment: effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy 4
Management of Anorectal Diseases
- Hemorrhoids and anal fissures: frequently benefit from non-operative treatment, but may require surgical procedures 5
- Anorectal abscess and fistulas: mainly treated surgically 5
- Stepwise method: mainstay of treatment for anal fissure, initiating with vasodilators, followed by botox, and ultimately sphincterotomy 6