What causes pruritus ani (anal itching)?

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From the Guidelines

Anal itching can be caused by various factors, including hemorrhoids, poor hygiene, moisture, certain foods and beverages, skin conditions, infections, and medications, with hemorrhoids being a significant contributor, as they can cause prolapse of the rectal mucosa, leading to deposition of mucus on the perianal skin, resulting in itchiness and discomfort 1.

Common Causes of Anal Itching

  • Hemorrhoids: Enlarged internal hemorrhoids can cause prolapse of the rectal mucosa, leading to deposition of mucus on the perianal skin, resulting in itchiness and discomfort 1
  • Poor hygiene: Inadequate cleaning after bowel movements or excessive cleaning with harsh soaps can contribute to anal itching
  • Moisture: Trapping moisture in the anal area, often due to tight clothing, synthetic underwear, or excessive sweating, can exacerbate anal itching
  • Skin conditions: Conditions like psoriasis or eczema can cause anal itching
  • Infections: Fungal infections like candidiasis, parasitic infections such as pinworms, and bacterial infections can cause anal itching
  • Medications: Certain medications that can cause diarrhea as a side effect can contribute to anal itching

Other Possible Causes

  • Dietary triggers: Coffee, alcohol, spicy foods, citrus fruits, tomatoes, and chocolate may trigger anal itching in some individuals
  • Medical conditions: Diabetes, inflammatory bowel disease, and certain cancers may cause anal itching
  • Anorectal abscesses and fistulae: These conditions can cause anal itching, pain, and discharge, and are often associated with underlying conditions like Crohn's disease 1

Management and Treatment

  • Identifying and addressing the underlying cause of anal itching is crucial for effective management
  • Improved hygiene practices, dietary changes, and over-the-counter antifungal creams like clotrimazole or miconazole for fungal infections may be recommended
  • Prescription medications may be necessary for specific conditions, such as inflammatory bowel disease or certain infections
  • Using unscented, alcohol-free wipes, wearing loose cotton underwear, and keeping the area dry can help manage symptoms while addressing the root cause.

From the Research

Causes of Anal Itching

  • Anal itching can be caused by various factors, including skin conditions such as eczema 2, 3
  • Eczema is a common skin condition that can cause itching, redness, and inflammation, and can affect various parts of the body, including the anal area 2, 3
  • Other potential causes of anal itching include fungal infections, such as those caused by Candida or Trichophyton 4
  • Certain medications, such as topical corticosteroids, can also cause skin thinning and increase the risk of anal itching 2, 5
  • Bacterial infections, such as those caused by Staphylococcus aureus, can also contribute to anal itching 6

Risk Factors

  • Prolonged use of topical corticosteroids can increase the risk of adverse effects, including skin thinning and anal itching 2, 5
  • Use of higher-potency topical corticosteroids can also increase the risk of adverse effects 2, 5
  • Application of topical corticosteroids to areas of thinner skin, such as the face and genitals, can also increase the risk of adverse effects 5
  • Certain medical conditions, such as atopic dermatitis, can also increase the risk of anal itching 2, 3

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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