Anal Irritation ('Pruritis Ani')

What is pruritis ani?
Anal irritation is a very common condition in men and women

What causes pruritis ani?
In some patients, the itching is a reflection of a more generalised skin condition such as eczema. In many patients, it is a symptom associated with haemorrhoids, anal fissure or a fistula. It may also be caused by prolapse of the bowel lining. Small amounts of stool may get onto the anal skin, causing low grade infection, made worse by scratching.

What symptoms do patients get?
Unremitting itchiness of the perianal region is the main symptom, often worse at night.

Which tests will I need?
Examination in clinic is often all that is needed. Sometimes we recommend a proctogram to look for prolapse. In a small number of patients, no cause is found and in these patients, the condition is said to be “idiopathic” or of unknown cause.

Which treatments might be offered?
Scrupulous hygiene will help with all cases of pruritis ani. Regular baths, bidet use or washing in the shower after each bowel motion will help. Baby wipes may be helpful but creams should be avoided as these tend only to make the area damp. Patients with anal irritation should wear loose fitting cotton clothes. Certain foods may accentuate anal irritation including tea, coffee, chocolate, nuts, raw fruits and vegetables. If there is evidence of haemorrhoids, fissure, fistula or prolapse then we will treat this problem on the hope of improving itching. If we find an underlying skin problem, we may recommend referral to a dermatologist. Some patients with idiopathic itching may benefit from methylene blue injection which numbs the anal skin.