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Anal Itch (Pruritus Ani)
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Pruritis ani is usually not caused by poor hygiene. Rather, the overuse of soaps and other topical products to clean the anal region or vigorous scrubbing with a washcloth or rough toilet paper can cause irritation. Excess perspiration or moisture may become trapped in the anal area if constricting or tight-fitting underwear is worn. Some foods and beverages, such as carbonated drinks, caffeinated beverages coffee, tea, colas and spicy or acidic foods tomatoes, citrus fruits have been linked to the condition. Having frequent bowel movements diarrhea or infrequent ones constipation may also play a role.
Other causes of pruritis ani include: Some types of bacteria, fungi yeastor parasites can cause itching. Staphylococcus aureus or Streptococcus pyogenes types of Anal pruritis tomatoCandida albicans a yeastpinworms mainly in childrenand Sarcoptes scabiei scabies mites are some organisms that result in itching and irritation. Psoriasis, contact dermatitis inflammation due to allergens or other irritantsor atopic dermatitis a chronic condition found in patients with allergies may cause a rash in the perianal region. Psychological factors such as stress or anxiety Systemic diseases: These include diabetes mellitusleukemialymphoma, thyroid disease, renal disease, and liver disorders obstructive jaundice.
Colorectal and anal disorders: Anal itch also can be triggered by over-the-counter medications suppositories, creams, ointments intended to treat anal problems. Intense cleaning after a bowel movement — Although the anal area should be cleaned after every bowel movement, this cleaning must be gentle. Aggressive rubbing and scrubbing, especially with soaps or other skin cleansers, can irritate the skin and trigger anal itch. Less often, anal itch is a symptom of some illness or condition that either affects the anal area alone, or involves larger areas of the digestive tract or skin.
Local diseases and conditions involving lower portions of the digestive tract — These include hemorrhoids, skin tags, rectal fistulas, rectal fissures and, rarely, anorectal cancer. Infections and parasites — These include pinworms especially in childrenscabies, pediculosis, condyloma acuminata and skin infections due to Candida or tinea fungi. Skin problems — These include psoriasis, eczema and seborrhea. In many cases, these conditions cause symptoms in several different areas of the skin surface, not only around the anus. Worldwide, anal itch is a very common problem that occurs in up to 45 percent of people at some time during their lives. Men are affected two to four times more often than women.
People who are overweight, perspire heavily or routinely wear tight-fitting underwear or hosiery are more likely to get anal itch. Symptoms Anal itch is an irritating sensation around the anus that is relieved temporarily by scratching or rubbing. The problem is often worse at night and may interfere with sleep. In most cases, the skin in the area is red. If anal itch becomes a chronic long-term problem, the skin around the anus may become raw and tender from repeated scratching, or it may thicken and become leathery. Repeated scratching also can cause breaks in the anal skin that can lead to painful local infections. Diagnosis To help identify the cause of your anal itch, the doctor may ask you to describe your current diet and medications, your bowel habits, and the way you routinely clean your anal area after a bowel movement.
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The doctor will review your medical history, including any history of rectal problems hemorrhoids, fissures or fistulas or skin problems psoriasis, eczema or seborrhea. Your doctor's questions will be followed by a physical examination of your anal area and sometimes, by a digital rectal examination. If you have a history of skin symptoms involving other parts of your body, your doctor will want to examine these skin areas as well. Any factor which increases occult or overt soiling augments exposure of the peri-anal skin to irritants and is a potential area of therapy.
Studies have investigated stool consistency and mucous seepage as an aetiological factor. These individuals seem to be unable to evacuate their anal canals completely and the retained faecal material escaped later with resultant itch.
Prolonged Anap contact is irritant to peri-anal skin and, as a group, patients with tomxto ani are less able to maintain absolute continence when prkritis with loose stools and an anorectum whose physiology and morphology has been altered primarily by food, surgery or, presumably, by medications. Unfortunately, there are no controlled clinical trials regarding the benefit of altered personal hygiene in managing pruritus ani. However, it is widely accepted and recommended by most in the literature and is discussed later. Bulk-forming agents and loperamide are recommended to improve stools consistency.
Peri-anal infection Although occurring in the minority, the importance of bacterial and fungal infection should not be underestimated. Threadworms infect multiple family members. Peri-anal viral infections commonly cause itch, but there is no evidence for their causative role in idiopathic pruritus ani.
Sexually transmitted bacterial infections cause pruritus, but chronic symptoms are likely to be caused by other bacteria. Erythrasma is the cutaneous infection caused by C. It is rarely reported in adults and can be treated with oral antibiotics together with a topical steroid combined with an antifungal and antibiotic. This can be the result of sensitisation by chemicals found in cleansing and therapeutic preparations including creams, soaps, wet wipes, glyceryl trinitrate, anaesthetic, toilet paper dye and other topical preparations.
Tomato Anal pruritis
Emollient creams are tomatl, as perhaps the short-term use of topical steroids, rpuritis secondarily infected. However, most creams and ointments do not sensitise the peri-anal skin in most people. Ointments have fewer preservatives and constituents tomtao creams. They are less likely to sensitise or be washed off. Food Foods have been implicated in idiopathic pruritus ani such as caffeinated drinks, alcohol, milk products, peanuts, spices, citrus, grapes, tomato histamine and chocolate; some researchers have claimed diminution of itch within 14 days if these were avoided. However, there are no controlled clinical trials that provide evidence that dietary exclusions improve symptoms.
Nevertheless, most of the literature suggests that dietary measures should be tried. Mechanisms by which foods are thought to cause itch are reduction in anal sphincter pressures, exaggerated anal reflexes and undigested foods sensitising the peri-anal skin.