Paonessa Colon and Rectal Surgery, PC

26 Medical Professionals Got An Itch That Can’t Be Scratched?

Nina Paonessa, DO, FACOS

As we enter the New Year, a common ailment affects many individuals. This is the time of year when people make New Year’s resolutions to eat “healthy” and diet in order to lose weight for spring break or in preparation for the summer. This is also the time of year for football season and tailgating parties and all of the foods that are associated with it. Because of these unique situations, many people suffer from aggravating symptoms of perianal itching, burning, and discomfort as well as a “wet” or moist feeling in the perianal area. What is Pruritus Ani?

Pruritus ani is a Latin term literally meaning “itchy anus”. It is an uncomfortable sensation around the anus which produces the desire to scratch. Scratching causes irritation of the perianal skin which in turn causes the desire to scratch more. The skin becomes more irritated and damaged which causes the desire to scratch even more. This becomes a vicious cycle.

Pruritus ani affects 1% to 5% of the population. Although it affects both men and women, it is four times as common in men. This condition is most often encountered in patients in their 40’s to 60’s. Pruritus ani is treated medically. An accurate diagnosis is mandatory for proper care. What causes Pruritus Ani?

The symptom of pruritus or itching is common to many anorectal conditions. Disorders such as hemorrhoids, skin tags, fecal soilage and/or incontinence, anal fistulae, anal fissures and anal warts all may be associated with itching. This is termed secondary pruritus ani. However, pruritus ani may be independent of these conditions. This is called primary pruritus ani. The cause of the syndrome in these cases is usually from topical agents applied to the perianal skin and/or the pH of the stool. The pH of the stool is determined by foods which we eat.

In addition to inadequate hygiene, overzealous or aggressive hygiene using irritating soaps, fragrances and lotions may cause pruritus ani. Overzealous cleaning and the use of topical steroids can destroy natural skin barriers and cause trauma to the anal skin, making the problem worse. As such, attempting to keep the perianal skin too clean, is harmful and may worsen the problem. The use of baby/toilet wipes is a common culprit for many patients suffering from pruritus.

It is very important to note that there are many medical conditions that may cause perianal itching and are treated differently from basic, primary pruritus ani. There are infectious conditions such as bacterial skin infections, fungal infections, parasitic infections (pinworms or scabies) and viral infections (anal warts). Skin conditions such as psoriasis, seborrheic dermatitis, contact dermatitis, and lichen sclerosus may cause secondary perianal itching. Local cancers such as Bowen’s disease or Paget’s disease are also potential causes of pruritus ani. How is Pruritus Ani diagnosed?

In order to accurately diagnose pruritus ani, your physician will obtain a complete history and physical examination. The timing and duration of the symptoms are important factors. Toileting rituals/behaviors, stool frequency and consistency and hygiene/cleansing routines are noted in order to help make a diagnosis. Travel history, medical history and medications taken are also important. It is crucial to include any supplements taken, topical ointments/creams used and whether or not baby/toilet wipes are being used. A careful diet history is also taken in order to identify any possible contributing agents.

Your doctor will perform a physical examination. This will include a careful inspection of the perianal skin and a digital rectal examination. Common findings are irritated, swollen, reddened skin that may have linear ulcerations/cracks. Sometimes the perianal skin may be thickened. An examination of the anal canal via an anoscope will also be performed in order to ensure there is not any intra anal pathology causing the symptoms such as hemorrhoids, warts, a polyp or tumor. Considering the serious diseases that may cause the symptoms of pruritus ani, it is very important not to selfdiagnose, but rather to seek consultation with a physician. In certain situations, a small skin biopsy may need to be performed. How is Pruritus Ani treated?

The first goal of treatment of pruritus ani is to make a correct diagnosis. That means determining if the condition is primary pruritus ani or secondary pruritus ani caused by a medical condition/disease. Once this has been accomplished and it is confirmed that the patient has primary pruritus ani, the goal of therapy is to restore clean, dry and intact perianal skin. This will help to alleviate the symptom of itching. The first step is to alter the consistency of the stool so as to avoid seepage of stool from the anus. This may be accomplished with diet modification and adding a fiber supplement.

The second step in treatment is to discontinue any offending agents such as cortisone ointments, hemorrhoid creams, lotions, perfumes, soaps and baby/toilet wipes. Topical agents containing alcohol are very irritating to the perianal skin. Likewise, any topical agent that causes the perianal skin to remain moist should be avoided. This includes Vaseline, witch hazel, A & D ointment, antibacterial ointments, etc. Additionally, it is important to remember not to over clean the perianal area. This causes further skin break down and irritation. Believe it or not, plain water is the best way to keep the perianal skin clean and healthy.

Finally, the last step in treatment is to modify the diet to avoid a change in pH. Foods related to pruritus ani include: caffeine, colas, citrus, dairy, tomatoes, nuts and beer. As mentioned earlier, these foods are very common during this time of year while watching football or trying to lose weight. Where can you find help?

Dr. Paonessa is very familiar with diagnosing and treating pruritus ani as well as all the other diseases/conditions that may be mistaken for pruritus ani. Since there are many serious diseases that may be mistaken for primary pruritus ani, it is very important to see a physician trained in treating this condition. It is incredible how a fairly simple ailment such as pruritus ani can alter a patient’s daily life and affect his/her quality of life. Don’t hesitate to pick up the phone and call for a consultation. Stop suffering and begin to live life again.

Colon and Rectal Surgery

Board Certified in General Surgery and Proctology • laparoscopic surgery • abdominal/pelvic surgery • fecal incontinence • endoanal/rectal ultrasound • anorectal surgery • pelvic floor disorders • office proctology • anorectal manometry/ physiology

603 Higgins Avenue Brielle, NJ 08730 1301 Route 72 West, Suite 240 Manahawkin, NJ 08050

Phone: (732) 282-1500 • Fax: (732) 292-9600