Pruritus ani is a bothersome and sometimes intense itching or burning sensation of the skin around the anus (rectal opening). It is most noticeable at night or after a bowel movement. The most common complaint is an irresistible urge to scratch. Some people will note occasional bleeding when wiping after a bowel movement. This is a common problem that affects up to 5% of the population. It affects men and women equally and may occur at any age.

It is diagnosed by an examination of the skin around the anal area. The appearance of the skin will vary, depending on the severity and the length of time the condition has been present. It may start with redness of the skin and can progress to thickening of the skin. It may also lead to cracks and open sores which may result in small amounts of blood on the toilet tissue. Sometimes a biopsy (a small piece of skin removed for microscopic examination) is necessary.

There are many causes of pruritus ani but most fall into four categories:

• Excessive Cleanliness: Excessive washing, rubbing, cleansing with soap, face cloths, and brushes which lead to chronic skin irritation.
• Moisture: Prolonged exposure to moisture from vaginal discharge, perspiration, loose stools or mucus discharge from other rectal problems may lead to pruritus ani. For example, people who perspire when they exercise may find the moisture irritating to the skin around the rectum. Tight clothing, nylon underwear, and skin folds resulting from obesity may trap moisture in the area.
• Diet: Certain foods can produce irritation to the skin when stool is passed. The most common ones are products containing caffeine (coffee, tea, colas, and chocolate), spicy foods, dairy products, beer, acidic foods like citrus fruits, tomatoes, and nuts.
• Skin Irritants: Dyed or scented toilet paper, soaps, and laundry detergent may cause the irritation. Stool left on the skin from leakage or incomplete hygiene may be another cause. Occasionally, once the itching starts, some people may respond with excessive wiping of the area which can increase symptoms.
• Other Causes Other rare causes are pinworms and various skin conditions such as fungal infections or skin burns from radiation. There is no specific test to determine the cause of pruritus ani. It is often a trial and error process to discover what may be causing your skin irritation and how to resolve it.

Treatment of pruritus ani is directed at the care of the skin and determination of the underlying cause. After gently cleansing the skin and patting it, it is important to make sure the skin is dry. Some people use a hair dryer. Apply the ointment recommended by your doctor. Place a wisp of rolled cotton between the cheeks to absorb moisture.

DO NOT:

• Scratch or rub the anal area. Wipe gently.
• Use scented, colored or patterned toilet paper.
• Use cleansing pads moistened with alcohol.
• Consume spicy foods, tomatoes, nuts, dairy products, or beer.
• Consume caffeine (cola drinks, coffee, tea, chocolate).

DO:

• Use plain white toilet paper or moist wipes to cleanse after bowel movements.
• Wipe gently - never rub harshly.
• Use mild soap or don’t use soap at all.
• Gently dry skin thoroughly (you can use a hairdryer).
• Wear loose clothing and underclothing.
• Wear cotton rather than nylon underwear.
• Take prescribed medications.
• Watch your diet and eliminate foods that seem to make your condition worse. When your symptoms (itching) disappear, you may be able to resume these foods in moderation.
• Increase your fiber and water or juice intake if you tend to be constipated.
• Loose stool may require evaluation. Increase your fiber intake to absorb the extra moisture in the stool.
• Return to your doctor’s office for follow-up visits as recommended. Your physician may have additional suggestions for you.