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Anal itch (Pruritis ani)


Itching of the anal canal or the peri-anal skin

Anal itch (Pruritus ani)

Pruritus ani is a very common condition but is usually self-limiting

Majority of cases caused by leakage of mucus, faeces or pus onto the peri-anal skin

Treatment involves excluding anal or low rectal pathology and then breaking the scratch-itch cycle using the ‘Golden rules’

Anal inspection and digital rectal examination should be performed to exclude a low rectal or anal cancer

Potential causes of anal itch:

  • Anal fistula / sepsis
  • Warts
  • Anal fissure
  • 2nd/3rd degree piles
  • Psoriasis or eczema
  • Worms (more common in children and if close contact with animals at home or work)
Conservative management

With no obvious pathology to account  itch  treat with topical Daktacort for no more than 2 weeks

The Miconazole will eradicate any fungal cause and the cortisone will control the itch allowing the scratch/itch cycle to be broken

At the same time give the patient a copy of the ‘Golden Rules’ see link right and abbreviated details below

Surgical management

Surgical management is aimed at treating pathology leading to leakage (prolapsing piles, fistulas, warts etc.) combined with the ‘Golden Rules’

Self management / Golden Rules

For further information see leaflet right

  • Keep the area as clean as possible, carefully washing and gently drying the area at least once a day and after each bowel movement
  • Don’t use soap as it can sting. It is best to use water on your hand rather than a flannel
  • Use soft toilet paper or damp cotton wool if this is more comfortable
  • If your leakage continues after cleaning into the anus, use a small plug of cotton wool in the anus to prevent the faeces or mucus from coming out and irritating the skin
  • Dry the area by gently patting with a soft towel or tissue. Avoid rubbing
  • Do not use any creams, deodorants, talcum powder, antiseptics or anything else on your anus, apart from the treatment suggested by your specialist
  • Do not put anything in bath water – avoid all antiseptics, bath salts, bath oils and bubble bath
  • Wear loose cotton underwear and change this every day. Avoid man-made fabrics coming into contact with the skin around your bottom. Women should wear stockings or open-crotch tights rather than regular tights to reduce sweating
  • You should also avoid tight trousers or jeans and sitting on plastic chairs for long periods of time
  • Wash your underwear in non- biological washing powder and make sure that all traces of detergent are rinsed out
  • A diet that is high in fibre makes the faeces softer and more likely to cause leakage
  • Avoid lagers and flat beers as these can make the problem worse
  • Avoid coffee, chocolate and fruit juices high in citric acid as these too make the pruritis worse



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