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Anal itching (pruritus ani) definition and facts
- Anal itching is itching around the anus.
- Examples of possible causes of anal itching include hemorrhoids, anal fissures, pinworms (Enterobius vermicularis), spicy foods, and medications.
- Additional symptoms associated with anal itching include burning and pain if the anal skin is traumatized by scratching.
- The diagnosis of the cause of pruritis ani requires examination of the anus for common anal problems such as hemorrhoids or fissures, skin conditions such as psoriasis or cancer, infectious diseases such as pinworms or yeast, and leakage of stool.
- Treatment of an itchy anus depends on the cause.
What is anal itching (pruritus ani)?
Anal itching (known medically as pruritus ani) is irritation of the skin at the opening of the anal canal through which stool exits the body that leads to itching. The skin surrounding the opening is known as the anus. The itching is accompanied by the desire to scratch. Although itching may be a reaction to chemicals in the stool, it often implies that there is inflammation of the anal area. The intensity of anal itching and the amount of inflammation increases with the direct trauma of scratching and the presence of moisture. At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness.
What are common causes of anal itching?
- An itchy bottom can be caused by irritating chemicals in the foods we eat, such as are found in spices, hot sauces, and peppers.
- Anal itching also can be caused by the irritation of continuous moisture in the anus from frequent liquid stools, diarrhea, or escape of small amounts of stool (incontinence or fecal spoilage). Moisture increases the possibility of infections of the anus, especially yeast, particularly in patients with diabetes or HIV.
- Treatment with antibiotics can lead to a yeast infection and irritation of the anus.
- Psoriasis can irritate the anus.
- Abnormal passageways (fistulas) from the small intestine or colon to the skin surrounding the anus can form as a result of medical conditions (such as Crohn's disease), and these fistulas bring irritating fluids to the anal area.
- Rarely, tumors of the anus (anal cancer) may be the cause of itching.
Other problems that can cause anal itch include:
- Tears of the anal skin (fissures), and
- Skin tags (abnormal local growth of anal skin).
What are additional symptoms associated with anal itching?
- The intensity of anal itching and the amount of inflammation increases from the direct trauma of scratching and the presence of moisture.
- At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness, especially during and after bowel movements.
- There also may be small amounts of bleeding.
What kind of doctor treats anal itching?
Although anal itching can be evaluated by a family practice or internal medicine physician, it most often is evaluated by a colorectal surgeon (proctologist) and sometimes by a gastroenterologist.
How do medical professionals diagnose the cause of anal itching?
Anal itching is first evaluated with a careful examination of the anus for such abnormalities as hemorrhoids, anal fissures, skin tags, moisture, and excoriations (breaks in the skin from scratching).
A rectal examination with a finger inserted into the anal canal can identify rectal tumors. For a closer look at the anal canal, a proctoscope can be used. A proctoscope is a short tube that is inserted through the anus and into the rectum so that the anal canal can be examined visually If pinworms are suspected, they and their eggs can be identified using the pinworm test, a test in which the worms and eggs are recovered from the anus using transparent adhesive tape.
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What are treatment options and home remedies for anal itching?
Initial self-care for simple itching is directed toward relieving symptoms, like burning and soreness. It is important to clean and dry the anus thoroughly and avoid leaving soap in the anal area.
- Cleaning efforts should include gentle showering without direct rubbing or irritation of the skin with either the washcloth or towel.
- After bowel movements, moist pads (such as baby wipes, flushable moist wipes, and flushable anal cleansing wipes) should be used for cleaning the anus instead of toilet paper.
- If there is constant moisture present in the anus or stool incontinence, it may be necessary to clean the anus with wet wipes between bowel movements.
Many over-the-counter (OTC) products are sold for the treatment of an itchy anus and are available as ointments, creams, gels, suppositories, foams, and pads. These products often contain the same drugs used to treat hemorrhoids.
- When used around the anus, ointments, creams, and gels should be applied as a thin covering.
- When applied to the anal canal, these products should be inserted with a finger using finger cots (latex covers for the fingertips) or a "pile pipe." Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion.
- Suppositories or foams do not have advantages over ointments, creams, and gels.
Most products contain more than one type of active ingredient. Almost all contain a protectant in addition to another ingredient. Only examples of brand-name products containing one ingredient in addition to the protectant are discussed in this article.
Local anesthetics temporarily relieve pain, burning, and itching by numbing the nerve endings. The use of these products should be limited to the perianal area and lower anal canal. Local anesthetics can cause allergic reactions with burning and itching. Therefore, the application of anesthetics should be discontinued if burning and itching increase.
Examples of local anesthetics include:
- benzocaine 5% to 20% (Americaine Hemorrhoidal, Lanacane Maximum Strength, Medicone)
- benzyl alcohol (Itch-X) 5% to 20%
- dibucaine 0.25% to 1.0% (Nupercainal)
- dyclonine 0.5% to 1.0%
- lidocaine (Xylocaine) 2% to 5%
- pramoxine 1.0% (Fleet Pain-Relief, Procto Foam Non-steroid, Tronothane Hydrochloride)
- tetracaine 0.5% to 5.0%
Vasoconstrictors are chemicals such as epinephrine, a naturally occurring chemical. Applied to the anus, vasoconstrictors make the blood vessels become smaller, which may reduce swelling. They also may reduce symptoms due to their mild anesthetic effect.
Vasoconstrictors applied to the perianal area -- unlike vasoconstrictors given by injection -- have a low likelihood of causing serious side effects, such as high blood pressure, nervousness, tremor, sleeplessness, and aggravation of diabetes or hyperthyroidism.
Examples of vasoconstrictors include:
- ephedrine sulfate 0.1% to 1.25%
- epinephrine 0.005% to 0.01%
- phenylephrine 0.25% (Medicone Suppository, Preparation H, Rectocaine)
Protectants prevent irritation of the perianal area by forming a physical barrier on the skin that prevents contact of the irritated skin with aggravating liquid or stool from the rectum. This barrier reduces irritation, itching, pain, and burning. There are many products that are themselves protectants or that contain a protectant in addition to other medications.
Examples of protectants include:
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Astringents cause coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal. This action promotes dryness of the skin, which in turn helps relieve burning, itching, and pain.
Examples of astringents include:
- calamine 5% to 25%
- zinc oxide 5% to 25% (Calmol 4, Nupercainal, Tronolane)
- witch hazel 10% to 50% (Fleet Medicated, Tucks, Witch Hazel Hemorrhoidal Pads)
Antiseptics inhibit the growth of bacteria and other organisms. However, it is unclear whether antiseptics are any more effective than soap and water.
Examples of antiseptics include:
- boric acid
- benzalkonium chloride
- cetylpyridinium chloride
- benzethonium chloride
Keratolytics are chemicals that cause the outer layers of skin or other tissues to disintegrate. The rationale for their use is that the disintegration allows medications that are applied to the anus and perianal area to penetrate the deeper tissues.
The two approved keratolytic used are:
- aluminum chlorhydroxy allantoinate (alcloxa) 0.2% to 2.0%
- resorcinol 1% to 3%
Analgesic products, like anesthetic products, relieve pain, itching, and burning by depressing receptors on pain nerves.
Examples of analgesics include:
- menthol 0.1% to 1.0% (greater than 1.0% is not recommended) (Calmoseptine)
- camphor 0.1% to 3% (greater than 3% is not recommended)
- juniper tar 1% to 5%
Corticosteroids reduce inflammation and can relieve itching, but their chronic use can cause permanent damage to the skin. They should not be used for more than short periods of a few days to two weeks. Only products with weak corticosteroid effects are available over-the-counter. Stronger corticosteroid products that are available by prescription should not be used for treating anal itching.
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How to stop vaginal itching and burning
Medical Author: Karthik Kumar, MBBS
Medical Reviewer: Shaziya Allarakha, MD
Treating feminine or vaginal itching or burning depends on the cause of the symptoms.
- For yeast infection, the patient may need an antifungal cream or a pill to alleviate the symptoms. A gynecologist can often prescribe oral medication to get rid of the yeast. An over-the-counter cream is sometimes also effective when trying to eliminate yeast infection.
- Bacterial vaginosis is remedied by creating a balanced level between the good and bad bacteria in your vagina. Antibiotics will remedy this infection along with reintroducing healthy bacteria into the system. Some women take natural supplements that include probiotics to help them feel better. Flagyl (metronidazole tablet), MetroGel (metronidazole gel), or Cleocin (clindamycin cream) may be prescribed.
- If chemical irritants are the cause of the discomfort, stop using scented soaps and feminine sprays, and avoid harsh laundry detergents. Patients should discontinue douching and wearing underwear made of synthetic materials. Allow the vagina to breathe, and wear panties made of natural fibers. Because the side effects of menopause contribute to vaginal discomfort, the patient may wish to use a lubricant to soothe the itchiness.
A gynecologist may also prescribe
- Stronger medications, such as estrogen-containing medications, for itching and irritation due to menopause.
- Corticosteroid cream, such as Hydrocortisone or Clobetasol, for bacterial vaginosis or trichomoniasis.
- Antibiotics for sexually transmitted diseases, such as chlamydia, gonorrhea, syphilis, and trichomoniasis.
- Antifungal cream or suppository such as Monistat 1 (miconazole), clotrimazole, butoconazole or Vagistat-1 (tioconazole), or antifungal medication such as Diflucan (fluconazole) for yeast infections.
- Antihistamine to relieve irritation or allergic reaction.
Common home remedies:
- Taking a bath with baking soda may help to treat yeast infections and reduce skin irritation. It has antifungal properties, which can kill irritation causing bacteria. Put one-fourth cup of baking soda in the bath or make a paste and apply it on the skin and wash after a few minutes.
- Apple cider vinegar (ACV) may also help to soothe an infection. ACV has antifungal and antibacterial properties, which prevent the growth of bacteria. Put half a cup of ACV in water and take a bath with it for relief.
- Coconut oil can help manage yeast infections. Take a few drops of coconut oil on your fingers and rub them properly on your skin.
- Eating food items containing probiotics promotes the growth of healthy bacteria and can help to get rid of nasty infections. Probiotic foods are good for your vagina and gut. When suffering from vaginal issues, include kombucha, kimchi, and yogurt in your diet.
- Some essential oils are also effective in treating infection. Tea tree and oregano oils are the two most effective oils that you can use for an itchy vagina. Their antifungal properties can kill a range of yeasts and fungi. Applying essential oils directly can irritate the vaginal skin. You may mix a few drops of the essential oil in other oils, such as coconut oil, before applying.
- Placing a cold compress, such as a washcloth, on the labial area can help with discomfort.
- Take a sitz bath with water covering the genital and rectal areas.
What are the common causes of feminine itching and burning?
The following are the common causes of feminine itching:
- Bacterial vaginosis: It results from excessive growth of bacteria that are normally present in the vagina. The symptoms of bacterial vaginosis include a thin, white, gray, or green discharge and a burning sensation during urination. There is also a fishy smell that exudes from the vagina that gets stronger after sex.
- Yeast infections: They are common among women and are caused by candida fungus. This fungus is naturally present in the vagina, but when it grows out of control, it becomes a painful infection. The symptoms of a yeast infection include a thick, white, odorless discharge that looks like cottage cheese. The vagina and vulva become swollen, red, and extremely irritated, and itchy. The patient may experience pain during sex, frequent urination, and burning when they pee.
- Chemical irritants: Chemical irritants may irritate the vagina and cause itching and burning because of their toxic ingredients. To avoid vaginal itching, we should refrain from using odorized toiletries. Women may also wear cotton panties, avoid douching and avoid wiping front to back after urination to avoid vaginal irritation.
- Menopause: When a woman reaches menopause, the hormones in her body drastically change. The drop in estrogen levels can create vaginal dryness. This change in chemistry makes the vaginal walls thin and dry. The reduction in tissue causes the vagina to become itchy and irritated. To decrease these uncomfortable symptoms, a physician may prescribe estrogen tablets, creams, or ring inserts.
- Common hormone or pH imbalances: The body goes through hormonal changes during a month. When the body goes through these changes, estrogen and pH levels are knocked off balance and can contribute to vaginal itchiness and dryness.
What if anal itching persists?
For persistent anal itching, efforts are directed toward identifying an underlying cause. An examination by a doctor can rapidly identify most causes of anal itching. Adjustments in diet, treatment of infections, or surgical procedures to correct the underlying cause may be required.
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Breen, E. "Approach to the patient with anal pruritus" UpToDate. Sept. 12, 2018. <http://www.uptodate.com/contents/approach-to-the-patient-with-anal-pruritus>.
All About Women. What Causes Vaginal Itching? https://www.allaboutwomenmd.com/knowledge-center/vaginal-itching-causes.html
WebMD. Vaginal Itching, Burning, and Irritation. https://www.webmd.com/women/guide/vaginal-itching-burning-irritation#1
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