Anal itching: causes, diagnosis and treatment

Anal itching, anus, itching, hemorrhoids, anal fissure, perianal fistula, anal condylomata, diet, fiber, pruritus ani

Anal itching

Anal itching is a common and widespread problem in both men and women, although more frequent, and by a lot (about four times), in the former.
It may be primary, or idiopathic, when no specific cause is recognized; or secondary, when its cause is clearly recognizable. Scratching the affected area causes skin lesions that aggravate the skin irritation, further worsening the problem.


Anal itching: causes

Itching is a common symptom in many anorectal afflictions; major causes include hemorrhoids, the presence of bulky perianal marisades (or "skin tags"), soiling (limited leakage of fecal fluid from the anus) andfecal incontinence, anal fistulas, fissures, and condylomata. Other causes are sweat and poor perianal hygiene; in particular, the persistence of fecal debris is an important cause of itching, and its removal by thorough washing promptly resolves the problem, confirming the central role of feces in the genesis of anal itching.
On the other hand, aggressive anal hygiene, with inadequate cleansers, can also be a cause of anal itching, in what is sometimes referred to in Anglo-Saxon literature as " polished anus syndrome" (in Italian we could translate it as "polished anus syndrome"). Excessive polishing of the perianal area, along with the use of ointments containing cortisone and derivatives, destroys normal skin defenses, worsening itching.
Although there are no definitive studies, it is fairly common experience that certain foods can also cause anal itching; these include coffee, tea, chocolate, coca-cola, citrus fruits, tomatoes, spices, beer, dairy products, and nuts.
Most often, anal itching originates from aninfection: agents can be skin bacteria, fungi, some parasites such as pinworms, and some viruses, including the papilloma virus, the cause of anal condylomas.
Several skin diseases can cause anal itching: mainly psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen; and some systemic diseases, such as diabetes mellitus, leukemias, lymphomas, renal failure, and jaundice, can also cause anal itching.
However, many times the causes of anal itching remain unknown.


Anal itching: treatment

The goal of treating anal itching is to reconstitute clean, dry, intact skin. This can be very difficult, since, as mentioned, frequently the cause of itching remains unknown.
1) The feces must have the appropriate consistency; they must be soft, well-formed and easy to clean. For this purpose, fiber-based dietary supplements are used, which absorb excess fluid in the stool.
2) If despite this, the stools remain excessively watery, the following can be used anti-diarrheal medications, the use of which, however, should always be evaluated and prescribed by the physician.
3) It is then advisable to eliminate from the diet the foods that can cause anal itching, and which we mentioned earlier.
4) Also improving hygiene practices is very important. It is important to understand that the perianal area does not have to be sterilized. It is usually sufficient to simply use water, possibly accompanied by mild soaps, such as Marseille soap; and it is much better to dry the area with a hair dryer, rather than with paper or cloth napkins.
5) It is important to to avoid scratching, an act that seriously worsens skin lesions and increases the likelihood of bacterial or fungal overinfection.
6) The time-limited use of ointments containing steroids such as hydrocortisone or betamethasone may be helpful in improving symptomatology. Use of more potent steroids, or prolonged use of topical steroids, can cause skin atrophy and worsen itching. The zinc oxide creams help create a protective barrier on the skin and improve symptoms. If infection is suspected, or if skin integrity is injured, application of topical antibiotics (gentamicin, clindamycin, bacitracin) or of antifungals such as clotrimazole and nystatin. In special cases, antibiotics can be given orally.
7) If a parasitosis, oral administration of specific antiparasitic agents is indicated.

In all cases, anal itching is a condition that needs to be evaluated by the coloproctology specialist; who is the only one who can formulate a diagnostic hypothesis and prescribe the most appropriate therapy.