Causes and symptoms

Pruritus ani may also be seen in initial stages of hemorrhoids, anal fissure, pelvic inflammatory disease, anorectal abscess, intestinal infection or a lump. There may be associated symptoms as the disease progresses. These symptoms may include fever, rectal bleeding, anal pain, vaginal discharge, hematuria, diarrhea, neurologic problems.

At doctor’s office

A careful history, physical examination include anoscopy, pelvic examination are usually done in gastroenterologist. A careful examination will reveal any local causes like hemorrhoids or fissures. Skin tags (enlarged folds of skin around anus), the buttocks touching with each other and have to be parted firmly for examination and hairy anus are usual findings on examination by gastroenterologist.

Examining doctor will classify the symptom according to examination findings as mild, moderate, severe and chronic. In mild pruritus ani, lesion is not seen on examination but the patient finds palpation and/or anoscopy painful. In moderate pruritus ani red dry skin only with some fissures maybe seen. In severe pruritus ani reddened, weeping skin, with excoriations and pale, whitish areas seen on examination. In chronic              pruritus ani, pale, whitened, thickened, dry, leathery, scaly skin with no hairs and no excoriations seen on examination.

Investigations

Detailed radiology like pelvic ultrasound, microbiological tests like pap smear, urinalysis with culture may be needed if a local cause is not found. Complete stool examination including culture, and tests for ova and cysts may show any intestinal infestations.

Management

For mild to moderate symptoms, following is recommended:

- Apply vaseline or coconut oil regularly in the area.

- Add butter to your foods to make it softer

- Drink lots of fluids. Drinking cleaner water with low TDS will definitely help. Outside foods and unclean water can be source of infection.

- Eating curd can also help. Taking probiotics may also help.

- Tab Albendazole 400 mg single dose to eradicate any parasites.

- Mild steroidal preparation like Hydrocortisone acetate 1% ointment, applied 1-2 times a day for a brief period (< 1 wk), may relieve inflammation.

For moderate to severe symptoms, medical help is needed. Ask A Gastroenterologist online if your symptoms are bad enough to need stronger medicines.