Pruritus ani is a condition associated with the urge to scratch the skin around the anus. Common causes of anal itching include skin problems such as infection or rash, excessive washing, excessive sweating, residual stool and hemorrhoids.
Listed below are some of the treatments that may be recommended. These may take 4-6 weeks or more to be effective. Itching that does not improve should be evaluated by your physician; further evaluation and testing may be necessary.
Clean and dry: It is very important to keep the area clean and dry. When showering or bathing, cleanse the area gently using a mild soap. Avoid using scented soaps, deodorants and bubble baths. Rinse the area well to avoid leaving residual soap. Dry the area gently, do not scratch or rub the area with a towel. A hairdryer on a cool setting can also be used.
After a bowel movement: Wash the anal area with water, a wet piece of cotton or unscented mild baby wipe. Sitz baths, showers or a “bidet” (a special toilet with an irrigation system) can also be used; be sure to carefully pat the area dry, moisture can worsen the problem.
Cotton: If itching is related to excess moisture, placing a small thin wafer of cotton up against the anus can be very effective in reducing irritation. It should be changed when it becomes damp and after each bowel movement. A sanitary napkin is not a substitute. Cotton underwear and loose-fitting clothing is also recommended.
Ointments and creams: Apply the cream gently with your finger to the affected area and then apply the cotton wafer. Some creams come with a plastic applicator; do not use this. Simply apply the ointment with your fingertip to the affected area.
- Hydrocortisone creams such as Cortaid® and Preparation H anti-itch® can be applied to the affected area. Any steroid cream should only be used for a short time as using them too long can worsen the problem.
- Barrier creams (zinc oxide) available over the counter include Calmoseptine®, Desitin® and Balmex®. Most diaper-rash type ointments can be used to protect the skin from moisture, especially during summer months or during heavy activity or exercise.
- Lidocaine® ointment or jelly can also help by numbing the area and decreasing the urge to scratch, but are very short-acting. Your physician can prescribe this.
Foods: There are many foods that produce gas, indigestion, loose bowel movements and/or secretions that might irritate the anal area. Start off by avoiding the following foods altogether for 2 weeks. To determine which foods you are sensitive to, slowly introduce them back, one at a time.
Foods to avoid:
- Foods with seeds or kernels (for example: popcorn, nuts, berries)
- Highly acidic foods (for example: oranges, tomatoes)
- Spicy foods (for example: barbecue, hot sauces)
- Caffeine (for example: chocolate, coffee, colas)
- Tea or coffee – Herb tea may be substituted for regular tea
- Beer and ales
This management program should be adjusted depending on your symptoms. The use of the cotton wafer should be the last measure stopped and the first to be resumed. Recurrences are common, especially during summer months.