Pruritus Ani
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  • 25 Jan, 2020
  • Post author:Dr Tom Leach
  • Reading time:2 mins read
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Introduction

Pruritis Ani is “itchy anus”, and is a common presenting complaint to general practice. Symptoms are typically worse at night, and can keep the patient awake, and may be exacerbated by hot weather or exercise.

There can be many causes; in children threadworm is a common cause, whilst more benign causes are common in adult males. Seborrhoeic dermatitis (the same condition that causes dandruff on the scalp) is often associated with pruritus ani.

Mose cases do not have an easily identified cause, and may resolve with reassurance, and modification of hygiene practises.

Causes

  • Psychological factors
  • Excessive sweating
    • +/- associated with exercise
    • +/- associated with tight fitting clothing
  • Over-zealous hygiene – may be associated with too much washing!
    • In some – may be associated with not enough washing – especially after exercise
  • Infectious
    • Threadworm
    • Infectious causes of diarrhoea (causing excoriation)
  • Generalised skin conditions
  • Local skin causes:
  • Contact dermatitis
  • Diabetes

Diagnosis

Typically clinical diagnosis assisted by history and examination. Consider also:

  • Urinalysis (for glycosuria and diabetes)
  • Skin scraping – for fungal causes
  • Stool examination for intestinal parasites

Management

  • Treat the cause!
  • General hygiene advice:
    • Avoid the use of soap
    • Try aqueous cream instead
    • Shower as soon as possible after exercise
    • Avoid tight fitting clothing
    • Avoid excessive scratching
    • Avoid perfumed soaps and powders
    • In obesity with excessive sweating, consider strapping the buttocks apart with adhesive tape
  • Trial of steroid cream
    • e.g. 1% hydrocortisone
  • Trial of anti-fungal cream
    • e.g. clotrimazole 1%

References

  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

Read more about our sources

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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