What is Pruritis Ani?Â
Patient information: Pruritis Ani [American College of Colon and Rectal Surgeons]
Pruritis ani is an unpleasant itching of the perianal skin (around the anus). Scratching can lead to further irritation and sets up a vicious cycle.
Caused by other anorectal diseases, primary dermatology conditions, hygiene issues (sweat, stool, mucus on the skin), foods, soaps, clothing, or over-vigorous hygiene (aggressive wiping with rough material, use of topical cleaning agents).
Diagnosis- detailed history, thorough exam to rule out underlying anorectal pathology
What is conservative management for pruritis ani?
Try not to scratch/ wipe/ scrub. It will just itch more, and things will get worse.
Clean the anal area after bowel movements with hypoallergenic personal wipes. Do NOT over clean, as this may worsen your condition. Dry with a hairdryer on the cool setting instead of wiping the area dry.
Use unscented Dove soap or dilute white vinegar for cleansing.
AVOID potential contributing factors
Citrus foods, caffeine-containing foods/ beverages- coffee, tea, cola, chocolate.
Scented soaps, lotions, creams, powders, medicated wipes, witch hazel.
Keep the area dry (can use cotton ball or a gauze pad).
Avoid tight synthetic clothing that doesn’t breathe. Wear cotton undergarments.
Maintain regular bowel movement with normal consistency (minimize stool leakage). Increase stool bulk by increasing fiber intake. Maintain adequate hydration- you MUST drink at least 64 ounces of fluid per day, in addition to increasing fiber intake.
Medication
Capsaicin- causes a low-grade burning sensation and decreases the perception of itching
Zinc oxide- Apply a small amount of a barrier cream to the perianal skin in a thin layer. This will protect the skin from irritants.
Mix Benadryl cream with the zinc oxide cream and apply it to the affected area.
Benadryl- 25 mg by mouth at night for itching