Pruritus ani denotes the constant irritation and itching of the perianal skin or the mucosa within the anal opening. There are many causes for this distressing problem and finding and eliminating the underlying cause is of paramount importance in the management of pruritus ani. Itching, when severe, can cause acute discomfort, burning sensations and soreness in the area. In children and women, itching of the perianal skin is often accompanied by itching and skin changes in the genital area as well.
In most cases the perianal skin does not show any changes except a mild redness and scaling. In others, maceration caused by constant rubbing and cleansing can lead to painful fissures in the skin.
Pruritus ani is more common in males than in females.
Causes of Pruritus Ani
Causes of itchy butt can broadly be classified into mechanical, chemical, biological, dermatological, systemic and psychological causes
- Mechanical or Physical Causes of Pruritus Ani. As the skin around the anal opening is very sensitive, anything producing irritation in the area can cause itching of the perianal skin. Frequent motions due to diarrhea, hard stools in constipation and vigorous use of toilet papers can cause irritation in the area. Pressure and rubbing of clothes caused by prolonged horse or cycle driving can also be a cause for mechanical pruritus ani. Piles or hemorrhoids and fistulous tracts can also cause itching in the perianal area by constantly keeping the area moist.
- Chemical Causes of Perianal Itching. Itchy butt can be caused by irritant acidic digestive products in the stool. Frequent scrubbing with water and soaps can exacerbate the problem. Spicy food, alcohol, coffee, tea and other acidic beverages can also cause perianal itching. Other examples of food items which provoke anal itching are ketchups, cheese, milk products, chocolates, nuts, prawns and other shell fishes.
- Biological Causes of Itchy Butt. The moisture and warmth in the perianal region provide a rich media for bacterial and yeast growth. Erythrasma, a bacterial infection of the skin caused by Corynebacterium minutissimum is a common cause for pruritus ani. In women and in immune-compromised individuals, yeast infection caused by the Candida albicans is a major cause for anal pruritus. Pin worms or thread worms cause nocturnal itching, especially in children living in unhygienic conditions.
- Dermatological Causes of Perianal Itching. Allergic or irritant contact dermatitis due to excessive use of soap and water, synthetic under wears or topically applied creams and scented papers can cause inflammation and itching in the perianal skin. Flexural psoriasis can affect the perianal skin and cause severe incessant itching. Skin tags and perianal warts are some of the other common causes for perianal itching.
- Systemic Causes of Itchy Anus. Systemic diseases associated with pruritus ani include lymphoma, pellagra, hypovitaminosis A and D and diabetes mellitus. Fixed drug eruptions to certain medications can also cause itching of the perianal skin.
- Psychological Causes of Pruritus Ani. Excessive anxiety and depressive illness can produce symptoms of anogenital itching in some individuals. The itching in the anal region may be accompanied by scrotal itching in males and vulvar pruritus may be a prominent symptom in females. Pruritus ani can be a symptom of neurodermatitis, where the skin becomes thickened and lichenified due to constant scratching and rubbing. Some individuals with obsessive and compulsive cleansing habits can also cause irritation to the perianal skin predisposing to the itchy anus.
- Finally, ideopathic pruritus ani, where no cause could be found even after extensive investigations.
Thus elucidating the causes of the perianal itching is of prime importance in the Treatment of Pruritus Ani.
Reference
- CB Bunker & SM Neill. Pruritus Ani. The Genital, Perianal and Umbilical Regions, Rook’s Textbook of Dermatology, 68.85-68.88; 7th Ed, 2004
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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