Anal Itching

Anal Itching (Pruritus Ani) – Treatment Overview

Introduction
Anal itching, or pruritus ani, is a common symptom characterized by persistent itching, burning, or irritation around the anus. It is usually a symptom rather than a disease, with causes ranging from poor hygiene, excessive cleaning, infections (fungal, pinworms), hemorrhoids, fissures, dermatitis, dietary triggers (spicy foods, caffeine, citrus), systemic disease (diabetes, liver disease), or idiopathic cases where no clear cause is found.

Treatment focuses on identifying and correcting the underlying cause, alongside general measures to reduce irritation and break the itch–scratch cycle.

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Treatment Options

1. General Measures

• Maintain gentle perianal hygiene: Clean with water or mild unscented wipes (avoid soaps, perfumes, or harsh wipes).

• Keep the area dry and ventilated; use cotton underwear and avoid tight clothing.

• Avoid scratching to prevent skin damage.

• Identify and avoid dietary triggers (coffee, alcohol, chocolate, spicy foods, tomatoes, citrus).

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2. Topical Treatments

• Barrier creams/ointments: Zinc oxide, petroleum jelly – protect skin from moisture and irritation.

• Topical corticosteroids (mild, short course): Hydrocortisone 1% cream applied twice daily for up to 1–2 weeks (not for prolonged use due to risk of skin thinning).

• Antifungal creams (if fungal infection suspected): Clotrimazole, miconazole.

• Antihistamine creams: May help with itching, though systemic antihistamines at night can reduce scratching during sleep.

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3. Treating Underlying Conditions

• Hemorrhoids/fissures: Appropriate medical or surgical treatment.

• Pinworm infection (Enterobius): Mebendazole 100 mg orally as a single dose, repeat after 2 weeks; treat household contacts.

• Secondary infections: Topical antibiotics for bacterial superinfection if present.

• Systemic disorders (diabetes, liver disease, thyroid disease): Optimize management.

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Supportive Measures

• Sitz baths (lukewarm, not hot water) for soothing effect.

• Avoid irritant topical agents (perfumed creams, strong steroids, antiseptics).

• Loose-fitting clothes to reduce sweating and friction.