Persistent Anal Itching: Causes and Treatment Options

Anal itching

Hello, doctor.
Recently, I have been experiencing anal itching that occurs at a similar frequency both day and night.
Could this indicate that it is less likely to be caused by a pinworm infection? Previously, I was diagnosed with eczema in the groin area by a physician, and after using medication, it has mostly healed.
However, I have since developed anal itching.
At that time, the doctor asked if my anus was itchy (which it wasn't), so I wonder if there is a connection between the two.
I tried applying the same ointment I used for the groin to the anal area, but it didn't seem to help.
Lastly, I would like to know if I should see a dermatologist, a colorectal surgeon, or if a family medicine physician would be sufficient without needing a referral.
Thank you, doctor.

Miss Chen, 20~29 year old female. Ask Date: 2018/08/28

Dr. Ke Fangxu reply Surgery

Anal itching may be caused by excessive wiping and is generally unrelated to parasitic infections.
In addition to medication and topical treatments, there are three important considerations: avoid scratching to prevent wound infection, temporarily refrain from consuming spicy foods to prevent capsaicin from irritating the skin, and avoid using soap or body wash to clean the anal area to prevent excessive removal of the skin's natural oils.
If these measures are followed, improvement can typically be seen within about a week.
As for which specialist to consult, it depends on the individual.
I have received referrals from both family medicine and dermatology physicians, and some surgeons may refuse to treat such cases.
It is important to find a physician willing to provide treatment.

Reply Date: 2018/08/28

More Info

Persistent anal itching, or pruritus ani, can be a frustrating and uncomfortable condition. Understanding its potential causes and treatment options is essential for effective management.

Causes of Persistent Anal Itching
1. Skin Conditions: Conditions such as eczema, psoriasis, or contact dermatitis can lead to itching around the anal area. Since you mentioned having a history of groin eczema, it’s possible that a similar skin condition could be affecting the anal region.

2. Infections: While pinworm infections (enterobiasis) are a common cause of anal itching, they typically present with more pronounced symptoms, especially in children. If the itching occurs at all times of the day and is persistent, it might be less likely to be due to pinworms. However, other infections, such as yeast infections or bacterial infections, could also be culprits.

3. Hygiene Issues: Both inadequate and excessive cleaning can lead to irritation. Insufficient cleaning can leave irritants behind, while excessive cleaning can strip the skin of its natural oils, leading to dryness and itching.

4. Dietary Factors: Certain foods, such as spicy foods, caffeine, and alcohol, can irritate the anal area and lead to itching.

5. Hemorrhoids or Anal Fissures: These conditions can cause discomfort and itching, often accompanied by pain or bleeding.

6. Systemic Conditions: Conditions like diabetes or liver disease can also manifest as skin changes, including itching.

Treatment Options
1. Topical Treatments: Over-the-counter hydrocortisone creams can help reduce inflammation and itching. However, prolonged use should be avoided as it can lead to skin thinning.

2. Antihistamines: Oral antihistamines may help reduce itching, especially if it is related to an allergic reaction.

3. Moisturizers: Applying a gentle moisturizer can help soothe the skin and reduce dryness.

4. Avoid Irritants: Identifying and avoiding potential irritants, such as scented soaps or wipes, can help alleviate symptoms.

5. Dietary Changes: Keeping a food diary to identify potential dietary triggers may be beneficial.

6. Proper Hygiene: Maintaining good hygiene without over-cleaning is crucial. Gentle cleansing with mild soap and water, followed by thorough drying, can help.

When to See a Doctor
Given your symptoms and previous skin condition, it would be advisable to consult a healthcare professional. You can start with a visit to a family physician or a dermatologist. A family physician can assess your symptoms and provide initial treatment or refer you to a specialist if necessary. A dermatologist would be particularly helpful if the itching is related to a skin condition.
If your symptoms persist or worsen, or if you notice any additional symptoms such as bleeding, pain, or changes in bowel habits, it may be necessary to see a gastroenterologist or a colorectal surgeon for further evaluation.

Conclusion
Persistent anal itching can arise from various causes, including skin conditions, infections, and hygiene issues. Identifying the underlying cause is crucial for effective treatment. Starting with a family physician or dermatologist is a good approach, and they can guide you on the next steps based on your specific situation. Remember to avoid self-medicating without professional advice, especially if you have underlying health conditions.

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