Persistent Anal Itching: Causes and Treatment Options

Regarding anal itching?

Hello Doctor, I have been experiencing persistent itching around my anus for a long time.
In the past, I visited several hospitals in Kaohsiung, and many doctors diagnosed it as itching caused by internal hemorrhoids.
However, since the hemorrhoids were small, the doctors advised that surgery was not necessary and recommended topical ointments instead.
Initially, the ointments seemed effective, but eventually, they made the itching worse.
After moving to Taichung, I researched some well-known gastroenterology hospitals online, but the doctors also prescribed topical ointments.
While they were somewhat effective at first (though not completely relieving the itching), now they seem to exacerbate the itching, which is affecting my sleep.
Currently, whenever I feel itchy, I rinse the area with clean water and dry it, which provides some temporary relief.

However, I am concerned about whether my anal itching is primary or secondary (caused by internal hemorrhoids).
I really want to resolve this issue quickly, and I would be open to taking medication if it could provide faster relief.
I have read online that internal hemorrhoids are often associated with constipation, but I do not have any issues with constipation or bowel movements.
Therefore, I am quite puzzled about the cause of my anal itching.
This has been a long-standing and difficult issue for me to discuss, and I would greatly appreciate any advice from the doctors.
Thank you very much!

Ye Nu, 20~29 year old female. Ask Date: 2015/10/13

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, there are many causes of hemorrhoids, with constipation being one of the common reasons.
As for anal pruritus, there are also numerous causes, including hemorrhoids, parasitic infections, and unknown reasons.
It is important to keep the anal area clean and dry.
If necessary, seek medical attention from a gastroenterologist or a colorectal surgeon.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/10/13

More Info

Persistent anal itching, also known as pruritus ani, can be a frustrating and uncomfortable condition. It can arise from various causes, and understanding these can help in determining the most effective treatment options.

Causes of Persistent Anal Itching
1. Hemorrhoids: As you mentioned, internal hemorrhoids can lead to itching, especially if they are inflamed or if there is any leakage of mucus. Even small hemorrhoids can cause discomfort and itching.

2. Skin Conditions: Conditions such as eczema, psoriasis, or fungal infections can affect the anal area and lead to itching. These conditions may require specific topical treatments or medications.

3. Hygiene Issues: Both inadequate and excessive cleaning can lead to irritation. Inadequate cleaning can leave fecal matter that irritates the skin, while excessive cleaning, especially with harsh soaps or wipes, can strip the skin of its natural oils and lead to irritation.

4. Dietary Factors: Certain foods, such as spicy foods, caffeine, and alcohol, can irritate the anal area and lead to itching.
5. Infections: Fungal infections, sexually transmitted infections, or pinworms (especially in children) can cause significant itching.

6. Anal Fissures: Small tears in the anal lining can cause pain and itching, often exacerbated by bowel movements.

Treatment Options
1. Topical Treatments: While you have tried topical medications, it may be worth discussing with your doctor the possibility of trying different formulations or active ingredients. Sometimes, over-the-counter hydrocortisone creams can help reduce inflammation and itching.

2. Dietary Changes: Keeping a food diary to identify any potential dietary triggers can be beneficial. Reducing spicy foods, caffeine, and alcohol may help alleviate symptoms.

3. Hygiene Practices: Gentle cleaning with water after bowel movements and avoiding harsh soaps can help. Some people find that using a sitz bath can soothe the area.

4. Oral Medications: If topical treatments are ineffective, your doctor may consider prescribing oral medications, such as antihistamines, to help reduce itching.

5. Addressing Underlying Conditions: If hemorrhoids are indeed the cause, discussing other treatment options with your doctor, such as rubber band ligation or sclerotherapy, may be necessary.
6. Referral to a Specialist: If the itching persists despite treatment, it may be beneficial to see a gastroenterologist or a proctologist for further evaluation. They may perform a more thorough examination and consider other underlying conditions that could be contributing to your symptoms.

Conclusion
Persistent anal itching can be multifactorial, and it’s essential to identify the underlying cause to determine the most effective treatment. Since you have already tried some treatments without lasting relief, it may be time to revisit your healthcare provider for a more comprehensive evaluation. They can help you explore other treatment options, including potential dietary changes, different topical medications, or further diagnostic tests to rule out other conditions. Remember, it’s important to communicate openly with your healthcare provider about your symptoms and concerns, as this will help them provide the best care possible.

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