Anal itching is a condition characterized by persistent itching in the anus and is a clinical symptom of many proctological diseases. It can be observed in the absence of pathology of the large intestine. In order to identify the causes of anal itching, laboratory (examination of perianal scraping, feces on helminth eggs, blood glucose) and instrumental diagnostics (anoscopy, rectoromanoscopy) are carried out. The algorithm for eliminating anal itching involves conservative or surgical treatment of the underlying pathology, the use of local remedies, and physiotherapy procedures.
ICD 10
L29.0 Itching of the anus
General information
Anal itching is a pathological sensation of persistent itching in the anus. It can be an independent disease or serve as a symptom of other diseases: hemorrhoids, worm infestations, anal fissures, diabetes mellitus, dysbiosis, etc. It causes physical and psychological discomfort, causes sleep disturbance and habitual lifestyle. It leads to combing, the appearance of anal fissures and the attachment of infection. In advanced cases, ulceration, bleeding, and the transition of the disease to a chronic form are observed. Anal itching can be quite persistent and it can be difficult to cure it.
Causes of anal itching
The cause of irritation of the anus and the appearance of anal itching may be increased dryness of the skin (a common condition in the elderly, and also characteristic of dehydration). The tendency to high humidity (and, accordingly, irritation and anal itching) occurs in persons suffering from excessive sweating, as well as with frequent diarrhea and in the case of fecal incontinence.
Persistent anal itching can be caused by regular use of a hard washcloth, caustic detergents, coarse toilet paper, poorly flushed soap. Irritation of the skin around the anus can be caused by some anti-hemorrhoids, contraceptive candles and topical gels. Itching can occur in lovers of spicy spicy food as a result of irritation with its components of the mucous membrane. Insufficient personal hygiene, particularly in the anus, also leads to skin irritation. Sometimes anal itching is a consequence of hair removal in this area.
Many diseases are accompanied by this clinical symptom: proctological (hemorrhoids, anal fissure, sphincteritis, proctitis), gynecological (inflammation of the external genital organs), viral infections (genital warts), fungal (actinomycosis, thrush) and bacterial, worm infestations, pubic lice, scabies; dermatological (psoriasis, seborrhea, inflammation of the sweat glands, atopic eczema, lichen planus), diseases associated with violation metabolism (diabetes mellitus, liver failure, pancreatitis, etc.).
In addition, anal itching can be a consequence of neurosis (neurogenic) and occur as a result of the use of certain medications (iatrogenic). When it is not possible to identify the obvious cause of the pathology, they talk about idiopathic itching and assume that it is associated with a decrease in the contractile function of the sphincter and irritation of the skin with mucus secreted from the rectum.
It is worth noting that chronic proctosigmoiditis can occur covertly, the only clinical symptom in this case will be anal itching, resulting from a sharp change in the acid-base balance of the rectum and sigmoid colon, the presence of proteolytic enzymes in the feces, which contributes to the growth in the near-anal zone of the amount of residual nitrogen, directly irritating nerve receptors.
Classification
In clinical proctology, primary and secondary anal itching are distinguished. Primary (true, idiopathic, cryptogenic, suigenic, essential, neurogenic) is an itch that has no apparent cause (one or another intestinal pathology, which may be accompanied by anal itching).
Secondary anal itching occurs with hemorrhoids, chronic anal fissure, worm infestations, inflammation of the terminal parts of the intestine (proctitis, proctosigmoiditis), inflammatory diseases of the genitals, fungal lesions of the anal area and perineum, burns, mechanical injuries of the anus. In the early stages of diabetes, one of its clinical signs – itching of the skin – may be limited to the anal area. In addition, anal itching is divided into acute and chronic.
Symptoms of anal itching
Itching in the anal area is usually the only complaint of the patient. It can occur at night and contribute to insomnia. With prolonged course, the skin around the anus becomes covered with abrasions, turns red, eventually becomes coarser or thinner and becomes easily damaged. Deep pronounced combs can become infected.
Acute anal itching begins suddenly and intensely, has a permanent character, maceration (moisturizing) of the skin, its irritation, changes in the type of wet skin are detected in the anus. There may be traces of scratching. Chronic itching develops slowly, gradually intensifies. The skin around the anus is usually prone to dryness (sometimes thinned dry skin like parchment paper is noted). There may be no pigmentation characteristic of this area. Combs, as a rule, are not noted.
Existing anal itching for a long time leads to pronounced scratching, can contribute to bacterial skin lesions, eczema, ulceration and bleeding. Complications of secondary itching are associated with the underlying pathology of which it is a symptom. It should be remembered: after detecting the disease, it is necessary to consult a doctor, and not ignore the symptoms and not self-medicate. Anal itching can be a clinical sign of serious pathologies.
Diagnosis of anal itching
The direct diagnosis of anal itching is carried out by a proctologist on the basis of complaints and the absence of other clinical signs. However, the detection of the disease requires to establish its probable cause, in the case of its secondary nature to detect the underlying pathology. Therefore, a wide range of instrumental and laboratory studies are used for anal itching. The nature and features of itching can contribute to the establishment of a probable cause: whether it is associated with defecation, the use of alcoholic beverages or spicy food, the time of detection, duration of existence, intensity.
On examination, signs of inflammation are noted, a scrape is taken. All patients undergo a three-fold analysis of feces for worm eggs. To exclude infections of the genitals, a gynecologist is consulted with the sampling of smears. If there are signs of stool disorders, a bacteriological examination of feces is performed. To detect inflammatory bowel diseases, rectoromanoscopy is performed (the rectum is examined), irrigoscopy, colonoscopy. Colonoscopy allows you to detect inflammatory changes in the intestinal mucosa throughout the large intestine.
The blood is examined for sugar content and the detection of metabolic disorders accompanied by skin itching. To determine the functional insufficiency of the anal sphincter, sphincteromanometry is used. In order to detect pathology of the upper digestive tract, accompanied by regular diarrhea or constipation, gastroscopy and ultrasound of the abdominal organs are performed. Prostate ultrasound may be recommended for men.
Treatment of anal itching
Treatment can present certain difficulties and be quite lengthy. The key point in the therapy of anal itching is to identify the cause of its occurrence and its eradication. In addition, local remedies are used to relieve itching. In the case of a secondary nature of the disease, therapy is aimed at getting rid of the underlying pathology. In infectious diseases, antibiotic therapy or fungicides are prescribed (for fungal infection). Anthelmintic drugs are used to treat helminthic invasion.
In inflammatory diseases of the large intestine, a full course of appropriate treatment is indicated. Some diseases require both therapeutic means of treatment and, according to indications, surgical intervention. Hemorrhoids are treated with hemorrhoidectomy, ligation with latex rings and other operations. If there is a corresponding pathology, the anal fissure is excised. Sometimes anal itching is a clinical symptom of serious diseases (diabetes mellitus, syphilis, hepatitis, cirrhosis of the liver), the treatment of such diseases can be quite long and complicated.
For topical use, ointments with prednisolone, dexpanthenol and lidocaine, as well as microclysms (with 3% collargol or protargol, herbal decoctions, oils) are recommended as means to reduce discomfort and reduce itching. Electrotransquilization can be used to relieve persistent pain syndrome. It is most difficult to treat anal itching, the cause of which has not been identified. In such cases, there are only measures of symptomatic therapy, sedatives, careful (but not excessive) hygiene and restriction in the diet of products that can irritate the mucous membrane and skin of the anal zone (pepper, citrus fruits, chocolate, tea, cola, alcohol, spicy seasonings).
Prognosis and prevention
The prognosis directly depends on the etiology and pathogenesis of anal itching, early detection and timely initiation of therapeutic actions. If anal itching is not a consequence of an incurable disease, the outcome is favorable with strict adherence to medical prescriptions. Preventive measures to prevent relapses and worsening of the course of the disease consist in following the recommendations on diet and hygiene of the anal zone.