Some Causes of Pruritus Ani
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Anorectal disorders | ||
Purulent discharge Pain in the rectum (sometimes) and/or abdomen (often) Sometimes draining fistula Sometimes diarrhea | Anoscopy, sigmoidoscopy, or colonoscopy | |
Hemorrhoids (internal or external) | With internal hemorrhoids, bleeding (a small amount of blood on toilet paper or in the toilet bowl) With external hemorrhoids, a painful, swollen lump on the anus | Clinical evaluation Usually anoscopy or sigmoidoscopy |
Infections | ||
Bacterial infection (secondary to scratching) | Inflamed, excoriated area | Clinical evaluation |
A rash around the anus | Clinical evaluation Sometimes examination of skin scrapings | |
Usually in children Sometimes present in several family members | Microscopic examination of transparent tape that was applied to the anal area to check for pinworm eggs (see diagnosis of pinworms) | |
Intense itching, usually worse at night Possibly itching of other body areas Possibly pink, thin, slightly raised lines or bumps (burrows) on the affected areas | Clinical evaluation Examination of skin scrapings | |
Skin disorders | ||
An itchy, red, oozing, and crusty rash | Clinical evaluation | |
Perianal carcinoma (eg, Bowen disease, extramammary Paget disease) | Scaly or crusted lesion | Biopsy |
Typical psoriatic plaques Sometimes plaques on other areas of the skin | Clinical evaluation | |
Small flap of tissue on anus | Clinical evaluation | |
Drugs | ||
Antibiotics | Current or recent antibiotic use | Trial of elimination |
Foods and dietary supplements | ||
Symptoms only after ingestion of substance | Trial of elimination | |
Hygiene-related problems | ||
Excessive sweating described by the person, particularly with wearing of tight and/or synthetic clothing | Trial of measures to limit sweating (eg, wearing loose cotton underwear, changing underwear frequently) | |
Overly meticulous or aggressive cleansing of the anal area Poor cleansing | Inappropriate cleansing practices described by the patient | Trial of a change in cleansing practices |
Skin irritants | ||
Local anesthetics, ointments, soaps, and sanitary wipes | Use of a possibly irritating or sensitizing substance described by the patient | Trial of elimination |