Pruritus ani is a set of sensations that involves the more or less urgent need to scratch. It is located around the anal orifice but, over time, it often tends to extend to involve the perineum and buttocks. In cases where anal itching becomes particularly intense, it is frequently associated with scratching lesions which in turn can become infected, thus increasing the discomfort and further worsening the situation. Pruritus ani occurs more frequently in the male gender, especially in adult age.
PRURITUS ANI: TYPES AND CAUSES
Pruritus ani can be distinguished in: idiopathic pruritus ani and secondary pruritus ani. In idiopathic anal pruritus ani, whose picture appears intermittently, no specific causes are recognised. It would appear that some important role can be given to faecal contamination, associated with peripheral nerve trunk injury or metabolism disorders with nerve endings problems.
In secondary pruritus ani, on the other hand, the causes may be linked to:
- anorectal diseases (haemorrhoidal disease, fissures, neoplasms, fistulas, prolapse);
- parasitic infestations;
- dermatosis and contact dermatitis (pharmacological and/or allergic);
- systemic causes (diabetes, hemopathies and chronic nephropathies);
- hygiene factors;
- rubbing irritations;
- hyperhidrosis (excessive sweat production).
DIAGNOSIS AND TREATMENT OF PRURITUS ANI
The wide variety of possible causes that give rise to pruritus ani requires a particularly careful diagnosis and the collection of patient information must be thorough and meticulous. The proctologist will analyse the state of health, the symptoms, the use of drugs, ointments and creams, previous diseases and surgery, work and sports activities, sexual habits, etc.
The objective examination, based on an accurate general and specialist examination, could involve more than one specialist (e.g. proctologist, dermatologist and gynaecologist). It is often necessary to use laboratory tests, including repeated blood, skin and faeces tests. Treatment will be closely related to the established cause of the pruritus ani. In general, we mention, among the basic therapeutic suggestions:
- thorough intimate hygiene to be carried out with lukewarm water and mild soap or particularly delicate detergents;
- the choice of underwear (breathable cotton) and toilet paper (soft);
- interruption of the pruritus-scratching cycle;
- the regularisation of intestinal function in times and quality of evacuation.
At the end of the diagnostic pathway, pruritus ani may not be related to a given cause and the above basic suggestions may be completely ineffective. One could then hypothesise the psychological nature of the disorder which, in these cases, will need to be resolved through an appropriate psychotherapeutic path.
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