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Updated 05 October 2015

Answer: What's your diagnosis? – Case 30

Mr Q's had an anal itch for a while. 'Pruritis ani', or anal itching, can cause significant discomfort and may have a number of causes.

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Pruritis ani causes significant discomfort to sufferers and is an embarrassing problem. Occasionally the persistent itch can lead to poor concentration and sleep.

Causes

Often there is no clear cause for pruritis ani (idiopathic pruritis ani). Other common causes include:

1. Problems in the digestive tract like indigestion, diarrhoea and faecal incontinence

2. Haemorrhoids

3. Local skin irritation when the area is not kept completely dry or clean. A change in bath and/or washing products may also cause irritation.

4. Growths: cancerous or non-cancerous

5. Parasites (like worms)

6. Yeast infections

7. Sexually transmitted diseases

8. Immune conditions like psoriasis may also affect the anal area.

Symptoms and signs

Patients suffering from pruritis ani often complain that the itch is so bad that they can't concentrate on work and other activities. Some patients can't resist the urge to scratch, causing damage to the skin, which may lead to tears in the area. Prolonged scratching causes burning, painful skin.

Treatment

The most important part of treatment is to try and establish the cause of the persistent itch. Once the cause is established, the treatment can be directed towards eliminating it.

By simply keeping the skin surrounding the anus dry and clean, patients often find great relief. The following are also important treatment modalities:

1. Over-the-counter creams containing hydrocortisone may relieve the itch if no clear cause is found.

2. De-worming tablets where parasitic infections are considered to be the cause

3. Ointments containing zinc oxide  

4. Anti-histamines to control the itch and the need to scratch

If first-line treatments make no difference, you may need to visit your doctor – especially if the problem persists in the case of sudden constipation, or if faecal incontinence is a problem.

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

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What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

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What's your diagnosis? - Case 15: the world is spinning

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What's your diagnosis? - Case 18: boy with persistent fever

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What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

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What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

What's your diagnosis? – Case 26: swelling of face

What's your diagnosis? – Case 27: sudden severe leg pain

What's your diagnosis? – Case 28: painful ear

What's your diagnosis? – Case 29: tired and drained

What's your diagnosis? – Case 30: persistent anal itch

 
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