Some patients report it to be most troublesome in the bed at night. Rubbing, sctratching of the itching area can bruise the sensible scarfskin with consequent infection and skin breakdown. Anal itch must be taken seriously and should it become long-lasting or recurrent a Poctologist needs to be seen.
Where does anal itching originate from? What are the characteristics of the skin at the anus?
The skin of the anus, similarly to the skin of the opening of the vagina has a special texture under the microscope. The reason for that is that this special scarfskin (ano-derma) has to provide a transition between the moist lining of the bowel and the normal skin. Besides fulfilling the skin’s usual defensive duties it also has to comply with the conditions originating from the bowel (the secretions of glands, the billions of bacteria in the stool, etc). The ano-derma usually takes this challenge excellently, but sometimes an error creeps into the compliance. The first sign of this disturbance is anal itching.
What can cause anal itching?
Anal itching in earlier Proctologic practice was found many times to originate from poor anal hygiene (fecal soilage). Patients with uneven, rough anal skin are still prone to have residual stool deposits which irritate the skin. Itching can easily develop in these patients, especially if they also have other predisposing factors (see later). The skin surface can become uneven following previous inflammations of haemorrhoids, or following anal surgery. The consequent skin tags make proper cleaning of the rear end difficult.
In today’s practice however the causative role of exaggerated washing/cleaning of the anal area is more frequently seen. Excessive wiping with abrasive toilet paper, the use of scented paper or scented soap, shower gel containing perfumes, even the long term use of baby wipes of the anal area is frequently the culprit. In these instances the anal skin gets dry, loses its natural defensive properties and can get easily irritated. If the underwear gets in close contact with the anal region (tanga-panties), the material of them or the washing chemicals used for cleaning them can also be a cause. Body lotions, creams, the dye on the toilet paper can also be responsible for anal itch.
Internal factors such as frequent liquid stool or chronic diarrhea are frequent causes, while constipation with very firm stool can also play a role. Certain beverages, including alcohol (especially beer), citrus, and caffeine-containing drinks, chocolate, nuts, dairy products, tomato and spicy food can also irritate the anus when they are expelled during a bowel movement. Anal itching can be a side effect of or allergic reaction for antibiotics or other drugs. Systemic diseases such as diabetes, liver- or thyroid diseases can also predispose to it.
Not only the dryness, but also the excessive moisture of the anal skin can bring about itching. Heat together with moisture (sweating, underwear with poor ventilation) is risky especially for overweight or diabetic patients. Excessive secretion production due to inflammed haemorrhoids, anal fistula or fissure, rectal polyp, tumour, cancer, bowel inlammations cause itching through the increase of moist and the change in pH of the skin.
Infections are important factors in itching. The warm, wet conditions around the anus are favoured by mycosis such as Candida or yeast, but parasites such as pinworms, itch, lise, bacteria also favour this location. Genital wharts caused by herpes virus and sexually transmitted other infections (chlamydia, gonorrhea) can also settle down here and some non-infectious skin diseases such as psoriasis, atrophic skin inflammation, eczema may also cause anal itching.
Investigations also suggest a role of mental stress in the developement and worsening of anal itching.
As a conclusion it can be said that the anal itching is connected to the derangement of the normal conditions and balances of the anal skin. The role of the Proctologist in anal itching is to diagnose, to exclude malignant or infective origin and restore the original conditions of the skin with proper treatment. As for the Patient, they by keeping the dietary and lifestyle advices they received, should sustain the restored conditions in order to prevent relapse.