Anal itch (pruritis ani)

Anal itching is most often misdiagnosed as hemorrhoids.  In fact, hemorrhoids are usually not itchy.  Hemorrhoids are inside structures covered by bowel lining (mucosa).  Bowel lining does not have proper itch receptors.  The skin, as we all know, has excellent itch receptors.  So when itching is a problem around the anus, it is almost always a skin problem.  This can be due to simple irritation of the skin, a more significant inflammation of the skin called dermatitis, or possibly an anal fissure (a crack in the anal canal skin).

Another frequent misdiagnosis as the cause of anal itch is pinworms or other infestations.  These are almost never responsible.  A rare superficial cancer of the anal skin (Bowen’s Disease) can sometimes be identified as the cause of pruritis ani in an elderly patient.  Biopsies are generally required to make the diagnosis of Bowen’s Disease, so if a patient repeatedly fails to improve following treatment or if the skin around the anus looks unusual, a skin biopsy of the area should be undertaken.

Treatment of pruritis ani includes diet changes, altered hygiene methods, occasionally anti-inflammatory topical ointments, and treatment any underlying cause such as a fissure, if present.

© Pezim Clinic, Vancouver, British Columbia, Canada