Proctology

Anal Itching

Anal Itching

The anal itching – a pathological condition characterized by persistent itching in the anus. The disease occurs quite often, and Coloproctology know how serious it is, and how difficult it is to achieve lasting positive treatment outcome.

Anal itching should be clearly divided into “primary” (synonyms: true, shanny, cryptogenic, idiopathic, neurogenic, essential) and “secondary”, often accompanying as the main symptom of diseases such as hemorrhoids, anal fissure, worm infestation, proctosigmoiditis various etiologies, insufficiency of the sphincter of the anus, constipation (diarrhea), inflammation of genitals, exposure to harmful endogenous and exogenous substances and factors fungal skin in the sacrococcygeal region. In addition, anal itching can be an early sign of latent diabetes.

If the causes of secondary anal itching listed above are more or less known, the etiology of primary, true, and pruritus of this region are not fully understood.

Noteworthy are the studies indicating a major role of latent (at least not clinically manifested) chronic proctosigmoiditis. The dramatic shift in the content of rectum and sigmoid to the alkaline side (pH 8.5 to 10.0) in patients with chronic anal itching, the presence in Calais unsplit proteolytic enzymes contribute to content growth in the perianal skin of residual nitrogen from 6-8 to 14— 17 g/l, its impact on nerve endings, i.e. itching. In this case, however, in the very sensitive nerve endings perianal skin any characteristic changes were found.

Causes

Idiopathic itch. Often without obvious specific causes. As a result of reduced ability to retain fluid in the anus, a small amount of mucus from the rectum gets on the skin of the perianal area and cause irritation.

  • Unrecoverable diseases: hemorrhoids, fistulas, fissures, genital warts, purulent hydradenitis, tumors, sphincter dysfunction, vaginal.
  • Dermatological diseases: psoriasis, seborrheic dermatitis, atopic eczema, flat lichen, etc.
  • Contact dermatitis from topical application of ointments, deodorants, powders, Soaps, suppositories, etc.
  • Infection: fungi (Candida), bacteria (scratching).
  • Parasites: E. Vermicularis, trichomoniasis, scabies, pubic lice.
  • Oral antibiotics: tetracycline, erythromycin, etc.
  • Systemic diseases: diabetes, liver disease.
  • Personal hygiene: insufficient or excessive.
  • Heat and humidity: narrow clothing, warm climate, obesity, intense physical activity.
  • Food: drinks (coffee, tea, Cola, milk, beer, wine), food (condiments, hot peppers, tomatoes, citrus fruits, chocolate).

Symptoms

Often itching in the anus is the main and only complaint of the patient.

The clinical course it is expedient to distinguish between acute and chronic anal itching true. For the first form (the stage) is characterized by sudden onset, constant current, significant intensity and local changes in the skin like wet eczema with maceration, signs of scratching, hypertrophy perianal folds. In chronic itching, on the contrary, the beginning is slow, the skin is often dry, thinning (compare it with parchment paper), sometimes depigmentirovannah, no signs of scratching at all, or they have the appearance of thin, linear abrasions, skin folds radiare, expressed little (“spokes of wheel”).

Classification and types

Anal itching should be clearly divided into “primary” (synonyms: true, shanny, cryptogenic, idiopathic, neurogenic, essential) and “secondary”, often accompanying as the main symptom of diseases such as hemorrhoids, anal fissure, worm infestation, proctosigmoiditis various etiologies, insufficiency of the sphincter of the anus, constipation (diarrhea), inflammation of genitals, exposure to harmful endogenous and exogenous substances and factors fungal skin in the sacrococcygeal region. In addition, anal itching can be an early sign of latent diabetes.

If the causes of secondary anal itching listed above are more or less known, the etiology of primary, true, and pruritus of this region are not fully understood.

It is also necessary to distinguish between acute and chronic anal itching true. For the first form (the stage) is characterized by sudden onset, constant current, significant intensity and local changes in the skin like wet eczema with maceration, signs of scratching, hypertrophy perianal folds. In chronic itching, on the contrary, the beginning is slow, the skin is often dry, thinning (compare it with parchment paper), sometimes depigmentirovannah, no signs of scratching at all, or they have the appearance of thin, linear abrasions, skin folds radiare, expressed little (“spokes of wheel”).

Diagnostics

Diagnose disease seems to be just itching at the anus is the main and only complaint of these patients. However, the definition of the type of itching (real or secondary), its stage (acute or chronic), form (dry or wet), as well as figuring out causes of secondary pruritus is not so easy.

First of all, you need to install:

1) if itching is associated with defecation. This symptom could indicate a lack of function of the sphincter of the anus, which is often observed in chronic hemorrhoids, rectal prolapse, various traumatic injuries sphincter (postpartum, postoperative, etc.), nervous lesions (especially in children), sexual perversion. To determine the degree of failure is possible only with the help of sfinkterami;

2) if itching is enhanced after taking alcohol, spicy or salty foods: the presence of this feature indicates the presence of proctosigmoiditis;

3) does the patient in the home or the workplace the harmful effects of chemical production, exposure, work in dusty environments, under high temperature, etc.;

4) there are no close contact with Pets (worm infestation);

5) a patient or his relatives diabetes, fungal infections, constipation, diarrhea.

From laboratory studies under anal itching produce blood sugar and a three-fold analysis of a feces on eggs of worms. In case of pathological changes using a conventional (rigid) sigmoidoscopy should be performed barium enema. Men need to eliminate urethritis and prostatitis in women — vaginal itching. In the presence of unstable stool should do the bacteriological analysis of fecal microflora: in severe dysbiosis therapy anal itching should include special medicines.

Treatment

Treatment of anal itching is a complex business, requiring patience and perseverance of the doctor and the patient. Secondary itching of the actions of the physician definite therapy of the underlying disease. It is important to diagnose even the initial stage of hemorrhoids, papillitis, criptica, not to mention anal fissure, rectal prolapse or insufficiency of sphincter of the anus of any etiology. In these cases, as a rule, itching is a symptom of an underlying disease.

If sigmoidoscopy revealed proktoshigmoidit it is necessary to conduct a full course of appropriate treatment.

If there is intestinal dysbiosis without proctosigmoiditis, the treatment of anal itching combine with the appointment of the bacterial preparations.

However, the most persistently leaking those forms of anal itching, in which the most thorough questioning of the patient, clinical and laboratory studies no pathology detected. In these cases, you should start the treatment with therapy hidden proctosigmoiditis: diet, microclysters with collargol, skin ointment. For the removal of pathological reflex with itchy perianal skin of such patients is advisable to apply different types of injectable treatment.

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