Symptoms

After itching: itching on the anus

After itching: itching on the anus


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If the anus itches: causes and help with itching

After itching can appear as a short-term harmless symptom that subsides immediately after scratching or also by itself. But with various, sometimes quite serious diseases, an uncomfortable burning and itching in the anal area also develops. The itch on the anus should therefore be checked urgently by a doctor if it occurs repeatedly. In general, itching is a relatively common complaint, but most people are reluctant to talk about it. A variety of different causes can cause itching, from eating certain foods to stress and organic diseases. Children who suffer from intense itching in the anal area are often caused by worm diseases.

Immediate measures: what helps against itching?

In many cases, the itch on the anus is caused by a temporary irritation that subsides over time. Some measures can help the itching to go away faster. However, if there is no improvement, a doctor or medical doctor should be consulted. This can help against itching:

  • Do not scratch! Even if it is difficult, in the long term scratching will worsen the symptoms.
  • After bowel movements, during the menstrual period and before and after sexual intercourse, clean the intimate region with clear water without soap. Then pat the region dry with soft toilet paper.
  • Use a soap-free wash lotion for the intimate area for daily care.
  • Do not use wet toilet towels. These often contain chemical additives and are often the cause of allergic reactions.
  • Avoid creams in the genital area completely or use petroleum jelly without additives.
  • Avoid spicy, spicy, sour and salty food. Nuts, chocolate, milk products or citrus fruits as well as alcohol or caffeinated drinks can also be responsible for the itching.

After itching: overview

The medical term for after itching is pruritus ani. This extremely unpleasant symptom is often associated with a high level of suffering among those affected. Especially at night, the urge to scratch can increase beyond the tolerable. The causes of the itching can be of many different types. If there is no relief after a few days, home remedies and ointments have no effect or the symptoms appear again and again, medical help should be sought. Here is a brief overview of the symptoms:

  • Symptoms: Severe itching in or on the anus, itching can spread to the testicles or labia, skin irritation, burning sensation, reddening of the skin, rash.
  • causes: Lack of hygiene, excessive hygiene, mechanical irritation, inflammation, allergy, spicy foods, hemorrhoids, anal fissure, infection with fungi, viruses or bacteria, chronic bowel diseases with diarrhea, anal cancer, pinworm infection.
  • diagnosis: The responsible specialist for after itching is the proctologist. Most causes can be uncovered by palpation, examination of the anal region, smears, stool samples and, if necessary, by endoscopic proctoscopy.
  • therapy: Depends on the underlying cause (see Treatment of Pruritus ani). In general, it is important to avoid scratching, because regardless of the cause, this leads to a worsening of the symptom in the long term.

Definition

After itching describes a symptom that is characterized by an intense itching in the anal area. The medical term for such impairments is pruritus ani. The terms afterburn and itching are often used to describe the same symptoms, since the burning is accompanied by an itch and the itching or subsequent scratching leads to afterburn.

Symptoms of pruritus ani

There is strong itching directly on the anus, which can spread further over the perineum to the male testicle or the female labia, so that it is additionally itchy or vaginal itchy. Most of those affected give in to the itching and try to get relief by scratching, which can be successful in the short term, but in the long term leads to a considerable deterioration in the symptoms. Because the injuries to the skin that occur when scratching, the development of a so-called anal eczema (itchy rash in the anal area) is promoted. Skin irritation, burning and itching increase significantly. The intensity and duration can vary significantly according to the numerous different causes. Some patients suffer only briefly from the unpleasant symptoms, others suffer from persistent itching for several days, often in connection with an extremely painful burning sensation. Numerous other accompanying symptoms can be observed with the various triggers of the afterburn, which are then explained in more detail in connection with the respective causes.

Causes of After Itch

The spectrum of possible triggers of pruritus ani ranges from relatively harmless allergic reactions and hygienic defects to local infections with bacteria, viruses, fungi or parasites to so-called anorectal diseases (diseases of the rectum and anus). Metabolic diseases such as diabetes or kidney dysfunction can also be mentioned as causes of skin irritation in the anal area and corresponding after itching.

Lack of hygiene or excessive hygiene

In general, the conditions in the anal area favor the appearance of itchy skin. Just like in the genital area, parts of the skin lie on top of each other that cause wrinkles. In these skin folds, warm and humid areas are formed which lead to swelling and cracks in the skin and at the same time offer good starting conditions for the multiplication of germs. Additional bacterial colonization is promoted by contact with stool, urine, discharge and sperm. These initial conditions worsen with pronounced overweight (obesity).

Thorough anal hygiene is particularly important in view of the conditions described. If stool residues remain in the anal area due to inadequate anal hygiene, this can easily lead to inflammatory skin irritation of the anal skin (anoderm), which causes a burning itch. However, excessive hygiene is also known to be a possible cause of after itching. For example, the sensitive anal mucosa is particularly sensitive to contact with the ingredients of soaps and creams. Their use can therefore lead to considerable skin irritation in the anal area. The same applies to printed and perfumed toilet paper. The skin shows a kind of allergic reaction, which is why we are talking about contact allergic anal eczema. This can also be due to an allergy to detergent or the underwear material.

Mechanical irritation

Mechanical irritation of the anoderm and corresponding itching can arise, for example, from the use of too rough toilet paper or unsuitable underwear. The surface of the skin is slightly damaged, which then favors the development of inflammatory processes. The mechanical irritation from rough toilet paper can be avoided, for example, by using moist toilet paper, but this is often enriched with fragrances and preservatives, which in turn promotes the development of contact allergic anal eczema. Other causes of mechanical irritation in the anal area are hiking and long cycling.

Food

Anyone who has ever eaten really well knows that excreting chilli and the like can also lead to an uncomfortable burning and itching sensation in the anal area. In addition to the spicy spices, citrus fruits, tomatoes and numerous other foods are known as possible causes of short-term after itching and burning. Here, however, the symptoms usually subside as soon as the ingested food has been completely excreted.

Hemorrhoids / hemorrhoids

Many people suffer from hemorrhoidal disease, which describes a pathological change in the ring-shaped vascular cushions around the anus. These so-called hemorrhoids are used to close the anus. They prevent the involuntary leakage of stool and secretions. If the tissue of the vascular cushions is weakened, as is the case with increasing age, pathological enlargement of the hemorrhoids and so-called hemorrhoidal nodules sometimes occur, which can also appear outside. Since the closure of the anus only works insufficiently, secretion escapes, which in turn can lead to inflammatory skin changes or the development of anal eczema and can thus cause the after itching. With hemorrhoidal disease, blood residues often appear on the toilet paper after bowel movements and blood residues can also become visible on the surface of the chair.

Anal fissures

Tears in the anal mucosa, also called anal fissures, are primarily extremely painful and less accompanied by itching. They are caused, for example, by a too hard stool consistency with already weakened tissue structure of the anal mucosa. Certain sexual practices such as the anal insertion of vibrators or anal intercourse can also cause the anoderm to tear. Especially during and after bowel movements, those affected suffer from an extremely painful burning sensation in the area of ​​the open wound, which can lead to cramps and obstruction of the stool output. If the anal fissure heals over time, this is often accompanied by severe itching. However, scratching can cause the wound to reopen and should therefore be avoided if possible. In the case of an anal fissure, bright red blood residues can often be observed on the toilet paper - similar to hemorrhoidal disorders.

Infections

Local infections with bacteria, fungi or viruses can also cause itching on the anus. The pathogens affect the upper layers of the skin and lead to corresponding skin irritation, usually in the form of a rash with redness, pustules, blisters and dandruff. Bacteria that can cause corresponding infections in the anal area include streptococci and staphylococci. Viral infections in the genital and anal areas, which can cause an uncomfortable itch, are often due to so-called human papilloma viruses (triggers of genital warts). Fungal infections and the corresponding rash are usually triggered by a pathological increase in the yeast Candida albicans. Injuries when scratching can significantly worsen the symptoms of local infections, as the pathogens reach deeper layers of the skin via an open wound. In the worst case, if the infection spreads massively, the patient is at risk of life-threatening blood poisoning.

Parasitic infections can also be mentioned as possible causes, with the so-called pinworm infections playing a particularly important role here. When it is infected with pinworms, the itching is caused by the egg laying of the female pinworms in the area of ​​the anus. Usually the animals live in the intestine and only leave it to place their eggs in the anus area. In addition to the after itching, symptoms such as abdominal pain, diarrhea and possibly rectal bleeding can be observed in the case of a severe pinworm infection. In addition, there are complaints of appendicitis such as loss of appetite, fever, nausea and vomiting. When scratching, the highly infectious eggs can stick to your fingers, which increases the risk of infection in the environment and promotes the oral intake of the eggs by those affected again. The skin is also injured by scratching, which can lead to inflammatory processes and secondary infections. Other parasites that can cause infection in the anal area and corresponding after itching are, for example, itch mites.

Other causes of after itching

Numerous other factors can cause itching in the anus, but they are significantly less common than the triggers already mentioned. For example, the itching occasionally stems from a skin tags (anatomical peculiarity; anal wrinkle) or an inherited skin disease such as Darier's disease. Non-hereditary skin diseases (for example lichen sclerosus) can also be the cause. Seborrheic dermatitis and perianal psoriasis (psoriasis in the anal area) should be mentioned as other skin diseases that cause an unpleasant after itch. The latter causes a whitish coating that resembles a fungal infection instead of the typically typical skin flakes.

In addition, after-itching is increasingly observed in connection with diseases in which chronic diarrhea is part of the clinical picture, such as Crohn's disease. Proctological diseases such as anal polyps, rectal polyps and cancers such as perianal carcinoma or anorectal melanoma can also be mentioned as possible triggers for after-itching.

Women suffer more from itching as a result of hormonal changes or lowering of estrogen levels after menopause. Itching can also occasionally occur in connection with a lack of vitamins (B + A) in the blood. If no physical causes can be identified, there is talk of an “idiopathic after itch”. A connection with psychological stress or stress is also suspected here.

Diagnosis

Persistent or repeated itching in the anal area should be checked by a specialist or proctologist. Since the complaints can be based on a variety of causes, all symptoms are first queried as part of a detailed anamnesis in order to enable the symptoms to be narrowed down here. This is followed by a proctological examination in which the skin of the anal region is examined more closely, the anus is scanned and, if necessary, an endoscopic proctoscopy is carried out. Possible hemorrhoidal disorders, anal fissures and various other proctological diseases can usually be clearly diagnosed in this way. If there is an infectious rash in the anal area, a smear followed by a laboratory test can be used to detect the bacteria, viruses or fungi. With a stool sample, a pinworm infection can be determined and a blood test provides important information about a possible vitamin deficiency and systemic diseases. A so-called rectoscopy and the taking of a tissue sample is carried out, for example, if cancer is suspected.

Treatment of pruritus ani

Regardless of the causes, it should be noted that scratching should be avoided - despite the itching sensation, otherwise the symptoms will deteriorate. In addition, other therapeutic measures should always be based on the causes of the symptoms. If, for example, the pruritus ani is based on allergic reactions to cosmetics and hygiene products, the complaints can generally be resolved by not using the corresponding products and / or by changing anal hygiene. In conventional medicine, acute inflammatory skin irritations are often treated with glucocorticoids, but these pose a considerable risk of side effects, especially when used for a long time. A long-term therapy of inflammatory skin diseases in the anal area is therefore usually carried out with gentler drugs, such as ointments based on ammonium bituminosulfonate.

Hemorrhoid treatment

Diseases of the hemorrhoids are often first treated with so-called hemorrhoidal agents (hemorrhoidals), which can be purchased in the form of suppositories, ointments, creams, multi-pads or anal tampons in the pharmacy. However, their effects are controversial in the professional world and self-therapy without medical support is strongly discouraged. With the help of a change in diet, stool consistency can be influenced in order to reduce the pressure on the hemorrhoids during bowel movements. A high fiber content and sufficient fluid intake contribute to a softer stool consistency. In general, those affected should avoid pressing hard when they have a bowel movement. Severe cases of hemorrhoidal disease require outpatient or even inpatient surgery.

Therapy for anal fissures

In the treatment of anal fissures, too, a change in diet is usually provided in order to achieve a softer stool consistency and to keep the stress on the anal mucous membrane as low as possible during bowel movements. For severe pain, ointments with local anesthetics can be used for relief. In addition, other ointments are available for local use, which should allow relaxation of the sphincter. With adequate care and thorough anal hygiene, the anal fissures usually heal completely within a maximum of two months. If this is not the case, surgery can be considered.

Treatments for infections

Bacterial skin infections in the anal area are usually treated with the external use of antibiotic agents, antifungals are used against fungal infections, and so-called antivirals or cytostatics can be used against viral infections. However, viral infections are much harder to treat than bacterial and fungal infections because the drugs often do not show the desired effectiveness. Nevertheless, the chances of a cure for infectious skin diseases in the area of ​​the anus are relatively good overall.

So-called anthelmintics (worming agents) are administered against parasitic infections with pinworms, which are said to cause the worms to die. A particularly thorough hygiene with changing the underwear several times a day is also a prerequisite for the therapy in order to avoid re-infections. The fingernails should also be cut short so that the eggs of the pinworms cannot stick here. Furthermore, a daily change of bed linen may be appropriate. Any laundry possibly contaminated with pinworms should be washed at at least 60 degrees to ensure that the worm eggs die.

Further treatment approaches

Corresponding to the numerous possible causes of after-itching, a number of other treatment approaches come into play, ranging from the use of anti-inflammatory and healing ointments for anal eczema to surgical interventions for skin tags and tumors to radiation therapy for cancer diseases that are difficult to treat. Which measures are required in the end largely depends on the individual symptoms of the patient.

Naturopathy

Naturopathy has effective remedies and measures against many causes of after itching. For example, skin irritation in the anal area is often treated on a plant basis with ointment from marigolds, horse chestnuts and arnica. I have also tried marigold ointment against hemorrhoids. The same applies to hip baths made of chamomile, horsetail and oak bark extract as well as extracts of witch hazel (witch hazel). However, such baths should only be used for a short period of time without a doctor's consultation.

However, according to its holistic use, naturopathy also includes other aspects, such as a possible overacidification of the organism and digestive complaints (e.g. constipation) in the treatment. For example, the active substances aloe, aesculus and nux vomica are used as homeopathic remedies for hemorrhoids. Against anal fissures, homeopathy uses Ratanhia. Sulfur is said to be a general homeopathic remedy for the itching of the anus. So-called orthomolecular medicine is increasingly being used in naturopathic therapy if an association of after-itching with a vitamin deficiency is suspected. If the symptoms are related to psychological factors, learning relaxation methods (e.g. autogenic training) can be an important part of the therapy. In many cases of serious proctological diseases, naturopathy only offers options to support conventional medical therapy. (fp, vb)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Professional association of German internists e.V .: causes & risk factors of hemorrhoids (accessed: 08/13/2019), internisten-im-netz.de
  • Merck and Co., Inc .: After Itch (Pruritus ani) (accessed: August 13, 2019), sdmanuals.com
  • German Society for Coloproctology (DGK): S3 guideline on hemorrhoidal disease, as of April 2019, detailed view of guidelines
  • Rectal and large intestine center Essen: anal fissure (anal tear) (access: 13.08.2019), enddarmzentrum-essen.de
  • Mayo Clinic: Anal itching (accessed: August 13, 2019), mayoclinic.org
  • National Health Service UK: Itchy anus (accessed: 13.08.2019), nhs.uk
  • Harvard Health Publishing: Anal Itch (Pruritus Ani) (accessed: August 13, 2019), health.harvard.edu


Video: Itchy Anus Dr Rosenfeld - CBS Doctors (May 2022).