Anal Itching (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Anal itching facts
- What is anal itching?
- What causes anal itching?
- What are additional symptoms associated with anal itching?
- What kind of doctor treats anal itching?
- How is the cause of anal itching diagnosed?
- What is the treatment for anal itching?
- Local anesthetics
- What if anal itching persists?
- Take the Hemorrhoids Quiz
- Inflammatory Bowel Disease (IBD) Slideshow Pictures
- Psoriasis Slideshow Pictures
What are additional symptoms associated with anal itching?
- The intensity of anal itching and the amount of inflammation increases from the direct trauma of scratching and the presence of moisture.
- At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness, especially during and after bowel movements.
- There also may be small amounts of bleeding.
What kind of doctor treats anal itching?
Although anal itching can be evaluated by a family practice or internal medicine physician, it most often is evaluated by a colorectal surgeon (proctologist) and sometimes by a gastroenterologist.
How is the cause of anal itching diagnosed?
Anal itching is first evaluated with a careful examination of the anus for such abnormalities as hemorrhoids, fissures, skin tags, moisture, and excoriations (breaks in the skin from scratching).
A rectal examination with a finger inserted into the anal canal can identify rectal tumors. For a closer look at the anal canal, a proctoscope can be used. A proctoscope is a short tube that is inserted through the anus and into the rectum so that the anal canal can be examined visually If pinworms are suspected, they and their eggs can be identified using the pinworm test, a test in which the worms and eggs are recovered from the anus using transparent adhesive tape.
What is the treatment for anal itching?
Initial treatment of simple itching is directed toward relieving the burning and soreness. It is important to clean and dry the anus thoroughly and avoid leaving soap in the anal area.
- Cleaning efforts should include gentle showering without direct rubbing or irritation of the skin with either the washcloth or towel.
- After bowel movements, moist pads (such as baby wipes, flushable moist wipes, and flushable anal cleansing wipes) should be used for cleaning the anus instead of toilet paper.
- If there is constant moisture present in the anus or stool incontinence, it may be necessary to clean the anus with moist pads between bowel movements.
Many over-the-counter (OTC) products are sold for the treatment of anal itching and are available as ointments, creams, gels, suppositories, foams and pads. These products often contain the same drugs used to treat hemorrhoids.
- When used around the anus, ointments, creams, and gels should be applied as a thin covering.
- When applied to the anal canal, these products should be inserted with a finger using finger cots (latex covers for the fingertips) or a "pile pipe." Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion.
- Suppositories or foams do not have advantages over ointments, creams, and gels.
Most products contain more than one type of active ingredient. Almost all contain a protectant in addition to another ingredient. Only examples of brand-name products containing one ingredient in addition to the protectant are discussed in this article.
Local anesthetics temporarily relieve pain, burning, and itching by numbing the nerve endings. The use of these products should be limited to the perianal area and lower anal canal. Local anesthetics can cause allergic reactions with burning and itching. Therefore, the application of anesthetics should be discontinued if burning and itching increase.
Examples of local anesthetics include:
- benzocaine 5% to 20% (Americaine Hemorrhoidal, Lanacane Maximum Strength, Medicone)
- benzyl alcohol (Itch-X) 5% to 20%
- dibucaine 0.25% to 1.0% (Nupercainal)
- dyclonine 0.5% to 1.0%
- lidocaine (Xylocaine) 2% to 5%
- pramoxine 1.0% (Fleet Pain-Relief, Procto Foam Non-steroid, Tronothane Hydrochloride)
- tetracaine 0.5% to 5.0%
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