Pruritis ani literally means "itchy anus." It is the most common anal condition and is most often misdiagnosed as hemorrhoids. Hemorrhoids, in contrast to pruritis ani, do not itch or burn and rarely cause any pain or soreness. It is the skin that produces itching and burning sensations. As a result, the most common cause of anal symptoms is a skin problem - pruritis ani - not hemorrhoids.
Pruritis ani is almost always a benign (noncancerous) condition. Very rarely, a skin cancer can develop in this area - just as it can happen in other areas of the skin. Some skin cancers can cause itch so it's important to see a doctor if itching in the anal area doesn't respond to simple measures.
People with pruritis ani will often have redness and significant irritation of the skin around the anus, sometimes with marks from scratching. Even if a person with pruritis ani carefully avoids scratching during the day, they may not be able to resist the urge to do so when they are asleep - hence the "sleep with gloves on" treatment that is sometimes recommended.
The skin in the area may be wet as well. Seeping moisture through the skin surface is common during any significant skin irritation (dermatitis) and is a sign that the skin is breaking down. Pruritis ani is often worse in the summer when we sweat more. However, it is probably not the sweating that is the underlying problem, but rather the addition of salty sweat to skin that is already irritated.
Hot water is a simple test for whether or not you have pruritis ani
If you have symptoms and want to know if it's pruritis ani, sit in a bath of hot water, or direct hot water onto your anus when taking a shower. If it makes your anal area feel better, then you have pruritis ani. If you have hemorrhoids, you won't feel much of anything - hemorrhoids are on the inside of the body, and fairly insensitive. However, some people have a combination of hemorrhoids and pruritis.
Hot baths are sometimes recommended for the treatment of pruritis ani, however this may damage the skin further and make things worse, delaying recovery.
What causes pruritis ani?
There's a long list of suspected reasons for pruritis ani. One of the most common suspicions is a fungus infection. Cultures often show funguses when they are taken from the affected skin, but it appears fungus is a secondary problem and not the true (primary) cause of the problem. Funguses like warm wet environments and so take the opportunity to grow under the favorable conditions of pruritis ani. But, if you take the real cause of the pruritis away and allow the skin to heal, the fungus disappears.
The factors that cause pruritis ani are generally related to the person's diet:
- coffee
- alcohol of any kind, particularly beer and homemade wine
- citrus fruits and juices, particularly grapefruit juice
- milk in adults who don't digest it well
It's unclear why any of these foods and beverages cause sudden irritation of the anal skin, particularly in someone who previously tolerated them. However, a protective barrier in the skin may become altered for some reason, resulting in the skin becoming sensitive to these items.
