John Murtagh, Patient Education, Third edition, McGraw-Hill Book Company

Pruritus ani
What is pruritus ani?
Pruritus ani simply means 'itch of the anus' or 'itchy
backside'. It is a very common disorder of the skin surrounding
the anus. In children threadworms may be suspected; however,
it is usually seen in adult males with considerable inner drive,
often at times of stress and in hot weather when sweating is
excessive.
What are the causes and aggravating
factors?
It can be caused or aggravated by:
medical problems such as eczema, threadworms, antibiotic
treatment, diabetes and fungal infection
tinea cruris or 'jock itch', which has to be ruled out
local anal disorders such as piles, fissures and warts
poor hygiene
excessive sweating (e.g. due to tight clothing such as panty
hose in summer)
contact dermatitis caused by dyed or perfumed toilet tissue,
soap, powders or clothing
overwork, both physical and mental
obesity
RuIes of treatment
1. Scratching
Stopit's taboo! If you scratch at night, wear light cotton
gloves to bed.
2. Bathing
Avoid hot water. Excessive showering and scrubbing is also
bad for this condition. Use a cream such as bland aqueous
cream for cleaning rather than soap.
3. Drying
Keep the area as dry and cool as possible. After washing,
dry gently and thoroughly with a soft towel or soft tissue: do
not rub. Warm air from a hairdryer is very useful.
4. BoweI movements
Keep bowels regular and smooth by eating plenty of high-
fibre foods such as bran, fresh carrots and apples. Some
doctors claim that your bowel actions should be so smooth and
complete that toilet paper should not be necessary.
5. ToiIet
Clean gently after bowel movements. Use soft paper tissue
(avoid pastel tints), then clean with tufts of cottonwool with
aqueous cream or bland soap and water. The best way is to use
cottonwool wetted with warm water only.
6. Soaps and powder
Do not use perfumed soaps and talcum powder, including
baby powder. A neutral soap such as Dove or Neutrogena is
preferable.
7. CIothing
Wear loose clothing and underwear. In men, boxer shorts
should be used in preference to jockey shorts. Cottons should
be used. Let the air circulate in the area. At times a skirt but no
underpants (in women) is desirable. Avoid panty hose if
possible.
8. TopicaI creams
Do not use ointments or creams unless your doctor has
prescribed them. If a cream has to be used, simple creams may
be the most soothing (e.g. toilet lanoline).
Seek your doctor's advice before using 'over-the-counter'
prescriptions. Your doctor may prescribe a special cream.
Remember
Pruritus ani will certainly settle with this plan of
management.
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