Pruritis ani is an unpleasant sensation characterized by varying degrees of perianal itching and burning. In most patients, no underlying cause can be identified and the condition, therefore, is referred to as idiopathic. In about 10% of patients, however, a specific underlying local or generalized disease is the cause. These can be ruled out by a careful history, physical examination and sigmoidoscopy.

Specific causes include:
 Skin disease - contact dermatitis, psoriasis
 Parasitic disease - pin worms, scabies, body louse
 Infections - bacterial, fungal, viral
 Anorectal disease - fissure, fistula, prolapse, hemorrhoids
 Cancer
 Generalized disease - diabetes, gout, kidney failure

The idiopathic form of pruritis ani is poorly understood and several factors including anal hygeine, diet, stress and inefficient emptying of the bowels are important. Pruritis ani is a common condition and is in NO way a pre-cancerous condition. Treatment is effective for most patients.

DON'TS
- don't scratch - this causes breaks in the sensitive perianal skin, resulting in increased pain, itching and bleeding.
- don't used scented, colored toilet paper - dyes and perfumes cause contact dermatitis and increase itching.
- don't drink excess coffee (even decaffeinated), tea, alcohol or colas. During severe attacks, you should avoid citrus fruits, chocolate, tomatoes and spicy foods. These foods have been implicated as a cause of pruritis ani either by their irritating nature or by causing the leakage of mucus. Deleting these foods does not always stop the itching for all patients, but if it does help, the deleted foods are returned to the diet one at a time. If the itching recurs, the offending food should be stopped immediately.
- don't use any skin medications without the advice of your doctor, as some of these preparations can be irritating.
- don't use medicated soaps.

DO'S
- do keep the perianal area clean: tub bath with warm water twice a day wash perianal area with wet toilet paper after each bowel movement or take a bath. Gently dry with paper or a hairdryer. Don't rub harshly. place a small wisp of cotton near the anal opening to absorb any mucus discharge. This will keep the area dry and allow healing to occur. avoid tight underwear(cotton is preferred) and tight fitting clothes.
- do keep bowels regular and make evacuation efficient. Use of 100% bran 1/3 cup per day or Metamucil or Citrucel 1 -2 teaspoons per day will minimize any anal discharge.
- occasionally, you may need to irrigate the rectum after a bowel movement with warm water to minimize leakage which irritates the skin.
- do watch your diet and eliminate foods that seem to make the itching worse (especially coffee).
- it is OK to use steroid containing cream for severe attacks, but this should be used sparingly and only for a short period. Prolonged use can lead to skin damage.

Remember that pruritis ani is a condition that can recur. The measures outlined here will help the majority of sufferers most of the time. If the itching remains uncontrolled please don't hesitate to call the office for a repeat appointment.

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