Pruritis sudden is a common medical problem that affects both men and women. It affects 1% to 5% of the general population. It is more common in men than women at a ratio of 4: 1. It is more common between the ages of 40 and 60. Pruritis ani has many causes and understanding the cause is important for the treatment plan. Medical treatment of pruritis ani is generally effective in relieving symptoms and increasing quality of life.

What is Pruritis Ani?

Pruritis sudden means "itchy anus" in Latin and is described as an uncomfortable sensation that causes itching in the skin around the anus. Pruritis can be classified as sudden primary and secondary. In primary, the cause is unknown, whereas in the secondary form, there is an established and usually treatable cause.

Mild irritation on the skin can cause itching. By scratching, irritation in the skin in this area may be increased and a more itchy condition may occur in a wider area. Scratching constantly increases the need for scratching, which further exacerbates the problem.
What causes Pruritis Ani?

Itching can occur in many anorectal diseases. Hemorrhoids, skin tag (protrusion on the skin), fecal contamination or stool incontinence, anal fistulas (abnormal connection between intestine and skin), anal fissures (crack in the anal skin), warts in the anal area are among the possible causes. The cause of primary pruritis sudden is not always well understood. It is believed that secretions from the anal canal cause itching. Nerve fibers in the anal area can become chronically active as a result of repetitive trauma or scratching. Itching may also occur due to nerve stimulation due to stimulation of the central nervous system due to reasons such as drugs. Sometimes itching may occur for psychological reasons.

Other causes of irritation may include sweating, moisture in the anal area, stool and mucus. Studies have shown that clearing stool quickly from that area reduces itching. Along with poor hygiene, aggressive hygiene can actually cause irritation. Soaps, fragrances, and lotions are other causes of irritation. In addition to excessive hygiene, the use of topical steroid creams can further exacerbate the problem by breaking the natural resistance of the skin.
Diet may also play a role in pruritis ani. Coffee is thought to be the most important factor in this regard. Coffee consumption lowers anal pressure during the resting phase and may cause feces to escape from the anus. Other foods that can play a role are tea, cola, energy drinks, chocolate, acidic fruits, tomatoes, spicy foods, beer, and dairy products.

Infectious diseases can also cause pruritis sudden. Examples include bacterial skin infections, fungal infections, parasitic infections such as pinworms or scabies, and viral infections such as anal warts.

Apart from these, diseases such as psoriasis, dermatitis, lichen diseases can also cause pruritis ani. Local cancers such as Bowen's disease or extra-breast Paget's disease are also among the causes of pruritis ani.

In addition, medical conditions that affect the whole body such as diabetes, leukemia, lymphoma, kidney failure, liver disease, iron deficiency anemia and hyperthyroidism may accompany sudden pruritis.
Although there are so many factors, a specific cause of itching may never be revealed.

Patient Assessment

Information should be obtained from the patient with a careful history, how long it has been going on, when it happened, and whether there is any other accompanying finding. It should be asked whether the frequency and consistency of the stool, toilet habits, whether there is stool or mucus incontinence, a sense of perianal dampness or a feeling that the stool cannot be completely evacuated. In addition, information should be obtained about hygiene practices and post-defecation cleaning. It is asked whether the drugs and diet-related foods that are mentioned above have been consumed in large quantities.

The doctor carefully examines the anal area and notes signs such as wounds, cracks, redness, and thickening of the skin. In addition to this inspection, the doctor also examines the anus and lower end of the rectum with a finger. In addition, he can examine the inside of the anal area in more detail with a device called anoscopy. If necessary, a biopsy can be taken or a swab can be taken from the skin. If necessary, other parts of the body can be examined.
Treatment of Pruritis Ani

The goal of the treatment is that the patient has a clean, dry and intact perianal skin. Treatment can sometimes be difficult, as there are so many possible factors. It is important to regulate bowel movements, to prevent possible leakage from the anus by increasing stool consistency and to evacuate completely by defecation. Fiber foods and fiber supplements may be recommended for this.

Dietary habits should be reorganized by avoiding the excess of the foods mentioned above. Another method is to try to understand which food touched the patient by avoiding each of these foods completely for a few weeks respectively.

Toilet hygiene and cleaning habits need to be reviewed. Excessive cleaning should be avoided and washing with water should be recommended. Soaps, perfumes, deodorant wet wipes should be avoided as they may be irritating. If soap is to be used, plain natural soap should be used and then washed with plenty of water. Cleaning should be avoided in the form of scratching with toilet paper. Many people can behave this way involuntarily. Drying with a hair dryer can be done after cleaning to keep the skin in the anal area dry. Tight and synthetic clothes should not be worn.
Short-term 1% hydrocortisone steroid creams can be used 2 or 3 times a day to control symptoms. Long-acting topical steroids such as betamethasone are also effective. The use of long-term steroid or strong-acting steroid creams can cause skin weakness and thinning, making pruritis ani worse. Steroid creams should not be used for more than 4 to 8 weeks.

Creams that will create a protective layer on the skin such as zinc oxide can also be useful for protecting the skin from irritating substances. Additionally, menthol, phenol, camphor, or a combination thereof may also be useful. If infection is suspected, topical antibiotics or antifungals (fungicides) can be used.

As an alternative to these medications, your doctor may recommend Berwick dye, topical capsaicin, or methylene blue injection.