Approach to the patient with anal pruritus
- Elizabeth Breen, MD
Elizabeth Breen, MD
- Assistant Professor of Surgery
- Harvard Medical School
- Ronald Bleday, MD
Ronald Bleday, MD
- Associate Professor of Surgery
- Harvard Medical School
Itching of the anus or perianal skin is a common disorder usually arising from benign conditions. It may be transient or chronic and difficult to treat. This topic will review the etiology, diagnostic approach, and management of patients with anal pruritus.
Anal pruritus is estimated to affect 1 to 5 percent of the general population . However, most of these patients probably do not come to medical attention. Anal pruritus is more common in the fourth to sixth decades of life and has a higher prevalence in males .
Approximately 75 percent of cases of anal pruritus are secondary to inflammatory, infectious, systemic, neoplastic, and anorectal disorders that contribute to or underlie the development of pruritus [2,3]. Idiopathic anal pruritus likely results from perianal fecal contamination and resultant trauma from wiping and scratching.
Anorectal diseases — Anorectal diseases associated with anal pruritus include prolapsed internal hemorrhoids, abscesses, fissures, and fistulas (picture 1 and picture 2 and picture 3) . Skin tags do not contribute significantly to anal pruritus . (See "Hemorrhoids: Clinical manifestations and diagnosis", section on 'Clinical manifestations' and "Perianal and perirectal abscess" and "Anal fissure: Clinical manifestations, diagnosis, prevention" and "Anorectal fistula: Clinical manifestations, diagnosis, and management principles", section on 'Clinical features'.)
Dermatologic diseases — Anal pruritus can also result from a variety of inflammatory skin disorders .
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- Anorectal diseases
- Dermatologic diseases
- Systemic diseases
- Dietary factors and medications
- Fecal soilage
- DIAGNOSTIC APPROACH
- Physical examination
- Laboratory testing
- Initial management
- Refractory symptoms
- - Capsaicin
- - Other
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS