Pruritus Ani

  • Bradley R. DavisEmail author


Pruritus is a common presenting symptom in patients presenting to the office for proctologic evaluation. The causes are extensive and may be the result of an anatomic abnormality. Treating physicians must be diligent to obtain a thorough history. Itching throughout the day, which awakens patients at night, is more commonly idiopathic and surgical intervention is unnecessary. Topical steroids used sparingly can often break the cycle with subsequent attempts to maintain a dry perineum. Other therapeutic options include the use of topical capsaicin and injection of intradermal methylene blue.


Idiopathic pruritus Secondary pruritus Pruritoceptive itching Scratch-itch cycle Fecal soiling Dietary modification Dermatologic Capsaicin Methylene blue 


  1. 1.
    Oueidat D, Bou Assi T, Jurjus A. Pruritus ani: more than a decade of personal experience in Lebanon. J Med Liban. 2014;62(4):203–6.PubMedGoogle Scholar
  2. 2.
    Siddiqi S, Vijay V, Ward M, Mahendran R, Warren S. Pruritus ani. Ann R Coll Surg Engl. 2008;90(6):457–63.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Hanno R, Murphy P. Pruritus ani. Classification and management. Dermatol Clin. 1987;5(4):811–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Murrray DH. Pruritus ani the probable cause and outline of treatment. J Am Med Assoc. 1911;LVII(24):1913–4.CrossRefGoogle Scholar
  5. 5.
    Ringkamp M, Schepers RJ, Shimada SG, Johanek LM, Hartke TV, Borzan J, et al. A role for nociceptive, myelinated nerve fibers in itch sensation. J Neurosci. 2011;31(42):14841–9.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Twycross R, Greaves MW, Handwerker H, Jones EA, Libretto SE, Szepietowski JC, et al. Itch: scratching more than the surface. QJM. 2003;96(1):7–26.PubMedCrossRefGoogle Scholar
  7. 7.
    Kuehn HG, Gebbensleben O, Hilger Y, Rohde H. Relationship between anal symptoms and anal findings. Int J Med Sci. 2009;6(2):77–84.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Abramowitz L, Benabderrahmane M, Pospait D, Philip J, Laouenan C. The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract. 2014;20(4):301–6.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Caplan RM. The irritant role of feces in the genesis of perianal itch. Gastroenterology. 1966;50(1):19–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Allan A, Ambrose NS, Silverman S, Keighley MR. Physiological study of pruritus ani. Br J Surg. 1987;74(7):576–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Farouk R, Duthie GS, Pryde A, Bartolo DC. Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: physiological evidence from ambulatory monitoring. Br J Surg. 1994;81(4):603–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith LE, Henrichs D, McCullah RD. Prospective studies on the etiology and treatment of pruritus ani. Dis Colon Rectum. 1982;25(4):358–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Marks MM. The influence of the intestinal ph. on anal pruritus. South Med J. 1968;61(9):1005–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Friend WG. The cause and treatment of idiopathic pruritus ani. Dis Colon Rectum. 1977;20(1):40–2.PubMedCrossRefGoogle Scholar
  15. 15.
    Kahlke V, Jongen J, Peleikis HG, Herbst RA. Perianal streptococcal dermatitis in adults: its association with pruritic anorectal diseases is mainly caused by group B Streptococci. Color Dis. 2013;15(5):602–7.CrossRefGoogle Scholar
  16. 16.
    Baral J. Pruritus ani and Staphylococcus aureus. J Am Acad Dermatol. 1983;9(6):962.PubMedCrossRefGoogle Scholar
  17. 17.
    Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Derm Venereol. 1971;51(6):444–7.PubMedGoogle Scholar
  18. 18.
    Watts PJ, Greenberg HL, Khachemoune A. Unusual primary syphilis: presentation of a likely case with a review of the stages of acquired syphilis, its differential diagnoses, management, and current recommendations. Int J Dermatol. 2016;55:714–28.PubMedCrossRefGoogle Scholar
  19. 19.
    Birkmann A, Zimmermann H. HSV antivirals—current and future treatment options. Curr Opin Virol. 2016;18:9–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Long KC, Menon R, Bastawrous A, Billingham R. Screening, surveillance, and treatment of anal intraepithelial neoplasia. Clin Colon Rectal Surg. 2016;29(1):57–64.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Zuccati G, Lotti T, Mastrolorenzo A, Rapaccini A, Tiradritti L. Pruritus ani. Dermatol Ther. 2005;18(4):355–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Gray M, Beeckman D, Bliss DZ, Fader M, Logan S, Junkin J, et al. Incontinence-associated dermatitis: a comprehensive review and update. J Wound Ostomy Continence Nurs. 2012;39(1):61–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Nasseri YY, Osborne MC. Pruritus ani: diagnosis and treatment. Gastroenterol Clin N Am. 2013;42(4):801–13.CrossRefGoogle Scholar
  24. 24.
    Stermer E, Sukhotnic I, Shaoul R. Pruritus ani: an approach to an itching condition. J Pediatr Gastroenterol Nutr. 2009;48(5):513–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Jillson OF. Pruritus ani: disputing the passage. Cutis. 1984;33(6):537, 41, 44 passim.Google Scholar
  26. 26.
    St Georgiev V. Chemotherapy of enterobiasis (oxyuriasis). Expert Opin Pharmacother. 2001;2(2):267–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Rezaee E, Goldust M, Alipour H. Treatment of scabies: comparison of lindane 1% vs permethrin 5. Skinmed. 2015;13(4):283–6.PubMedGoogle Scholar
  28. 28.
    Do-Pham G, Monsel G, Chosidow O. Lice. Semin Cutan Med Surg. 2014;33(3):116–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Daniel GL, Longo WE, Vernava AM 3rd. Pruritus ani. Causes and concerns. Dis Colon Rectum. 1994;37(7):670–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Murie JA, Sim AJ, Mackenzie I. The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haemorrhoidectomy or rubber band ligation. Br J Surg. 1981;68(4):247–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Bowyer A, McColl I. A study of 200 patients with pruritus ani. Proc R Soc Med. 1970;63(Suppl):96–8.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF. Allergic and irritant contact dermatitis. Eur J Dermatol. 2009;19(4):325–32.PubMedGoogle Scholar
  33. 33.
    Nahm DH, Lee ES, Park HJ, Kim HA, Choi GS, Jeon SY. Treatment of atopic dermatitis with a combination of allergen-specific immunotherapy and a histamine-immunoglobulin complex. Int Arch Allergy Immunol. 2008;146(3):235–40.PubMedCrossRefGoogle Scholar
  34. 34.
    Carli P, Cattaneo A, De Magnis A, Biggeri A, Taddei G, Giannotti B. Squamous cell carcinoma arising in vulval lichen sclerosus: a longitudinal cohort study. Eur J Cancer Prev. 1995;4(6):491–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Neill SM, Tatnall FM, Cox NH. Guidelines for the management of lichen sclerosus. Br J Dermatol. 2002;147(4):640–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Assmann T, Becker-Wegerich P, Grewe M, Megahed M, Ruzicka T. Tacrolimus ointment for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol. 2003;48(6):935–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Wang G, Li C, Gao T, Liu Y. Clinical analysis of 48 cases of inverse psoriasis: a hospital-based study. Eur J Dermat. 2005;15(3):176–8.Google Scholar
  38. 38.
    Kalb RE, Bagel J, Korman NJ, Lebwohl MG, Young M, Horn EJ, et al. Treatment of intertriginous psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2009;60(1):120–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Lian P, Gu WL, Zhang Z, Cai GX, Wang MH, Xu Y, et al. Retrospective analysis of perianal Paget's disease with underlying anorectal carcinoma. World J Gastroenterol. 2010;16(23):2943–8.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Perez DR, Trakarnsanga A, Shia J, Nash GM, Temple LK, Paty PB, et al. Management and outcome of perianal Paget’s disease: a 6-decade institutional experience. Dis Colon Rectum. 2014;57(6):747–51.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Lo OS, Li GK, Law WL. Management of perianal extramammary Paget’s disease involving the dentate line without abdominoperineal resection. Tech Coloproctol. 2016;20:419–22.PubMedCrossRefGoogle Scholar
  42. 42.
    Zhan W, Liao X, Tian T, Zhang RY, Li P, Wu XP, et al. Perianal multiple Bowen’s disease: a case report. Int J Clin Exp Pathol. 2015;8(11):15039–41.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Bath-Hextall FJ, Matin RN, Wilkinson D, Leonardi-Bee J. Interventions for cutaneous Bowen’s disease. Cochrane Database Syst Rev. 2013;6:Cd007281.Google Scholar
  44. 44.
    Kfoury LW, Jurdi MA. Uremic pruritus. J Nephrol. 2012;25(5):644–52.PubMedCrossRefGoogle Scholar
  45. 45.
    Gossard AA. Care of the cholestatic patient. Clin Liver Dis. 2013;17(2):331–44.PubMedCrossRefGoogle Scholar
  46. 46.
    Laurent A, Boucharlat J, Bosson JL, Derry A, Imbert R. Psychological assessment of patients with idiopathic pruritus ani. Psychother Psychosom. 1997;66(3):163–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Billingham RP, Isler JT, Kimmins MH, Nelson JM, Schweitzer J, Murphy MM. The diagnosis and management of common anorectal disorders. Curr Probl Surg. 2004;41(7):586–645.PubMedCrossRefGoogle Scholar
  48. 48.
    Sauer T. The role of the bidet in pruritus ani. Aust Fam Physician. 2010;39(10):715.PubMedGoogle Scholar
  49. 49.
    Tomi N, Weiser R, Strohal R, Mittlboeck M. A liquid-film forming acrylate cream for the treatment of anal pruritus. Br J Nurs. 2012;21(2):98. 100–2.PubMedCrossRefGoogle Scholar
  50. 50.
    Al-Ghnaniem R, Short K, Pullen A, Fuller LC, Rennie JA, Leather AJ. 1% hydrocortisone ointment is an effective treatment of pruritus ani: a pilot randomized controlled crossover trial. Int J Color Dis. 2007;22(12):1463–7.CrossRefGoogle Scholar
  51. 51.
    Lysy J, Sistiery-Ittah M, Israelit Y, Shmueli A, Strauss-Liviatan N, Mindrul V, et al. Topical capsaicin—a novel and effective treatment for idiopathic intractable pruritus ani: a randomised, placebo controlled, crossover study. Gut. 2003;52(9):1323–6.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Gooding SM, Canter PH, Coelho HF, Boddy K, Ernst E. Systematic review of topical capsaicin in the treatment of pruritus. Int J Dermatol. 2010;49(8):858–65.PubMedCrossRefGoogle Scholar
  53. 53.
    Ucak H, Demir B, Cicek D, Dertlioglu SB, Akkurt ZM, Ucmak D, et al. Efficacy of topical tacrolimus for the treatment of persistent pruritus ani in patients with atopic dermatitis. J Dermatolog Treat. 2013;24(6):454–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Mentes BB, Akin M, Leventoglu S, Gultekin FA, Oguz M. Intradermal methylene blue injection for the treatment of intractable idiopathic pruritus ani: results of 30 cases. Tech Coloproctol. 2004;8(1):11–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Sutherland AD, Faragher IG, Frizelle FA. Intradermal injection of methylene blue for the treatment of refractory pruritus ani. Color Dis. 2009;11(3):282–7.CrossRefGoogle Scholar
  56. 56.
    Samalavicius NE, Poskus T, Gupta RK, Lunevicius R. Long-term results of single intradermal 1% methylene blue injection for intractable idiopathic pruritus ani: a prospective study. Tech Coloproctol. 2012;16(4):295–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of Colon and Rectal SurgeryCarolinas Medical CenterCharlotteUSA

Personalised recommendations