Obsessive itching in the anal canal is a symptom that is rarely addressed to a doctor. It is considered inconvenient, sometimes indecent, and is often ignored. Meanwhile, itching near the anus or inside it does not occur for no reason. It may hide a serious intestinal or rectal disease, endocrine disorders and parasites.
To say goodbye to unbearable itching in an “inconvenient place” once and for all, you need to find out the reasons for its occurrence, and then select effective treatment methods.
What increases the likelihood of disease?
- skin damage in the perianal area
- poor hygiene
- poor living conditions and overcrowding at home
- atopic dermatitis
- poor nutrition
- chronic dialysis - the need for blood purification procedures due to kidney failure
The main cause is skin infection with group A streptococcus (GAS).
This microbe can also cause acute tonsillopharyngitis (tonsillitis), scarlet fever, acute otitis media, pneumonia, meningitis, and other skin infections (impetigo, etc.)
PID can also be caused by streptococci of other groups (B, C, G), Staphylococcus aureus, and fecal enterococcus (Enterococcus faecalis).
By the way, group A streptococcus normally does not live on the skin of the perineum, but it can easily get there from other areas from the hands. Infection is also possible through toilet seats, in a common bath, or through the air. For enterococcus, infection of the skin directly from the intestines of the child is typical.
It has been noted that PID often occurs if a child or someone close to him has recently suffered from streptococcal pharyngitis/sore throat. It happens that pharyngitis has already passed, the microbe has disappeared from the throat, but the infection in the perineum remains.
Anal itching - symptoms and treatment
Anal itching is a pathological condition manifested by persistent or recurrent itching sensations in the perineal area. Most often this is a dermatological problem, less often neurological or gastroenterological, and very rarely proctological. That is why patients sometimes visit different specialists for a long time and to no avail before they establish the true cause of the disease and eliminate the main cause of itching in the anus.
Itching in the anus causes a lot of discomfort. From constant nervous tension and unpleasant sensations, patients lose weight, become aggressive, irritable, sleep poorly, and their memory and perception of information deteriorate. The prevalence of mental disorders in outpatient dermatological practice is quite high (21-34%), so the study of this problem is relevant [10][11][13].
Various ointments and medications that doctors actively use to relieve symptoms of the disease eliminate complaints only for a short period of time, but after a few weeks the problem appears in a new light and develops with renewed vigor, coping with it becomes more and more difficult each time. Itching is just the tip of the iceberg, and the essence of the problem remains hidden from the eyes of the doctor and the patient, so it is necessary to carefully examine the patient, establish the real cause, and only then begin to treat this unpleasant symptom.
Causes of anal itching
Oddly enough, usually patients suffering from itching recover only after observation by a dermatologist. Before this, as a rule, they unsuccessfully visit various specialists, starting with a coloproctologist and ending with a psychiatrist. In most patients, itching in the anus is of dermatological origin. Therefore, this symptom is eliminated by a dermatologist after an appropriate examination, identification of the true causative agent of the disease and the use of a drug that affects the cause that caused the itching and burning. Such pathogens include streptococci, staphylococci, saprophytes, yeast-like fungi of the genus Candida, trichophyton, microsporum, amoeba, lamblia and many others.
Disturbance of the microflora of the perianal area
The cause of dermatological diseases is most often a violation of the microflora of the perianal area (around the anus). As a rule, this is associated with fungi - actinomycosis, candidiasis (thrush). The fungus can be infected from the outside, we are talking about violation of personal hygiene: using other people's things, bed linen, as well as self-infection with dirty hands during perineal hygiene after stool.
Itching in the anal area after taking antibiotics
The fungus can also “grow” due to the death of normal microflora in the anal area and its replacement by a pathogenic one, against the background of a weakened general immune system, long-term use of antibiotics or other potent drugs, as well as due to some concomitant disease.
Many patients have problems with the microflora large intestine , which is the cause of gastroenterological pathology. Very often, when collecting anamnesis, it turns out that a patient suffering from itching in the anus used antibacterial agents to treat some disease. While taking antibiotics, the phenomena of dysbiosis increased, the microflora of not only the intestines, but also the skin of the perineum was disrupted. In turn, disruption of the microflora led to the death of normal microorganisms inherent in a given environment and their replacement by pathogenic microbes that cause itching and burning.
Anal itching in chronic diseases
The presence of chronic diseases such as diabetes mellitus, obesity, hemorrhoids, paraproctitis (purulent inflammation of the fatty tissue around the rectum and anal sphincter), Crohn's disease (chronic inflammatory bowel disease), ulcerative colitis, dysbiosis of the large intestine, adnexitis (inflammation of the fallopian tubes and ovaries), cystitis, sexually transmitted infections, endocrine pathologies, metabolic disorders, etc. leads to an increase and increase in the incidence of itching due to the negative impact on the immune system and weakening of the body's strength in general.
Environmental factors
Currently, people of young working age who do not have concomitant pathologies and consider themselves practically healthy suffer from itching more and more often. Anal itching began to appear at a young age due to poor ecology, antibiotic resistance (resistance of microbes to antimicrobial chemotherapy), polyvalent allergies (the body's sensitivity to several types of allergens at the same time), the use of synthetic things, thong-type underwear, promiscuity, etc. .
Allergy
Local allergies are also a common cause of anal itching with intolerance to some suppositories and ointments used to treat hemorrhoids, prostatitis or gynecological pathologies.
Depilation
Depilation of the perineum also often leads to these symptoms, especially if after the procedure you use an ointment or cream that “clogs” the pores, resulting in their inflammation. If such a problem exists, then it is best to use creams for infants with a low Vaseline content that are quickly absorbed, for example Bepanten.
Infectious diseases
Human papillomavirus , herpesvirus and other infectious viruses are the cause of the appearance of pathological benign formations on the skin, such as anogenital warts [9] . These formations become injured, become inflamed, and produce additional fluid or exudate, which affects the skin and causes itching in the anus.
Crohn's disease
Perianal lesions in Crohn's disease can lead to an increase in enzyme levels, local purulent manifestations in the form of paraproctitis or rectal fistula, which negatively affects nerve receptors and leads to itching . The constant leakage of pus from the fistula openings in Crohn's disease makes itching a constant symptom inherent in this particular disease.
Itching in the anus with tumors
Various neoplasms and tumors in the intestinal cavity or other parts of the gastrointestinal tract can also cause itching. Such tumors often develop asymptomatically, which contributes to imperceptible total damage to intestinal tissue; itching is the first symptom of cancer. Sometimes people who go to the doctor with this single complaint undergo a full examination and identify the underlying, life-threatening problem. Often in such cases it is possible to save a person from death due to a malignant neoplasm. Therefore, you cannot ignore this symptom or self-medicate, but you must immediately be examined and treated by specialized specialists.
Psycho-emotional stress
It is important to note that in addition to somatic causes, anal itching can occur due to psycho-emotional stress and other neurological symptoms - that is, neurogenic itching is in no way related to the physical pathology of this localization. As a rule, neurogenic itching accompanies other mental disorders. To solve this problem, consultation with a psychiatrist or neurologist is necessary. Local therapies used by the patient to relieve symptoms of the disease, as a rule, do not have any beneficial effect. Only sedatives or sedatives help temporarily relieve itching.
Itching in the anus at night
One of the causes of anal itching at night may be a parasitic infection. When infected with worms, the parasites emerge from the anal canal to lay eggs and provoke unbearable itching.
When wearing warm, breathable clothing, a person sweats and the itching worsens. Also, exposure to cold in winter can significantly increase complaints of itching.
Itching in the anus after bowel movement
After bowel movement, the itching in the anus intensifies. The reason for the increased itching is that during the act of defecation, anal fissures are injured due to damage to the skin and mucous membranes.
Anal itching in children
There are no specific features of anal itching in children; its manifestations are the same as in adults.
How does perianal infectious dermatitis manifest?
- itching or pain in the anus (most often)
- pain during bowel movements, sometimes due to stool retention
- mucus discharge and weeping in the anal area
- streaks of blood in stool from cracks in damaged skin
General health usually does not suffer.
Rarely, holding back stool may cause abdominal pain due to overinflated intestinal loops or involuntary passage of stool particles.
If you yourself or a doctor examine the “sore spot,” you will notice pronounced redness of the skin around the anus (sometimes compared to the color of raw meat), usually 2-4 cm around the anus. Small cracks in damaged skin and mucous deposits may be visible.
Sometimes the infection spreads to the vulva area in girls, causing inflammation - vulvovaginitis. In boys, it spreads to the penis, causing balanitis.
The infection can occur in the form of a focal rash on the skin of the buttocks or even in more distant areas, usually due to infection with staphylococcus.
Disease prevention
Preventing the development of the disease is quite simple; for this you need:
- Treat diseases of the gastrointestinal tract in a timely manner.
- Normalize your lifestyle and diet.
- Wear comfortable underwear made from natural fabrics.
- Observe hygiene rules.
- Strengthen and maintain immunity.
- Avoid contact with allergens if you are prone to an allergic reaction.
Perianal dermatitis is an inflammatory disease that affects the skin in the anus. Pathology occurs as a result of numerous unfavorable factors and has a specific clinical picture.
Having noticed signs of the disease, it is necessary to contact a specialist as soon as possible, who will make a diagnosis and prescribe competent comprehensive treatment. If there is no therapy, serious complications that are dangerous to the patient’s health may develop.
How to determine the cause?
With a characteristic appearance, additionally taking a culture from the inflamed skin helps. This method helps to identify the microbe that caused dermatitis, as well as to clarify its sensitivity to antibiotics.
A rapid antigen test is available to confirm group A streptococcus .
You may have already seen how pediatricians and otolaryngologists use it to urgently resolve the issue of prescribing an antibiotic for acute inflammation in the throat.
Formally, the test according to the instructions is only for the throat, but many people are already actively using it for PID. For group A streptococcus, the sensitivity of the method is 77.9-98.0%, but remember that sometimes other microbes also cause PID.
Which doctor should you contact if symptoms occur?
If you or your loved ones have the described complaints, you should contact a coloproctologist as soon as possible, who, after consultation and examination, will establish a preliminary diagnosis and determine further tactics and urgency of treatment, or, if in doubt about the diagnosis, a list of necessary additional studies.
If surgery is required, you will be offered hospitalization in a hospital, where, after assessing the results of the studies, which, as a rule, do not take much time and are easy to perform, the operation will be performed.
What can most often be confused with perianal infectious dermatitis?
Due to the fact that knowledge of this pathology is still insufficient among doctors, the diagnosis is often delayed (according to foreign statistics, on average by six months)
Instead of PID, diagnoses such as:
- candidiasis - fungal inflammation of the skin
- enterobiasis (pinworms)
- anal fissure
- psoriasis
- eczema/atopic dermatitis
- Crohn's disease
- diaper dermatitis
- haemorrhoids
- perianal allergy
- dysbacteriosis
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Why is perianal infectious dermatitis dangerous?
If left untreated, it continues to cause discomfort to the child and also increases the risk of the infection spreading to other areas of the skin.
Group A streptococcus can also cause special immunological complications in the form of acute post-streptococcal glomerulonephritis and rheumatism .
Sometimes streptococcus can become a trigger for the development of certain forms of psoriasis , therefore, when diagnosing guttate psoriasis, examination of the perianal area is mandatory. Treatment of dermatitis can also be interrupted by psoriasis.
CLINIC
The wide spread of treatment not only affects the sick, but also the doctors and the attribution of all perianal scars to hemorrhoids. However, the doctor will not carry out any residual treatment, first of all he will not listen to all the patient’s misery and will finish the report. All non-hemorrhoidal causes of symptoms are to blame (swelling, fissures, nostrils, anal itching, condylomas, viral and bacterial infections of the skin).
Symptoms of hemorrhoids are divided into those associated with external and internal hemorrhoids. Internal hemorrhoids do not cause pain on the skin, but may be caused by bleeding or prolapsed nodes. This may still cause perianal pain due to spasm of the sphincter complex. Discomfort occurs after the knots are adjusted. Pain in the presence of internal hemorrhoidal nodes may also be due to the inheritance of their pinching and torsion. Again, if it is due to spasm of the sphincter complex, when torsion occurs, discomfort may arise in the final stage. In case of these symptoms, spasm of the sphincter can also lead to concomitant thrombosis of the external hemorrhoids and acute pain in this part of the skin.
Internal hemorrhoids with prolapsed nodes (Fig. 2) can be accompanied by chewed mucus on the skin of the perianal area. This mucus from the stool can cause dermatitis, which is called anal itching. Hemorrhoids, in this case, are not the primary cause, but rather a mechanical carrier of the causative elements.
| A) | b) |
| V) | G) |
Rice. 2.
Internal hemorrhoids. a) three groups of internal hemorrhoidal nodes; b) internal hemorrhoidal nodes along the dentate line; c) loss of internal nodes; d) prolapse of nodes and bleeding.
Hemorrhoidal bleeding is indicated by a bright-red color of blood, the blood is seen with or after stool, often simply dripping from the anus into the toilet. After defecation, the bleeding, as a matter of course, starts completely.
The symptoms of external hemorrhoids (Fig. 3) arise in two ways. First, acute thrombosis of the external hemorrhoidal vein may occur, which is primarily associated with specific conditions - physical forces, straining during fastening and carrying or changing food. The pain is acute and accompanied by pain. Due to the fluid tension of the skin over the thrombus and the accumulation of excessive tissue, 1–2 layers are removed and felt after the thrombosis is resolved. However, after lysis of the thrombus, the perianal skin is stretched, eliminating excess folds or “fissures”. Sometimes the skin rupture over the thrombosed node is blamed for bleeding.
Rice. 3.
External hemorrhoids.
Alternatively, the external hemorrhoids may become damaged during the hygiene of the site, which is due to the presence of skin growths after episodes of thrombosis.
How to treat?
Perianal infectious dermatitis almost never goes away on its own.
Only antibiotics can help.
The issue of treatment with topical skin antibiotics is discussed, but the generally accepted method in the world is now a course of antibiotics by mouth .
Penicillin or amoxicillin is usually prescribed for 10-14 days, sometimes in combination with local antibiotics (mupirocin, fusidine).
If it is not possible to destroy the infection the first time (this happens rarely), then they are treated with protected amoxicillin (with clavulanic acid), cephalosporins, and clarithromycin.
It is necessary to take into account the possibility of relapse if other family members are carriers of the infection. If the cultures are positive, they also undergo sanitation (removal of the infection).
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