gastrointestinal disorders
Pruritus Ani (Anal Itching)
History
History of present illnessshould note whether the problem is acute or recurrent. The patient should be asked about topical agents applied to the anus, including wipes, ointments (even those used to treat itching), sprays, and soaps. Diet and drug profiles should be reviewed for causative agents (see table), particularly acidic or spicy foods. A general sense of hygiene should be obtained by asking about frequency of showers and baths. Review of systemsshould seek symptoms of causative disorders, including urinary or fecal incontinence (local irritation), anal pain or lump, blood on toilet paper (hemorrhoids), bloody diarrhea and abdominal cramps (inflammatory bowel disease), and skin plaques (psoriasis). Past medical historyshould identify known conditions associated with pruritus ani, particularly prior anorectal surgery, hemorrhoids, and diabetes. 