digestive disorders
Anal Itching
Evaluation of Anal Itching
Not every episode of anal itching requires immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with anal itching, certain symptoms and characteristics are cause for concern. They include Pus draining from the anus or around it (draining fistula) Bloody diarrhea Bulging or protruding hemorrhoids Perianal skin soiled with fecal material Dull or thickened perianal skin People who have anal itching plus bloody diarrhea or draining pus should see a doctor in a day or two. Other people should see a doctor if the itching has lasted for more than a few days, but the visit is not urgent. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the itching and the tests that may need to be done (see table). The history is focused on when the itching started and how long it has lasted. Doctors ask about the following: Ingestion of irritating foods, particularly acidic or spicy foods Bowel habits, including use of wipes, ointments (even those used to treat itching), sprays, and soaps applied to the anus Hygiene habits, particularly frequency of showers and baths Known infections or disorders (such as diabetes, hemorrhoids, or psoriasis) Recent use of antibiotics The physical examination is focused on the appearance of the anus and the perianal skin. Doctors examine this area for Dullness and thickness Signs of irritation due to scratching Hemorrhoids , lesions, fistulas, and scrapes (caused by scratching and rubbing) Scabies Infestation or If doctors do not see any abnormalities on or around the anus, they usually do not do tests and simply treat the person's symptoms. If there are any visible skin abnormalities, doctors may examine a scraping of the perianal skin to rule out a fungal infection. Sometimes they give the person a local anesthetic and remove a small piece of tissue to examine under a microscope (skin biopsy). If pinworms, which most often occur in school-age children, are suspected, eggs can be collected from the anal region using sticky transparent tape to confirm the diagnosis (see Diagnosis ). Doctors may also examine the anus with a short, rigid tube (a procedure called anoscopy) to check for internal hemorrhoids. 