A 40 year old woman came to my clinic with a complaint of itching near her rectum. She told me that she had an intense desire to scratch the area all the time and especially at night. She found this very embarrassing and was ashamed to scratch in public but could not control herself. On examining the skin around the anus I found that she had a fungal infection, which had spread quite extensively. Also on asking for certain blood tests I found out that she was borderline diabetic.

A lot of people suffer from anal itch. It is a very common problem because the skin around the anal opening is prone to getting infected and affected. This area is where we pass over daily stools from and keeping it clean and dry is always a problem. The skin is in folds, which allows tiny faecal particles to get trapped. These faecal particles are infectious, cause irritation and inflammation of the area. When this skin becomes irritated the person feels like scratching to relieve it. However this damages the skin further and starts what is know as the itch-scratch cycle.

WHAT CAUSES ANAL ITCH?

There are a number of reasons for the skin near the anal opening to become irritated and inflamed. Here are the most common ones.

1. Skin Problems - this is one of the main reasons for itching around the anus. If there is already an underlying skin problem like psoriasis or eczema the skin is prone to getting irritated causing itching to occur.

2. Skin Infections - a number of infections can cause this problem. Fungal infections are the commonest of the lot. They thrive in areas of the body, which are damp, warm and moist. Damaging the skin by itching allows the fungi to multiply making the problem worse.

3. Threadworms or Pinworms - another very common problem seen in practice is worm infections. These worms live in the rectum and at night the female worms come out of the anus and lay their eggs on the skin around the anus causing a lot of irritation and encourages the person to scratch.

4. Sexually Transmitted Infections - these infections occasionally cause itching around the anus. Genital warts caused by Human Papilloma virus thrive in warm moist conditions like those present around the anus causing itching. Another infection is the Herpes Simplex virus infection. These infections are sexually transmitted and therefore can be prevented.

5. Creams and other applications - applying certain creams and ointments can give rise to this problem. If you have an underlying skin problem and have been prescribed a medicated ointment then beware of anal itching. This is one of the main side effects of using these external applications.

6. Washing too much or too little - we always advise all our patients to maintain a high level of hygiene. Always wash your anal area after passing stool or urine with water and wipe yourself dry. However too much washing and scrubbing can actually give rise to this problem too. Avoid using perfumed and harsh soaps while washing.

7. Foods that cause irritation - some foodstuffs can cause irritation of the rectal area while passing stools. Spicy foods like curry, hot sauces, pepper etc… , certain fruits like citrus fruits and grapes, tomatoes, coffee and other caffeinated beverages are known to cause irritation on the anal skin. Alcohol especially beer is another known cause.

8. Other medical problems - a number of health problems especially those involving the gastrointestinal system are known to cause problems around the anus. Diarrhoea and constipation are one of the main causes. While passing a hard stool and straining small tears of the anal skin occur which creates problems. Piles and skin tags are another cause for irritation. A fistula around the anus oozes a discharge, which can keep the area moist and promote itching.

9. Antibiotics and other medication - repeated use or abuse of antibiotics not only kills the harmful bacteria but also destroys the useful bacteria which keeps the yeast infections under control. Hence the yeast multiply and cause itching and other problems.

10. Diabetes and other chronic problems - chronic health problems and infections, which reduce the immunity of the individual make the person prone to acquiring certain infections.

HOW CAN THIS PROBLEM BE AVOIDED?

Anal itch can be avoided by taking care of yourself and the skin around the anus by following the tips given below.

1. Keep the area clean and hygienic - this point is most important. You have to constantly be aware of your hygiene. After passing stool or urine always wash the area with water. If possible use a hand shower or bidet as this enables the area to be thoroughly washed. Then use a non-perfumed, white toilet paper to wipe the area clean. Do not rub vigorously or use a cloth, which may irritate the area more. Always wipe from front to back and not the other way round.

2. Soap and detergent - use a mild soap, which is especially for sensitive skin and should be non-perfumed. Make sure that all the soap is washed off properly. While choosing a detergent look at the label and see whether it is sensitive skin. Harsh or too much detergent can also cause irritation of the skin around anus leading to itching.

3. Moisture - it is very important to keep that area dry. If you have a tendency to perspire a lot in that area change your underwear more often. It is always a good idea to change your underwear twice a day anyway. Wear only cotton underwear and avoid synthetic ones. Avoid tights, stockings, tight jeans and trousers as it does not allow air to circulate and accumulates moistures.

4. Avoid ointments, creams and powders - these things make the skin soggy and prone to getting infected and irritated. Powder tends to form small lumps in the crevices. You might be allergic to certain fragrance or perfume in these external applications.

5. Keep your nails cut - if you have a tendency to itch your anal area cut your nails short. This will prevent damage of the skin and prevent you from getting oro-rectal infections like worms.

6. Avoid diarrhoea and constipation - maintain healthy dietary habits like drinking pure water throughout the day and eating enough fiber in your diet in order to prevent constipation. Be very careful while eating or drinking something outside. Always boil or purify the water you drink, remember half the infections are acquired by drinking contaminated water especially diarrhoea. Do not eat any raw food or dairy products outside.

7. Underlying health problem - if you have any skin problem like eczema or psoriasis do not ignore it. Get proper treatment and cure for these problems. If you are diabetic then take care of your sugar levels. It is very important to avoid sexually acquired diseases because once acquired they become very difficult to treat and some like HIV have no known cure as yet.

WHAT IS THE TREATMENT FOR ANAL ITCH?

As I have explained earlier, Anal itch is a symptom of an underlying problem and a number of different problems can cause it. It can be due to piles or worms or any other infection. There could already be a skin problem, which could be the cause. Therefore the Homoeopathic physician should first take the entire history in detail taking into account the person's constitution and other health problems. If there is diabetes then the person has to bring the sugar levels within the normal range. Advise on hygiene and self-care must be given to all the patients. Here are a few drugs, which have proven very effective in curing the Anal itch.

SULPHUR

Sulphur is one of the most important remedies in our Materia Medica and is used often because of its effectiveness. It has special affinity of the gastro-intestinal system and the rectal area. The sulphur patient will complain of intense itching and burning of the anus. One look at him or her and you can tell from the shabby, unkempt appearance that this is a sulphur patient.
There is frequent desire to itch and redness of the anus is a characteristic of this drug. Here the cause could be piles or some skin problem like eczema. Or could be either diarrhoea or constipation where there is frequent urge but the patient does not feel satisfied even after passing stool. Sulphur is even useful in cases of threadworms, which could be irritating the area around anus.
The causes may be different but the Sulphur patient is always worse by bathing and being heated.

Start the treatment with Sulphur 200, and give it in constitutional doses.

PETROLEUM

This remedy is more known for its effectiveness in treating skin problems. Therefore if there is an underlying skin problem, which seems to be the cause of the anal itch, think of this remedy. Also if the itching is due to piles or fissures with violent itching you must think of this drug. The around the anus appears dry, rough, cracked, which bleeds easily. This itching is worse at night and especially during winter season.
Petroleum has a very peculiar type of diarrhoea. It is watery, gushing, only in the daytime and it causes itching of the anal region. Diarrhoea could be caused by eating something like cabbage or during pregnancy the woman suffers from this type of diarrhoea.

Give Petroleum 200, 5 pills 4 times a day till the underlying problem is taken care of.

NITRIC ACID

Nitric acid has great affinity for the rectal and anal areas. Here the rectal and anal problems could be because of piles or fissures. Here the patient will complaint of tearing pain while passing stool. This pain remains for hours after passing the stool. The piles bleed easily and could be prolapsed.
The anal itching could also be due to eczematous skin problems. Here there is oozing of a discharge on itching. There may even be bleeding due to the scratching.
Here walking or the slightest touch makes the condition worse. Night time and heat of the bed aggravates the problem. Peculiarly applying something hot gives relief.

Nitric Acid 1M, should be given according to the severity of the symptoms and constitution of the patient.

TELLURIUM

The case of the 40 year old woman narrated at the beginning received this remedy. She had an extensive fungal infection of the genital area including the anal region. There was intense itching and on examination the skin I observed ring shaped lesions with offensive smell. She described her itching as if something was pricking her.

This was worse on going to bed at night and by sitting or lying on the affected part. As she was borderline diabetic I advised her about diet and exercise in order to get the sugar levels to normal levels without medication.

She took Tellurium 200, 10 drops 4 times a day following all my advice. Within a few months not only her fungal infection got cured but also her sugar levels were within normal limits.

Readers are advised that the medical advice offered in this column pertains to generalised treatment of condition. Kindly consult your doctor before self-medication.