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Anal Itching (Pruritus Ani)
Pruritus, usually called "itching piles", is not piles
(hemorrhoids) at all, although
it may occur in patients who have hemorrhoids.
In my observation it is the
most tormenting of all rectal diseases, and
at the same time, it can be difficult to
successfully treat. Once pruritus gains a
foothold, there is little,
if any, relief from the agonizing itching
day or night, year in and year out. As the
affliction continues it becomes more complicated
and more severe. In their desperation patients
often scratch themselves until they are raw.
The itching is really a symptom
complex,
and the cause must be removed if the itching
is to be stopped.
Pruritus is very and increasingly common.
The itching is generally more pronounced at night when in bed and
it is a constant robber of sleep and rest.
As the condition progresses, the amount of
sleep lost due to scratching, either consciously
or unconsciously, increases. This loss seven
nights in the week, and thirty nights in
the month, soon begins to take its toll,
no matter how strong
he is. It affects patients both physically
and emotionally.
"There is no single disease which runs so chronic a course,
is so extremely rebellious to treatment, and for which such a multitude
of remedies has been advanced as 'prurtus ani'," - so says Dr.
William A. Rolfe, a prominent proctologist in Boston. The average
pruritis sufferer needs little to convince him of this because he
has generally already used the various home
remedies and drugstore preparations, including the run of anesthetic ointments and salves,
and has found them disappointing.
The causes of pruritus ani are legion and often most obscure
but they generally fall within two main groups. Group number one
is the local rectal ailment. In my experience, the
great majority of cases have some pathologic (disease) condition
of the rectum or anal canal which is the primary cause. This may
be the presence of hemorrhoids, infected crypts, skin tabs, fistulas,
fissures, polyps, the discharge of secretions, etc. When these causes
are fully remedied, there is usually permanent relief of the itching.
The second group is allergy, including both food
allergies and environmental allergies. Such
patients are well aware of other symptoms
caused by specific allergens such as bee
stings, poison ivy or oak, or various medications
or foods. In
these cases I treat whatever is wrong with
the ano-rectum (hemorrhoids, fissures,
etc), discuss with the patient removing contact
with known allergens (foods, medications,
household toxins), and clear various infections
that can create an allergic response (fungus,
yeast, condyloma, herpes type 2). Topical
anti-inflammatories are prescribed when appropriate.
Occasionally I will refer a difficult case
to a dermatologist.
By basing our treatment upon these two fundamental causes, we have
been able to obtain permanent and gratifying relief in the vast majority
of cases.
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