Pilonidal fistulas tend to recur; therefore, take care when examining the
patient. Also, tell him to avoid sitting too long in one position. If he must
sit for long periods of time, tell him to change sitting position frequently.
3-19. PRURITUS ANI
a. Definition. Pruritus ani is severe anal itching. The itching sensation is
usually more acute at night or during periods of inactivity. Warmth and scratching make
the condition worse.
b. Etiology. The chief causes are poor hygiene and tight, nonabsorbent
clothing. Urinary of fecal incontinence, anal fissure, or hemorrhoids can cause this
itching. Bacteria, fungi, yeast, trichomonads, or intestinal parasites can result in anal
itching. An individual with proctitis (inflammation of the rectum) or a person with rectal
prolapse (the rectal mucous membrane bulges through the anus) may have pruritus ani.
c. Diagnosis. Thorough examination of the perianal skin, anal canal, and
rectum with a proctoscope (instrument used to inspect the rectum) is used in the
diagnosis. Take skin scrapings to check for fungus. Also, check for ovum and
parasites to determine if these are the cause of the severe itching.
d. Treatment. If the specific cause of pruritus ani is found, eliminate that cause.
If the specific cause cannot be found, treat the symptoms. Follow these guidelines:
(1) Improve personal hygiene. Keep the area clean. After each bowel
movement, clean the area with moist toilet tissue or a cloth. Use bland, unscented,
nonmedicated soaps, or mild detergents such as pHisHex. Blot the area dry; do not rub
(2) Lukewarm sitz baths or cool compresses of Burow's solution may be
used to sooth the area.
(3) Shake lotions such as noncarbolated calamine or dusting powders such
as plain talc or cornstarch can be used to dry and protect the area.