Anal itching is a common localized pruritus. It is sometimes mildly itchy in the anal region, but becomes pruritus if the itching is severe and persistent. It is a common confined neurological dermatosis. It is usually limited to the perianal area, and some may spread to the perineum, vulva or the back of the scrotum. It occurs mostly in middle-aged and older people between 20 and 40 years old, less often in young people under 20 years old, and rarely in children. It is more common in men than in women, and this pruritus occurs more often in people who are used to silence and infrequent exercise. Secondary pruritus has an obvious cause, easy to treat; spontaneous or unknown cause of PA is not easy to cure, but also often relapses, accounting for about 50% of all patients. Chinese medicine treatment is recommended Weifang cream, the treatment is safe and thorough. Patients with anal itching usually pay more attention to their diet and avoid stimulating the onset of the disease. Anal itching is confined to the anal local pruritus is mostly related to or secondary to anal and rectal diseases. Local inflammation and congestion increase skin circulation and temperature, and the area between the buttocks is not easy to dissipate heat, prompting increased sweat excretion and moist impregnation, causing discomfort and itching. Clinical manifestations In addition to painful symptoms, the anus also has an itchy condition, medically known as anal pruritus. Patients will keep scratching with their hands because of itching, and even scratching the skin does not solve the problem. The causes of its onset are as follows: 1, the buttocks are not wiped clean, and the fecal residue irritates the skin and causes inflammation. 2. Inflammation of the anal fossa, caused by its secretion flowing out of the anus. 3.Prolapse of the rectal mucosa caused by the sequelae of surgery, or prolapse, caused by the mucus in the intestine staining around the anus. 4.Allergies caused by sitting agents or anti-itch ointments, such as diabetes or female hormonal abnormalities. 5.Prickly heat, perianal eczema. 6.Pinworms. 7, special neurosis, etc. Treatment misconceptions 1, many people in life think that anal itching occurs in special parts, so many people suffering from anal itching mostly because of shyness heart and avoid seeing a doctor, their own abuse of some anti-itch ointment. I do not know, some anti-itch creams contain hormonal ingredients, although at the time to stop the itching effect is good, but the late itching will recur, and with a long time will have many side effects. 2, anal itching should pay attention to keep the anus hygienic, dry, after washing with warm water, gently dry with a soft tissue. Do not use hot water to scald, soap repeatedly wash the anus, which will wash off the perianal skin sebum, destroy the anal skin environment, causing anal itching. In addition, too much soap, especially alkaline soap, stimulating the perianal skin is also prone to cause perianal itching. In addition, do not scratch hard, so as not to scratch the skin so that the infection spread, aggravating the disease. 3, anal pruritus is a common anal symptoms, causing anal itching for a variety of reasons. Anal itching is sometimes light and sometimes heavy, if the itching period is long, long and untreated, it will become pruritus. 4, door itching if long-term scratching, prolonged, resulting in rough thickening of the skin, the formation of anal fissures, and even combined infection, causing flushing and swelling pain. The lesion can also spread to the perineum, scrotum, vulva, and even double buttocks skin, that is more unbearable. So once you suffer from anal itching, do not scratch with your hands, this will make the local skin can produce secondary infection. The early manifestation of anal itching is limited to the itching of the skin around the anus, sometimes light and sometimes heavy, sometimes stinging or burning pain, sometimes like insects walking, sometimes like mosquito bites fire, sometimes it is intolerable, more at night, people are restless. The itching causes skin ulceration, oozing, crusting, and long-term failure to heal, resulting in thickening of the perianal skin, thickening and roughness of the wrinkled wall with radial folds, mossy changes, pigmentation or loss of pigmentation, and spreading to the perineum, scrotum, labia or sacro-caudal area. If the disease is prolonged, it is easy to develop secondary chaps. In the long run, it can cause neurasthenia, mental atrophy, loss of appetite, sleepless nights. Pathological causes 1, intestinal diseases caused by: anal fistula, hemorrhoids, anal sinusitis, anal papillitis, rectal prolapse, anal incontinence, etc., so that the anal opening secretions increase, damp stimulation of the skin caused by itching. 2, skin disease factors: such as anal eczema, neurodermatitis, ringworm, various warts, venereal disease, sweat gland inflammation, etc., feces attached to the anal folds, stimulating the skin and causing itching. 3, worm disease:also easy to cause anal itching. Systemic causes 1, allergic reactions: If you eat irritating food, such as chili, mustard, spices, wine or atopic protein food, but also taking certain y substances, such as antibiotics, etc. can cause anal itching due to allergies. 2, parasitic diseases: such as meconium, roundworms, vaginal trichomonas, pubic lice, scabies, etc., can cause anal itching. 3, endocrine and metabolic diseases: such as diabetes mellitus patients with increased sugar content in the skin, stimulating nerve endings caused by itching; hyperthyroidism skin itching, may be related to excessive sweating, increased basal metabolic rate, emotional tension, etc. 4, blood disease: iron deficiency anemia, etc. 5, gastrointestinal diseases: acute and chronic diarrhea, constipation, gastrointestinal neurosis, etc. Local factors 1, skin lesions: anal skin diseases such as anal eczema, neurodermatitis, ringworm, various warts, venereal disease, sweat gland inflammation, etc., feces attached to the anal crease, stimulating the skin and causing itching. 2, perianal microorganisms: such as pinworm parasites are often a common cause of anal itching in children, this anal itching, after deworming treatment, lining pants diligently changed and washed and other hygienic measures, can be cured. 3, anorectal diseases: such as anal fissure, anal fistula, hemorrhoids, anal sinusitis, anal papillitis, rectal prolapse, anal incontinence, etc., so that the anal opening secretions increase, vaginitis secretions stimulate and other damp stimulation of the skin caused by itching. According to Chinese medicine, wind, dampness, heat, blood deficiency and insect perversion are the main causes of the disease. Treatment is based on the principles of removing wind and dampness, clearing heat and detoxifying toxins, nourishing blood and moistening dryness, and activating blood stasis, so as to achieve the effect of driving away evil and helping to stop itching. Examination methods Disorders causing anal itching 1. perianal dermatitis Itching around the anus, with dampness, thickened, cracked and eroded skin. Occasionally, there is a history of foreign body contact, which belongs to contact dermatitis. 2, anal eczema around the anus skin erosion, ulceration. There is often a history of triggers and allergies. 3, ringworm caused by mycobacterial infection, patients often have a history of foot fungus or mycobacterial infection. 4.Perianal skin sweating gland inflammation. 5.Anal skin venereal disease, condyloma acuminatum. 6.Anal disease, anal fistula, internal and external hemorrhoids. 7.Anal overflow Anal sphincter hypofunction, rectal mucus overflow, which can stimulate skin inflammation. 8.Anal neurodermatitis. Disease diagnosis Based on the typical history of anal itching, combined with clinical symptoms and signs, it is not difficult to diagnose the disease, but it is more difficult to clarify the cause. Generally there is a local primary disease in the anus that becomes secondary pruritus, otherwise it is primary pruritus. In addition, a general physical examination should be performed, and the necessary laboratory tests should be targeted, such as blood, urine, stool routine, liver and kidney function, urine sugar, blood glucose, glucose tolerance test and biopsy and smear. According to the etiology can be divided into primary pruritus and secondary pruritus. 1, primary pruritus Primary pruritus is not accompanied by primary skin damage, with pruritus as the main symptom. 2, sexual pruritus Secondary pruritus arises from primary diseases and various skin diseases, accompanied by obvious specific skin damage and primary lesions, pruritus is often a symptom of the primary lesion. For example, anal itching caused by anal fistula, anal eczema, warts, neurodermatitis, anorectal tumors, pinworms, etc. all belong to this category. The initial anal itching is light, with no obvious changes in the anal skin, mostly paroxysmal. In patients with prolonged disease, itching is more intense and lasts longer, especially at night. Excessive scratching or mechanical stimulation makes the perianal skin hypertrophy and roughness, deepens the anal folds, local scratches, blood scabs, ooze, and residual fecal dirt in the folds, and in more severe cases, infection can be combined with pus vesicles or purulent secretions, flushing and swelling. The lesions may extend to the perineum, scrotum, female vulva and even the skin of both buttocks. Clinical examination may reveal internal hemorrhoids, external hemorrhoids, mixed hemorrhoids, anal fistula, or laboratory tests may reveal diabetes mellitus, pinworm disease, Candida albicans infection, etc. Prevention of anal itching 1, underwear and underwear should be kept clean, underwear should be soft and loose, cotton fabrics are good, should avoid wearing chemical fiber clothing close to the body. 2, pay attention to adjusting the gastrointestinal function, to light, vitamin-rich fresh vegetables and soy products is better; avoid cigarettes, alcohol, chili, strong tea, coffee and other stimulating foods; keep the bowels open. 3, the room temperature to 16 ℃ ~ 20 ℃, relative humidity of 30% ~ 40%. When the relative humidity is lower than 20%, the indoor air is too dry and dust and other allergenic substances are easily flown. Therefore, water should be sprinkled on the floor, the conditions can be enabled humidifier. The toilet paper should be soft to keep the anus fresh and clean. 4, sensitive skin should not only be appropriate to reduce activities, but also pay attention to the bath should not be too diligent, the water temperature should not be too high, otherwise the skin surface sebum will be washed away, making the skin more dry and easy to itch. In addition, the itch does not scratch to prevent proliferative changes in the epidermal cells, becoming rough and thick, the result is that the more you scratch the more itchy, forming a vicious circle. Prevention 1, timely treatment of local and systemic diseases that cause perianal pruritus, such as internal hemorrhoids, anal fissures, anal fistula, diarrhea, diabetes, parasitic diseases, etc. 2, keep the anus clean and dry, as far as possible every night to clean the anus, cleaning perianal appropriate to use warm water. 3, underwear should not be too tight, too hard, should wear cotton loose fitting underwear, do not wear artificial fiber underwear, and should be diligent washing and changing. 4, pay attention to the combination of work and rest, keep a happy mood, prevent excessive tension and anxiety, do not scratch the anus, do not use too hard objects to rub the anus. 5, eat more vegetables and fruits, do not eat or eat less stimulating food, such as chili, strong tea, coffee, high alcohol, etc. 6, perianal itching more than but the skin is not broken, you can immerse gauze or skim cotton in boric acid liquid, water temperature is appropriate, take out and wring until not dripping, put on the perianal area, can immediately stop the itching. Treatment According to the typical history of anal itching, combined with clinical symptoms and signs, it is not difficult to diagnose this disease, but it is more difficult to clarify the cause. Generally there is a local primary disease in the anus that becomes secondary pruritus, otherwise it is primary pruritus. In addition, a general physical examination should be performed, and the necessary laboratory tests should be targeted, such as blood, urine, stool routine, liver and kidney function, urine sugar, blood glucose, glucose tolerance test and biopsy and smear. 1. Treat the primary disease or comorbidities such as hemorrhoids, anal fistula, pinworm disease, etc. Give appropriate antibiotics or antimicrobials to treat co-infections. 2, avoid inappropriate self-treatment, many anal pruritus patients are reluctant to go to the hospital, take inappropriate self-treatment, such as scalding with hot water, external use of high concentrations of corticosteroids or containing anti-irritant drugs, self-purchase of some crude home physical therapy equipment self-treatment, these methods have many disadvantages, only temporary suppression of itching, over time, resulting in the lesion to delay the increase, patients should be advised to stop using. 3, pay attention to hygiene, do not eat or eat less irritating food, such as spicy food, strong tea and coffee, strong wine, etc.. Clothing and pants should be loose fitting, close underwear to cotton fabric is good. 4, limited anal pruritus drug treatment should be based on local topical treatment, systemic treatment of various types of agents used, such as corticosteroids, anti-inflammatory mediators, various sedatives and other anal pruritus does not have a significant anti-itch effect, but there are many side effects or adverse effects, in the absence of clear indications should avoid the application. 5, for only local itching and anal skin normal, to boric acid water cleaning cold anal compress, if the addition of ice so that the water temperature at about 4 to 5 ℃ cold compress. Patients squatting with gauze or skim cotton cold compress anal, can be received immediately to stop the itching effect. Once a day, once in the morning and once in the evening, each time about 5min, after the cold compress with a dry towel to wipe dry local, puff with ordinary powder, keep dry. This type of anal itch should not be applied externally ointment, ointment hinders heat dissipation, increased sweat prone to induce itching. It is advisable to use cool and dry lotion, such as white lotion, furnace glycerine lotion, etc. 6, the anal skin is rough and thick lichenified damage more often have a combination of infection, available appropriate antibiotics or antibacterial agents, infection control, the implementation of local encapsulation treatment; after cleaning the local, with alcohol or Neosporin solution local disinfection, with injectable prednisolone injection or de-inflammatory pine injection with an injection needle will be drops in the lesion site, so that the lesion is fully immersed in the solution, the patient feel itching reduced, the local solution The patient feels that the itching is reduced and the local solution is dried, and then apply common rubber cream or ointment containing anti-itching agent according to the size of the lesion, or use film-forming agent or gel containing the drug as a film-like package. This method should be performed at bedtime, and after 6-8 hours, remove the hard paste or film-forming encapsulation, clean the area, and apply a drying lotion or anti-itch aerosol spray. This method has a good effect on relieving itching and promoting the receding of lichenification damage. 7.Injection therapy Inject the drug into the subcutaneous or intradermal area to destroy the sensory nerves, so that local sensation decreases, symptoms disappear, and local damage is cured, and about 50% of cases or more can be cured permanently. However, those with strict itching are prone to recurrence and need to be treated by injection again. Injecting drugs not only destroy sensory nerves, but also motor nerves, which often lead to sensory anal incontinence and sphincter malfunction of different severity, but can recover on their own after a period of time. (1) Alcohol subcutaneous injection: Alcohol can dissolve the nerve myelin sheath without damaging the nerve axis, causing denaturation of sensory nerve endings and loss of sensation in the skin until the nerve regenerates, and there are two methods of injection. Zoned subcutaneous injection method: Divide the area around the anus into 4 zones and inject 1 zone each time. After skin disinfection, procaine solution is injected subcutaneously with a long needle, which is left in place, and then alcohol is injected. The injected drug should be evenly distributed and should not flow out or have tension. Nor should it be injected into the skin to avoid skin necrosis; moreover, it should not be injected into the anal canal sphincter to prevent sphincter paralysis. After injection, apply hot compresses, give sedatives to relieve pain, and inject another 1 area at an interval of 5 to 10 d. The 4 areas will be completely injected. Multiple subcutaneous injection method: After local anesthesia, use a very fine needle to inject alcohol into the subcutaneous area around the anus through multiple punctures at a distance of 0.5 cm each, injecting 2 to 3 drops each, avoiding injection into the skin or sphincter. (2) Intradermal injection of methylene blue: inject methylene blue solution into the perianal skin to make the sensation of internal nerve endings disappear and the itching subside. The injection solution is made of methylene blue and procaine dissolved in distilled water, and the skin of the anus is coated with red mercury solution, and the solution is injected into the perianal skin with a fine needle, 3 to 4 drops are injected at each place, and all the itchy area is injected. The total amount should not exceed 20ml, and after the injection, the anus should be reapplied with sterile gauze and pain relief with morphine or codeine. 8.Surgical treatment Spontaneous itching after the above treatment does not improve or repeated recurrence of the available surgical treatment. There are two types of surgical methods: removal of the skin innervation of the anus and excision of the skin of the anus. (1) Subcutaneous incision: A semicircular incision is made on each side of the anus, 5 cm from the anal verge, and the subcutaneous fat is incised, the skin is separated medially to reveal the lower edge of the external sphincter, and the skin is separated from the internal sphincter into the anal flap plane. The skin on the anterior and posterior sides of the anus was then separated by deep tissue to allow for wound traffic on both sides of the anus. Finally, the skin at the outer edge of the incision is separated outward for 1 to 2 cm, and after hemostasis, the skin pieces are sutured in place, sometimes requiring drainage to be placed and covered with an external compression dressing. The bowel needs to be prepared before surgery, and fecal evacuation is controlled for 3 to 4 days after surgery. The results, which vary from report to report, mostly achieve good results, but there are reports of recurrent cases and wound infection and dehiscence. (2) Excisional suture: make an incision along the anal margin from front to back, make another curved incision on the outside of the incision, include the lesioned skin in the incision, connect the two ends of the incision, excise the semilunar skin between the 2 incisions, and suture the wound. The contralateral side was excised in the same way. Itching can be stopped after skin removal, but wound infection sometimes occurs. The main components of propolis are flavonoids, organic acids, enzymes, vitamins and minerals. Propolis has a wide range of effects, one of which is antibacterial and anti-inflammatory. Therefore, for some anal itching caused by infectious factors, you can try the above methods. But to prevent anal itching, you must pay attention to personal hygiene, such as keeping the local dry and clean, change underwear regularly, etc. Do not use hot water to scald the local area, and do not blindly use some strong hormone creams to stop the itching. Chinese medical treatment 1, timely treatment of local and systemic diseases that cause anal pruritus, such as internal hemorrhoids, anal fissures, anal fistula, diarrhea, diabetes, parasitic diseases, etc. 2, keep the anus clean and dry, as far as possible once a night to clean the anus. It is advisable to use warm water to clean the anal area. The general soap is not used, especially not the strong alkaline soap. The towels and basins used for cleaning should be dedicated to each other to avoid cross-infection. 3, underwear should not be too tight, too hard, should wear pure cotton loose fitting underwear, do not wear artificial fiber underwear, and should be diligent washing and changing. 4, pay attention to the combination of work and rest, keep a happy mood, prevent excessive tension and anxiety, do not scratch the anus, do not use too hard objects to rub the anus. 5, eat more vegetables and fruits, do not eat or eat less stimulating food, such as chili, strong tea, coffee, high alcohol, etc.. Allergic people should eat less allergy-prone food, such as fish, shrimp, etc., to avoid contact with allergy-inducing chemicals. 6, anal itching more than but the skin is not broken, you can dip gauze or skim cotton into 4% boric acid liquid, the water temperature is kept at about 45 ℃ is appropriate, remove the wring to not drip, compress around the anus, can immediately stop the itching. Apply it once a day, morning and evening, for about 5 minutes each time. Wipe dry after dressing, puff with talcum powder. 7, Chinese medicine believes that the anal itch more heart meridian fire, blood heat wind; or qi and blood deficiency, blood does not feed the wind, liver wind, wind win is itchy; or by damp heat within the implication of the wind evil depression for a long time, heat into dryness caused. Externally, use 30 grams of bitter ginseng, 15 grams of snake bed seeds, 15 grams of pomegranate skin, 15 grams of alum, water decoction to wash the affected area, 1 to 2 times a day. If there are pinworms, use 30 grams of decoction of Baibei for enema.