Anal itching

　　Anal itching is often related to anal and rectal diseases, or secondary to anal and rectal diseases. Local inflammation and congestion increase skin circulation, raise temperature, and the buttocks are areas that are not easy to dissipate heat, which promotes increased sweat excretion, moisture, and irritation, causing discomfort and itching.

　　Patients in the early stages of the disease often use hot water to wash or apply drugs containing corticosteroid hormones for a long time externally, which can temporarily relieve the itching, but over time can form a vicious cycle of itching, bad stimulation, and more itching, making the local symptoms worse.

　　Eating spicy foods can also cause anal itching. Poor hygiene habits, not washing the anus and perineum in time, scratching and rubbing through pants, can exacerbate itching. Poor clothing, wearing tight pants or underpants that are uncomfortable in texture, such as certain synthetic fabrics or thick and rough ones, can also cause sweat around the buttocks to be difficult to disperse and to rub, thus triggering anal itching.

　　Most anal itching in children is caused by pinworm patients. The female pinworms蠕出肛门排卵，forming mechanical stimulation that causes anal itching.

　　Many patients choose to scratch their itchy areas with their hands, which can easily cause the skin around the anus to be scratched and infected, leading to the secretion of mucus, causing the anus to become moist, thus triggering anal eczema and making the itching sensation more severe.

　　Patients with anal itching initially have mild anal itching, no obvious changes in anal skin, mostly episodic. Long-term patients have more severe itching, lasting longer, especially worse at night. Excessive scratching or mechanical stimulation can make the perianal skin thickened, roughened, anal folds deepened, local scratching marks, blood crusts, exudation, residual feces and dirt in the folds, in severe cases, can be complicated with infection, with pus blisters or purulent secretions, redness and swelling, the lesions can extend to the perineum, scrotum, female external genitalia, even the skin of both buttocks.

　　Primary pruritus is not accompanied by primary skin lesions, with itching as the main symptom. Secondary pruritus syndrome occurs in primary diseases and various skin diseases, with obvious specific skin lesions and primary lesions. Itching is often a symptom of the primary lesion, such as anal fistula, anal eczema, condyloma, neurodermatitis, anal and rectal tumors, pinworms, etc. The anal itching caused by these diseases all belong to this category.

　　Anal itching often occurs in middle-aged and elderly people aged 20 to 40, young people under 20 are less, and rarely occurs in children. This disease often makes patients feel embarrassed and unbearable. So what can prevent anal itching?

　　1. Timely treat local and systemic diseases that cause anal itching, such as internal hemorrhoids, anal fissure, anal fistula, diarrhea, diabetes, parasitic diseases, etc.

　　2. Keep the anal area clean and dry, try to wash the anal area every night. Use warm water to clean the anal area. Generally, do not use soap, especially not strong alkaline soap. The towels, basins used for cleaning should be used by one person to avoid cross-infection.

　　3. Do not wear tight or hard underwear, wear loose and comfortable cotton underwear, do not wear synthetic fiber underwear, and change them frequently.

　　4. Pay attention to the combination of work and rest, maintain a pleasant mood, prevent excessive tension and anxiety, do not scratch the anal area, and do not use hard objects to wipe the anal area.

　　5. Eat more vegetables and fruits, and eat less or no spicy foods, such as chili, strong tea, coffee, and high-proof alcohol. People with allergic constitution should eat less allergenic foods, such as fish and shrimp, and avoid contact with chemical substances that cause allergies.

　　6. For those with anal itching but no skin breakage, you can dip gauze or cotton into boric acid solution, with appropriate water temperature, take it out and wring it until it does not drip, apply it around the anal area, which can immediately relieve itching. Apply it twice a day, morning and evening, for about 5 minutes each time. Dry it after application and sprinkle talcum powder.

　　7. According to traditional Chinese medicine, anal itching is often due to fire in the heart meridian, blood heat generates wind; or deficiency of both Qi and blood, blood does not nourish the wind, endogenous liver wind, wind prevails and itching; or due to internal damp-heat, wind evil depressed for a long time, transforming into heat and dryness.

　　8. Timely treat systemic and local primary lesions that may cause anal itching, such as hemorrhoids, anal fistula, eczema, and contact dermatitis.

　　9. Avoid anxiety and excessive tension.

　　Primary pruritus is not accompanied by primary skin lesions, with itching as the main symptom. No need for examination items, secondary anal pruritus occurs after other diseases, mainly check the diseases that cause anal pruritus, such as anal fistula, anal eczema, condyloma, neurodermatitis, anal and rectal tumors, pinworms, diabetes, etc. The examination items are as follows:

　　1. Blood, urine, and stool routine.

　　2. Liver and kidney function.

　　3. Urine sugar, blood sugar, and glucose tolerance test.

　　4. Biopsy and smear tests.

　　Patients with anal itching are troubled by the unattractive location of the itching, and their daily life is greatly affected. While treating the disease, it is advisable to adjust the diet to accelerate the recovery of the disease.

　　1. The patient's diet should be light.

　　2. Eat more vegetables and fruits to keep the bowels smooth. Increase them appropriately in daily diet.

　　3. It is not advisable to smoke, drink alcohol, strong tea, coffee, and spicy foods. Also, it is recommended to eat less or not eat animal protein foods such as fish, shrimp, crab, and beef.

　　4. Avoid eating and contacting foods, chemicals, lacquer, spicy foods, and certain medicines that cause allergies, as well as some nourishing products like sand root, rehmannia, silver ear, and snow frog. It should be emphasized that people who like to take tonics in autumn and winter should not eat an excessive amount of ginseng, astragalus, longan meat, ejiao, angelica, jujube, and prepared rehmannia, etc., in an impractical manner, in order to avoid the taboo of 'excess qi is fire'.

　　5. Foods like hot pot, stewed dishes, and old fire soup are prohibited, do not eat them.

　　Surgical treatment can be used for chronic anal itching that does not heal or recurs multiple times. The surgical methods include removing the nerve supply to the anal skin and excising the anal skin.

　　1. Subcutaneous Incision

　　Make half-circular incisions on both sides of the anus, 5 cm away from the anal margin. Cut through the subcutaneous fat, separate the skin flaps inward to expose the lower edge of the external anal sphincter, and separate the skin from the internal anal sphincter to the anal valve plane inside the anal canal. Then separate the skin on both sides of the anus from the deep tissue, allowing the wounds on both sides of the anus to communicate. Finally, separate the skin on the outer edge of the incision 1-2 cm outward, stop bleeding, and suture the skin flaps back to their original position. Sometimes drainage is needed, and a pressure dressing is applied externally. The intestines need to be prepared before the operation, and defecation should be controlled for 3-4 days after the operation.

　　2. Excision and Suturing

　　Make an incision along the anal margin from front to back, and make another curved incision on the outer side of the incision. Include the skin with lesions within the incision, connect the two ends of the incision, excise the crescent-shaped skin between the two incisions, and suture the wound. The same method is used on the opposite side. After excising the skin, itching can be stopped, but the wound may sometimes become infected.