Causes, other symptoms, and treatment

Some sexually transmitted infections (STIs), such as anal herpes or gonorrhea, can cause rectal itching. However, it is also possible that the itching results from other conditions, such as anal fissures or hemorrhoids.

In this article, we will discuss which STIs can cause rectal itching, and how to treat them. We also look at other conditions that can cause rectal itching.

Gonorrhea is the result of the Neisseria gonorrhoeae bacteria.

According to the Centers for Disease Control and Prevention (CDC), gonorrhea is a very common STI, affecting around 1.14 million people in the United States every year.

People can contract it via sexual contact with the genitals, mouth, or anus of a person who has gonorrhea.

Symptoms of rectal gonorrhea include:

• anal discharge
• anal itching
• soreness and bleeding
• painful bowel movements

However, not everyone with rectal gonorrhea will have symptoms. That is why it is important to have regular STI screenings.

Learn more about gonorrhea here.

Treatment

Treatment for gonorrhea involves a combination of ceftriaxone and azithromycin, which are antibiotics.

It is important that a person abstains from sexual activity for 1 week after treatment. This helps prevent passing the infection on to others.

Anal herpes is the result of herpes simplex virus type 1 or herpes simplex virus type 2.

People can contract herpes if they come into contact with:

• herpes lesions
• mucosal surfaces, such as the vagina or rectum
• genital and oral secretions

Symptoms of anal herpes include:

• small blisters that burst, leaving inflamed and open sores
• tingling, burning, or itching sensation
• pain while urinating

The CDC note that most people who have herpes are asymptomatic, meaning that they do not have any symptoms. Others may only experience very mild symptoms.

If symptoms do appear, the first outbreak of herpes lasts for approximately 2–4 weeks, and a person may also experience flu-like symptoms.

Learn more about anal herpes here.

Treatment

To diagnose herpes, doctors will take a culture of a sore or perform a blood test.

There is currently no cure for herpes. However, doctors can prescribe antiviral medications.

These can shorten the amount of time an outbreak lasts and reduce the chance of passing this infection on to others.

Anal warts are the result of the human papillomavirus (HPV). One 2020 article notes that approximately 10% of people who have HPV will develop genital warts.

Symptoms of anal warts include:

• individual or large masses of warts around the anal area
• warts that may bleed
• itching or discomfort

Learn more about anal warts here.

Treatment

There is no cure for anal warts. However, the article states that 80% of people will spontaneously clear the infection within 18–24 months.

A doctor can surgically remove the warts or prescribe topical agents.

Rectal itching may not be the result of an STI.

The following can also cause a person to experience an itchy anus. However, the list is not exhaustive, and therefore a person should contact a doctor if they are experiencing rectal itching.

Yeast infection

An anal yeast infection occurs when there is an overgrowth of the Candida bacteria.

One 2016 article notes that Candida infections are present in approximately 10% of those experiencing an itchy anus.

Although an anal yeast infection is not an STI, a person can transmit or develop it via anal sex without the use of a condom or other barrier method.

Alongside itching, a person may experience:

• burning
• anal discharge
• flushed or irritated skin
• soreness

Learn more about anal yeast infections here.

Hemorrhoids

Hemorrhoids, or piles, are swollen veins that appear inside and around the anus.

Symptoms of internal hemorrhoids include:

• itching, bleeding, pain, or burning in the anus
• mucous discharge from the anus
• swelling

Learn more about hemorrhoids here.

Anal fissure

Anal fissures are tears in the skin in the rectum and anus. The United Kingdom’s National Health Service (NHS) note that the majority of cases typically occur due to constipation or large stools that tear the lining of the anal canal.

However, anal fissures may occasionally occur due to STIs, such as syphilis or herpes. This is because they can infect and damage the anal canal.

Some anal fissures can last for more than 6 weeks.

Symptoms of anal fissures include:

• bleeding when passing a bowel movement
• itching around the anus
• intermittent pain while passing a bowel movement

Learn more about anal fissures here.

Pinworms

Pinworms are small thin white roundworms called Enterobius vermicularis. The CDC state that pinworm infection is the most common worm infection in the U.S.

People can contract pinworms after ingesting pinworm eggs. This can happen after swallowing the eggs that may be present on fingers, clothing, food, and other contaminated objects.

While a person sleeps, the female pinworm travels to the anal area and lays its eggs around the anus.

Symptoms can be mild, and some people do not experience any. However, the most common symptom is rectal itching. Other symptoms may include:

• redness and swelling
• watery diarrhea
• abdominal pain

A person may also be able to see the worms and their eggs on the skin near the anus approximately 2–3 hours after a person falls asleep.

Learn more about pinworms here.

Irritants

Certain irritants can lead to skin conditions, such as eczema or psoriasis. This can lead to anal itching, inflammation, swelling, and pain.

The most common irritants that may cause anal itching include:

• soaps
• shampoos
• recycled toilet paper
• intimate hygiene wipes
• certain foods, especially those that contain nickel

A person should always contact a doctor if they are concerned that they have contracted an STI.

However, according to the NHS, a person can try the following to provide relief from the itching:

• gently washing and drying the anus after having a bowel movement, and before bed
• wearing loose-fitting cotton underwear
• bathing or showering in lukewarm water
• eating plenty of fiber, such as fruit and vegetables and pasta
• avoiding wiping after having a bowel movement, and instead washing with water or using moist toilet paper and patting dry
• avoiding scratching on and around the anus
• avoiding fragranced products, such as soaps
• avoiding eating spicy food and drinking alcohol and caffeine

It is important to contact a doctor if a person is concerned that they have contracted an STI or if a sexual partner informs them that they have an STI.

People should also consult a doctor if any rectal itching does not resolve.

Several STIs can cause anal itching, such as herpes, anal warts, and gonorrhea. However, with medical treatment, people can manage the symptoms or cure the infection.

Rectal itching can also occur due to other conditions, such as anal fissures, irritants, or hemorrhoids.

Although a person may be able to manage the itching at home, it is important to contact a doctor if they are concerned or if the itching does not resolve.

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Hemorrhoids and its treatment

back to the outpatient surgery department

HEMORRHOIDS TREATMENT

Hemorrhoids and varicose veins.
Some people are surprised to learn that hemorrhoids are actually varicose veins located around the anus. This disease is very common in Russia. By the age of fifty, about half of the adult population is faced with itching, pain, blood in the stool, which usually indicates hemorrhoids.

Fig. Internal and external hemorrhoids

What are hemorrhoids?
In fact, hemorrhoids are nothing more than varicose veins of the anal canal and rectum, which form cavernous formations – the so-called hemorrhoids. Experts distinguish two types of hemorrhoids – external and internal – depending on the location in the anal canal. External hemorrhoids form in the immediate vicinity of the anus. Internal hemorrhoids form at the point where the anal canal passes into the rectum.

What are the symptoms of hemorrhoids?
The most characteristic symptoms of the disease are the prolapse of hemorrhoids during defecation (emptying the intestines), bleeding, the admixture of red blood in the stool, itching, foreign body (“painful bumps”), pain in the anal canal and rectum. Like any varicose vein, hemorrhoids can thrombose, causing severe pain. In the early stages of the disease, hemorrhoids can fall out during bowel movements, but then they can easily be set back on their own. In later stages, they require manual reduction. In the future, hemorrhoids may begin to fall out with any load, sometimes even with a cough. Over time, the fallen out hemorrhoids cease to be reduced and remain outside constantly. At this stage, the disease goes extremely far, which requires immediate treatment to a specialist. A complication of this disease is necrosis of the hemorrhoidal node, the appearance of severe bleeding or acute purulent paraproctitis

Fig. Stages of hemorrhoids

Who usually suffers from hemorrhoids?
Anyone can be affected by this disease. Predisposed to this disease are people who lead a sedentary lifestyle – drivers and office workers; people who do not follow a diet – abusing alcohol, spicy foods, and also regularly engaged in hard physical labor, including some athletes – weightlifters, shot putters.
Predisposing factors also include prolonged constipation. Hereditary predisposition also plays an important role in the development of the disease. Often, hemorrhoids develop during pregnancy, which is associated with increased pressure in the abdominal cavity.

How to treat hemorrhoids?
Various treatments for hemorrhoids are available today, depending on the stage of the disease and the severity of the symptoms.
Conservative treatment is carried out in the early stages of the development of the disease and consists in adjusting the diet, lifestyle and taking specific medications.

Traditional dietary recommendations for hemorrhoids include the following:

• Eat 0.5-1.0 kg of vegetables or fruits daily, add bran to the diet.
• Drink at least 1.5-2 liters of fluid per day.
• Prefer wholemeal bread.
• Eliminate spicy, fried, smoked foods, and alcohol from your diet.
• And finally stop smoking!!!
• Do not suppress the urge to defecate.

Surgical treatment of hemorrhoids.
Relatively few patients require surgery. The choice of a specific method depends on the severity of the symptoms and the stage of the disease. Persistent positive results in most patients can be achieved by following a diet regime and correcting lifestyle.
Surgical treatment of hemorrhoids today – outpatient operations hemorrhoidectomy or ligation of hemorrhoids .

Hemorrhoidectomy.
Hemorrhoidectomy, a traditional operation to remove hemorrhoids, is the “gold standard” surgical treatment of stage IV hemorrhoids, as well as thrombosis of prolapsed hemorrhoids. The intervention is usually performed under spinal or epidural anesthesia. The essence of the intervention is to excise a section of the skin or mucous membrane located above the hemorrhoid, which is stitched and intersected. If necessary, the operation can be supplemented by the use of electrocoagulation or a laser.
After surgery, be sure to observe a period of restriction of activity and strictly follow dietary recommendations.
The likelihood of recurrence after hemorrhoidectomy is rather small, but it should be remembered that the pathogenesis of hemorrhoids is varicose veins, and, therefore, new varicose nodes can form in the absence of recurrence of old ones. The possibility of recurrence and progression of the disease increases significantly if dietary and lifestyle recommendations are not followed.

Ligation of hemorrhoids with latex rings.
At present, a simple and effective outpatient method of treating internal hemorrhoids is widely used – ligation of hemorrhoids with latex rings.
This method of treatment is used in patients with II-III stages of hemorrhoids.
The essence of the method is to apply a small latex ring to the base of the hemorrhoid, which compresses it and thus stops the blood flow. Within a few days, the node dies and falls off along with the ring. A small wound forms at the site of the node, which heals on its own within 1-2 weeks.
As mentioned above, this manipulation is performed on an outpatient basis, takes about 10 minutes and does not cause disability. During the first two days after the manipulation, most patients note the feeling of a foreign body in the anal canal and minor pain, which is relieved by taking conventional analgesics.
According to modern research, ligation of hemorrhoids with latex rings avoids hemorrhoidectomy in approximately 80% of patients with hemorrhoids. Thus, to date, ligation with latex rings is the most promising, effective and radical method of treating hemorrhoids.

Laser hemorrhoid removal: the essence of the method

Laser hemorrhoid removal surgery or laser coagulation is a high-tech procedure that can be applied at stages 1-3 of the disease. Using this method allows you to get rid of internal and external hemorrhoids in the most gentle way.

Fig. Laser hemorrhoid removal scheme

The efficiency of the laser is that it is able to simultaneously cut and cauterize tissue. The thermal effect of the laser beam cauterizes tissues and blood vessels. Therefore, laser therapy is completely bloodless, the risk of infection is minimal, and patients tolerate such an intervention much more easily than with traditional methods.
The essence of the procedure is the layer-by-layer burning of hemorrhoids. In their place, small wounds remain, which soon crust over and heal. In the presence of external hemorrhoids, everything is even simpler – the laser simply cuts off the node at its leg and coagulates the wound with blood vessels, which ensures that there is no bleeding.

Indications for laser hemorrhoidectomy:

1. Chronic internal hemorrhoids of 1-3 degrees.
2. External varices.
3. Thrombosis of external nodes.

Contraindications to laser hemorrhoidectomy:

1. Advanced stage of hemorrhoids (4th).
2. Acute infectious processes in the anal area. In the presence of acute infectious processes, it is necessary to carry out preliminary conservative treatment until the inflammation subsides.
3. Chronic diseases in the stage of decompensation.

acute and chronic. Symptoms of hemorrhoids. Treatment of hemorrhoids in St. Petersburg

Hemorrhoids is considered to be one of the most common human diseases. Although estimates vary, it is safe to say that in Europe, hemorrhoids occur in 30-40% of people over 50 years of age.

Until recently, hemorrhoids were considered varicose veins of the rectum. But the fact that in patients with hemorrhoids there are not only venous, but also arterial bleeding, contradicts this theory.

Histological examination of hemorrhoids showed that they consist of a special cavernous (cavernous) tissue formed by numerous arteriovenous anastomoses (fusions of arteries and veins). In the process of human embryonic development, three cavernous (cavernous) bodies are laid in the anal canal – on the right anterior-lateral, left lateral and right posterior-lateral walls. It is in these places that the three main internal hemorrhoids are formed.

These hemorrhoids are formed as a result of impaired microcirculation in the cavernous tissue of the rectum. At the same time, the lumen of the anastomoses expands, the inflow of arterial blood increases, and the diameter of the efferent veins decreases. Microcirculation is negatively affected by both unfavorable environmental conditions and the state of the human body itself (frequent constipation, sedentary work or physical inactivity, pregnancy and attempts during childbirth).

Hemorrhoids may be asymptomatic. Approximately 10-12% of people with hemorrhoids do not feel any discomfort from their disease. However, with rectoscopic and Colonoscopy shows purple vascular growths at the locations of three cavernous bodies. Although asymptomatic hemorrhoids do not need to be treated, they should be detected early. In this case, preventive measures give a good result – a change in the mode of work and life, the correct and even distribution of physical activity, the selection of the right diet and the prevention of constipation.

Modern proctology distinguishes two forms of the course of the disease – chronic and acute hemorrhoids.

With both forms of hemorrhoids, a person can experience complications such as thrombosis, bleeding, inflammation, and prolapse of hemorrhoids. Drug treatment helps to stop the exacerbation, but gives only temporary relief.

Symptoms of chronic hemorrhoids:

• Itching and burning in the anal area.
• Pain in the anus during stool or as a result of long forced sitting in one place.
• Defecation is accompanied by slight bleeding.
• If the patient strains, sneezes, coughs, or walks a lot, hemorrhoids may prolapse from the anal canal.

Surgical treatment of hemorrhoids

Nowadays, proctology has a whole arsenal of methods for the surgical treatment of hemorrhoids.

• Hemorrhoidectomy in its various modifications (surgical removal of hemorrhoids).
• Sclerotherapy.
• Ligation (ligation) of hemorrhoids with latex rings.
• Infrared photocoagulation.
• Ligation of hemorrhoidal arteries under the control of ultrasound Doppler.
• Laser submucosal destruction of hemorrhoids.

Doctor-proctologist examines the stage of the patient’s disease and the complications that have arisen, and only then decides on one or another surgical method for treating hemorrhoids. For example, sclerotherapy and infrared photocoagulation are performed only in the early stages of the disease and most often on an outpatient basis. The same applies to the ligation of hemorrhoids with latex rings.

Submucous laser destruction (LHP)

Submucosal laser destruction is usually prescribed to patients both at the earliest stages of the disease and at later stages. A huge advantage of this surgical intervention is the possibility of its outpatient application.

With the help of a laser, hemorrhoids in the cavernous tissue are evaporated from the inside, without causing any harm to the rectal mucosa. Subsequently, the node collapses and scars.

The whole operation takes 15-20 minutes. The patient can go home within a few hours. The recovery postoperative period is not associated with severe pain. This type of operation can be performed even if there are other pathologies of the rectum – anal polyps, fistulas and fissures.

Surgical treatment of hemorrhoids in a hospital

If the patient suffers from stage 3-4 hemorrhoids or complications of hemorrhoids, then the patient is shown treatment in a hospital. The doctor recommends either dearterialization (HAL-RAR), or complete removal of hemorrhoids (hemorrhoidectomy), or a combined intervention is chosen. It is produced in a hospital due to the long rehabilitation of the patient after it.

A person remains under the supervision of specialists for a month due to possible severe pain during the recovery period. Most often, it is the fear of postoperative pain that causes patients to refuse hemorrhoidectomy, then the doctor selects a different method of treating hemorrhoids (if possible).

Hemorrhoidectomy with LigaSure

The proctologists of our clinic in St. Petersburg sometimes use a more gentle method of hemorrhoidectomy and perform it using the LigaSure device. This device allows you to remove hemorrhoids through rapid bipolar electrocoagulation, which eliminates the need for suturing. The duration of the operation is only 10-20 minutes, and the patient after it must be in the hospital for 1-2 days, instead of 4-7. This method allows you to reduce the level of discomfort during the postoperative period, and achieve a full recovery in 3-4 weeks.

HAL-RAR dezarterization

In 1996, the Japanese doctor Morinaga proposed to ligate the hemorrhoidal vessels under Doppler control. Currently, this high-tech operation is recommended for patients with stage 3 hemorrhoids or patients suffering from hemorrhoidal bleeding.

During the operation, the terminal branches of the superior rectal artery are ligated. It is through it that blood enters the hemorrhoids. After that, the nodes falling out of the rectum are pulled up and they are also ligated.

This procedure is called HAL-RAR or desarterization or Doppler-guided hemorrhoidal artery ligation.

Even compared to the previous one, this method of surgical intervention has a number of advantages:

• The operation eliminates the very cause of the disease – excessive arterial blood flow to the hemorrhoids.
• The operation allows you to restore the natural position of the nodes and fix them in it, which protects them from falling out.
• After surgery, there are no wounds in the anal canal.
• Hospitalization takes only 1-2 days.
• The patient’s ability to work is restored in 5-7 days after the operation.