ABSTRACT
Pruritus ani (PA) is defined as intense chronic itching of the perianal skin and is classified as idiopathic when no apparent cause is found. PA is one of those symptoms that can be managed by a variety of clinicians, mostly general practitioners, dermatologists and colorectal surgeons. Unfortunately, like irritable bowel syndrome and chronic pain syndromes, there is underestimation of how significantly PA can affect quality of life. Historically, PA has been poorly understood and considered to be symptom rather than a diagnosis. The limited evidence available led to theories about how perianal itch was the end result of multiple triggers, many of which appear to be unrelated. In 1941, Rothman defined itch as an unpleasant sensation that elicits the desire or reflex to scratch. The processing of itch has many similarities to that of pain and is no less complex. Pain and itch are processed in the dorsal horn and have some interconnection, with pain-processing neurons actively inhibiting itch neurons.
