Pruritus Ani—Not an Itch that Can Be Ignored

Despite its prevalence and suspected neoplastic associations, pruritus ani is a condition that is both under-reported and under-researched. There is a lack of knowledge surrounding the condition and consequent ambiguous diagnostic pathways, mismanagement, and inadequate patient care. This paper aims to tackle the vast causes of pruritus ani, and how to complete a thorough assessment of a patient presenting with such symptoms, before reviewing the literature for appropriate management strategies that may subsequently be implemented into clinical care at both a primary care and specialist care level. An electronic literature search was undertaken via databases including PUBMED, Scopus, and OVID Medline. Literature included those papers where the primary concept was pruritus ani. Over 32 articles were included in this review. Many of the included studies had small study sizes possibly indicating poor or underreporting of said condition. Known causes of pruritus ani were explored before further analysing the management of idiopathic pruritus ani, which represents the majority of pruritus ani cases. The basis of guidelines and recommendations for the treatment of pruritus ani is on poor research with small sample sizes and more on expert opinion, despite it being a relatively common disease. There are extensive conservative treatments that must be tried before progressing to medical treatment. Improving knowledge of this disorder and its associations with neoplastic conditions are the key goals of this paper.