Itching at the anus is almost always due to anal or rectal conditions, the most likely of which is hemorrhoids. If there is frequent passage of bright red blood in the stool along with a painful bowel movement, one should look for an anal fissure. If there is a chronic discharge, one should look for an anal fissure or rectal prolapse. Pinworms must be sought in children. Finally, contact dermatitis and candidiasis are always possible. If candidiasis is the cause, a search for diabetes mellitus should be made.
If the physical examination is normal, examination with an anoscope is essential. Sigmoidoscopy should also be done but is not adequate to detect hemorrhoids, anal fissures, and fistulas. If these are negative, a trial of antifungal creams (Lotrimin®, etc.) should be given before other expensive diagnostic tests are ordered. A Scotch tape test and stool for ovum and parasites are useful, especially in children.
Read excerpts from these other book chapters related to Cysts:
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
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Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9 
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