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To the Editor:—
A causal mechanism of pruritus ani, particularly in men of the middle-age range included by Dr. Copland in the "psychosomatic" group, is anal leakage of minute particles of liquid or semiliquid feces which often occurs when flatus is expelled. These small amounts of fecal material spread over the perianal skin and cause annoying irritation and at times a maddening pruritus.The usual absence of hemorrhoids, fissures, and detectable dermatitis, make this condition almost impossible to diagnose unless the patient is thoroughly questioned about flatus usually preceding or accompanying the pruritus ani. The flatulence itself is rarely continuous; it occurs in recurrent episodes which often follow the ingestion of certain foods; and it may be normal or the manifestation of some degree of food allergy or of intolerance due to digestive insufficiency.After the mechanism is explained to him, the patient is asked to maintain the anal orifice
Lamar CP. Management of Pruritis Ani. JAMA. 1965;194(9):1024. doi:10.1001/jama.1965.03090220080035