Itchy butt at night? Uh oh. It might be pinworms. This post will review
All things considered, in the big scheme of things there are a lot of worse things that can happen, but you are certainly entitled to give a big groan if this is happening to you or one of your family members. Who Gets Pinworms The Pinworm (Enterobius vermicularis if you want to impress folks the next time it comes up in conversation) is the most common worm infection in the USA. The target age range for the primary infection is children between the ages of 5 and 10. It is fairly uncommon under age 2. These preschool and school age kids are usually the culprits bringing it home, but it is really easy for the pinworms to spread among family members if you live in close quarters and spend any snuggle time in the same bed. Animals do NOT get pinworms, but they can carry them around on their fur and spread them that way. How Pinworms Spread The most common way for a person to get infected is by ingesting the eggs. They can also be inhaled through the nose. The eggs can live out of the body for up to 3 weeks, although they lose infectivity after 1 to 2 days in hot dry climates. These eggs are way too small to be seen by the naked eye, but can be seen under a microscope. If you happen to touch a surface that is contaminated and then put your fingers in your mouth or handle food...tag you're it. It takes between one and two months after the exposure for the symptoms to appear. The eggs mature into the worms.. They live in the intestine and gradually make their way down the GI tract until they are close to the anus. The actual worms are very small, white and threadlike. There is no microscope needed to see them. The male worms die fairly quickly, but the female worms make their way out of the body and lay the eggs on the anus. They tend to do this at night. Why is that? One theory is that the body temperature is a little higher when you are sleeping and this drives them out. When they emerge from the body, this might cause some itching. It is common for some children with pinworms to wake at night. Children that are old enough to use their words may tell you that they are itchy or that their butt hurts. Little girls might have itchy vaginas or vaginal discharge. Some kids just have mysterious tummy aches. Not everyone will be aware of them. In fact, many people with pinworms have no symptoms Diagnosis In some cases you can actually see little wiggling thread-like worms in the poop. You can just imagine the calls I get when that happens. But more often than not, diagnosing this condition won’t be quite as simple as glancing into the toilet. Some folks recommend putting a piece of scotch tape across the anus and looking in the morning to see if there is anything stuck on it. I prefer the actual ‘look and see’ method. I suggest that a parent go check in the middle of the night. Make sure that your child goes to sleep with a very clean butt, perhaps after a good bath. Once they have been asleep for several hours, take a flashlight and spread the butt cheeks far enough that you can actually visualize the anus. Unless your kiddo is a remarkably sound sleeper, I would tell them ahead of time that you are planning on doing a butt inspection. With a little advanced warning, if they wake up with a flashlight shining at the tush, they are not going to be startled. Pinworms will look like little white threads. They will likely be moving. If your sleeping angel has slept through this far, and you do see wriggling worms, try not to shriek and wake them up. Treatment Once the diagnosis is made, many folks opt to treat, even though most cases are asymptomatic. The medications do not kill the eggs, just the worms, so they should be taken initially and then repeated in one to two weeks. There is an over the counter medication called Reese pinworm (generic pyrantel pamoate), which has a rebate, making it even more affordable. They also have some very handy wipes to deal with the itching. If over the counter fails, there is a prescription medication called albendazole (Albenza) which can also be quite pricey. This also only comes in a tablet so it is a bit challenging for younger kids. This one is still over $400 but at least gives the 2 dose course. Check with your insurance to see if it’s covered, and if it’s not you can get the price down to ~$40-$70 on GoodRX. Singlecare is another option for getting it cheaper. Because most people do not have symptoms but can still spread it, the entire family should be treated if you want to really get rid of pinworms as quickly as possible. None of the medications have been rigorously tested for pregnant, breastfeeding (it does transfer into the milk) or children under two. While there have been no adverse reactions reported, if you are dealing with an infant, I am going to give you the unwelcome suggestion to ‘check with your doctor’. Natural Remedies Natural remedies include eating a diet high in garlic and/or believe it or not, enjoying some pumpkin seeds. Worms love carbohydrates. Limiting sugar and white flour (which is a good idea anyway) may keep them from thriving. Probiotics, which stimulate the healthy bacteria in the gut will also make the environment one where they can't flourish as well. Vaseline around the anus at night will make it harder for the eggs to be laid. If you like natural remedies, try crushing up garlic and making a paste with the Vaseline and putting that around the butt every night. The fact is that if there were absolutely no further ingesting of the eggs, pinworms could resolve untreated after about 14 weeks (two life cycles), but the problem is most folks just keep on ingesting the eggs which gets them reinfected, and so the cycle continues. Preventing Spread It is gross, I know, but the most common issue is fingers scratching an itchy butt and then making their way to the mouth. This might be why diaper-age kids don’t get impacted as often. They simply don’t have ‘butt access’. We must do our best to eliminate the eggs and prevent the egg to mouth circuit. Scrub under the fingernails and make sure that they are cut short. Focus on frequent and effective good hand washing. Do a nightly bath with particular attention to the butt. Add some apple cider vinegar to the bath water. If you are worried about dry skin, just make sure you apply a good all over lotion after the bath. Clean up As mentioned earlier, the eggs can live on a surface outside of the body for up to 3 weeks. They survive longer in moist environments. High heat will kill them. They can be easily dispersed into the air. Pay attention to this when changing the sheets. Avoid shaking the sheets out into the air as much as possible. Wash all sheets, towels, pajamas and underwear in HOT water. You want to vacuum or mop, NOT sweep. Scrub the bathroom and any surfaces. Clean your toothbrushes. Putting them through the dishwasher works. Remind yourself that there are worse things. But this is indeed the proverbial pain in the butt. |
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