Pinworms – You Have To Admire Them

Itchy butts are funny, as long as they are happening to someone else, right? The fact is, so called pruritis ani may be an explanation for some childrens’ sleep problems, mysterious red rashes in their nether regions, and could herald an infection of pinworms. (insert shudder here)

You may not have to love pinworms, but you have to admire them. You may definitely have questions about their preferences for real estate (your kids’ colon), but you should respect their tenacity and biological cleverness. While they may give you the heebie jeebies, they need us. Seriously. Archeologists have found coprolites (that’s a $10 word for fossil poop, use it in a sentence this week) with pinworms fossils inside from ancient Egypt, and even from campsites from the first humans to have crossed into the New World. We are their only host, and, they do a spectacular job of using us.

Enterobius vermicularis, as this little worm is called, affects up to about a 5-15% of individuals, most of them being children. Their contagiousness makes them a global phenomena, and as I tell my families who are blessed with them, they don’t care who you are or how clean your house is; they occur across all strata of class, culture and country. We see families whose members have them on a regular basis, all year round. Just about no one is happy to hear about it!

Most kids (and adults) who have them are asymptomatic or are unaware. The majority of their problems arise from the ick factor of having a critter in your innards. Put differently, and in the words of a friend, doctor, and mom whose kids were recently infected with pinworms, aka a “distressing, yet humorous condition” Her words say it best:”There’s just nothing like seeing worms crawl out of your child’s bottom.”

To understand how pinworms are spread, and treated, one must consider their life cycle. Pinworms do set up residence in the large intestine, and sustain themselves on the fare they find there. At night, (and, there is no explanation as to how these sightless dwellers in the land where the sun don’t shine know it’s night) the female worms then exit the anus, and lay upwards of 10,000 eggs in the surrounding skin. This process may generate the intense, or prickly itching in some children. That may be the root cause of restless sleep. Less known fact: pinworms may be associated with new onset bedwetting in other kids. Take note.

The eggs, which are too small to see with the naked eye, may remain in bedding, or be passed to furniture, toys, or other surfaces, including the hands. Transmission of new infection occurs when an individual (adult or child) swallows or inhales the eggs, which hatch when they reach the gut. The cycle begins anew. It takes the worms about 2 weeks to mature, and each one will live on for up to two months. Twerps.

Pinworms are tiny. They are called threadworms, in some parts, for good reason, as they appear like tiny bits of cotton lint. If the lint on your child’s buttocks moves, take a minute to scream, then know you have clinched the diagnosis. Less commonly, parents or children will see moving tiny worms on poop passed into the toilet.

Making the diagnosis in the office is much easier when families have observed worms and have described them for their health care provider. In some cases, suspicious clinicians will provide tape worm ‘kits’ for parents to apply and remove a small swatch of cellophane tape to the skin near the anus. Using a microscope a provider can pinworm eggs, and offer treatment. In other cases, the history provides an ample basis for the diagnosis, such as in the case of being a known contact of someone who was infected.

Parents may find their health care providers may treat only the symptomatic individuals or all members of a family (or, in the case of residential outbreaks, where rates can skyrocket). I urge parents to discuss and negotiate with their providers what seems most appropriate.

And the treatment? In ways that are seldom true, the pharmacology of antiworm medications feels like sweet revenge. “You wanna piece of me, wormy? Take this!” Antihelminthic drugs as they are called, paralyze the worm, and lock up its working parts. Once treated, the done-for worms are passed unceremoniously into the toilet via the stool, to a Viking funeral, of sorts. Is that justice, or what? Younger worms may not respond to the medication and those eggs may linger, and so we give our patients treatment for up to 2-3 weeks. And, caveat: reinfection and recurrence are common. Sometimes, it itakes a few rounds to get ‘em all.

How to prevent pinworm infections in the first place? Here’s where moms are right: washing hands before eating will reduce the transmission of the worm eggs. For those who are suspected of infection I counsel our families to do a few things to lower the likelihood or recurrence. Bedding and laundry should be washed in hot water. Parents should mop floors in the house over a few days to lower the number of potentially viable eggs. Family members should bathe in the morning to remove eggs laid overnight. And, comfort measures should be offered to those who are affected: trimmed nails, soothing baths, reassurance, and hugs. And, don’t blame the dog!  Pinworms are a human only problem.

Is there an upside to all this? Maybe. Recall my doctor friend and mom whose kids were recently affected? She turned the freakout energy into a great learning opportunity and biology lesson for her kids. Together, the family got on the web and learned all about pinworms. Information empowered her kids. She notes: “We also learned about other worms and now my son goes around saying “Round worms can grow up to 30 feet long!!” On the plus side, my kids’ interest in hand hygiene has increased CONSIDERABLY since our recent infestation. “

Well done.  Who knew a pain in the butt could be so edifying?

(photo above by jerol1; cartoon below by me.)

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