Pinworm Treatment, Prevention and When to See a Doctor

Pinworms or threadworms are intestinal parasites that can trigger a highly contagious infection cycle once they find their way into your system.

A pinworm infection is medically referred to as enterobiasis or oxyuriasis, and it is associated with a great deal of physical discomfort. However, it poses no real danger to your health.

This infection can be contracted by either ingesting or breathing in pinworm eggs. Fully grown pinworms are thin, white, and ¼ to a ½ inch in length and have a diameter of a strand of a thread or dental floss.

The World Health Organization states that the prevalence of pinworm infestation worldwide is approximately one billion.

In fact, the Centers for Disease Control and Prevention cite it as the most common type of worm infection in humans in the United States. (1)

The symptoms of pinworm infection usually come and go in cycles of every 2 weeks, coincident with the life cycle of the worm. The female pinworm is especially active at night when she lays her eggs around the anus.

How Does One Contract Pinworms?

One can become infected with pinworms in several ways:

• People with a preexisting pinworm infestation tend to have itchy bottoms and cannot help scratching the affected region.
  As a result, the pinworm eggs in and around the anus get stuck on their fingertips and are then transferred to their mouth, clothes, bedding, toys, or any surface they touch with their infected hands.
• Other people can contract this infection by touching contaminated objects and then eating with the same hands, thereby accidentally swallowing the pinworm eggs that their fingertips have picked up.
• Food items can also carry pinworms or their eggs and serve as a contamination source unless cooked properly.
  People often pick up this infection by consuming undercooked meats such as beef, pork, or fish.
• In very rare cases, inhaling airborne eggs present in the surrounding dust can also introduce pinworms into the body.

People of all ages can suffer from this kind of worm infestation, but it is most prevalent among school-aged children.

Given the ease with which pinworm eggs can be transferred from one person to the next, the infestation spreads rather easily in group settings such as homes, schools, and daycare centers.

In fact, pinworms are so contagious that even if a single member of the family is infested, it is highly likely that others will follow suit.

How Are Pinworms Spread?

A pinworm infection follows a cyclic pattern, which begins once the worm eggs enter your body either through ingestion or inhalation.

Once inside the body, the eggs make their way into the small intestine for a brief incubation period before they hatch into worms.

The baby worms then mature for about 4 to 8 weeks within the small intestine and then travel to the large intestine where they attach themselves to its inner lining.

Over the next few weeks, the worms advance through the large intestine to set base at its posterior end.

Pinworms lay their eggs in the area around the anus (bottom), typically at night. These infesting pinworms also secrete a mucus-like substance along with the eggs, which causes itching in the affected area.

When you scratch the nether region to relieve the itch, your nails or fingertips are likely to pick up the pinworm eggs, which can then be transferred elsewhere through direct or indirect contact.

Eating with infected hands will transfer the eggs to your mouth, prolonging the infestation for as long as you continue ingesting the fresh eggs. These fertilized eggs can survive for up to 20 days in the environment.

After birth, a pinworm survives for a period of 4-6 weeks on an average. People below the age of 15 rarely develop immunity to these worms and have to rely on treatment to fight off the infestation.

Infected people can spread these eggs to their clothes or the surfaces they come in contact with by touching them with infected hands.

Anyone else who touches the contaminated surface thereafter may get infected with the eggs as well and transfer them to his/her mouth.

Signs and Symptoms of a Pinworm Infection

Pinworm infections, because of the long incubation time or carrier states, can go unnoticed for a long time. However, in symptomatic cases (more frequent than carriers), the complaints of the infected individual include:

• Itching in and around the anus, which gets especially aggravated at night
• Restless sleep due to anal itching
• Decrease in appetite
• Dark circles or bags under the eyes due to lack of sleep
• A general feeling of malaise or being unwell
• Vaginal inflammation
• Sweet cravings
• Visualization of adult worms in the feces
• Eggs that are seen stuck to the skin around the anus
• General irritability
• Pain, rash, or other skin irritation/infection around the anus
• Mood swings or behavioral changes
• Abdominal pain, which can range from mild to intense
• Nausea

Children with pinworms in the body do not usually exhibit any noticeable symptoms that can alert you to their condition.

However, the infestation may be easier to spot in cases where the child becomes unusually cranky and agitated at night due to itching around the anus and vagina.

The discomforts related to a pinworm infection tend to be much more pronounced during the night.

In cases when the infection is particularly severe, the child may remain uneasy and restless throughout the night. This makes it very difficult for the child to get a good night’s sleep, making him/her increasingly irritable.

How Do I Know if My Child Has Pinworms?

Anal itching is perhaps one of the characteristic symptoms of a pinworm infestation.

Visual Examination

So, if your child is having trouble going to sleep due to anal itching at night, it may be best to check for pinworms, preferably on a night when your child didn’t have a bath.

All you need to do is to make your child lie face down on the bed such that the buttocks are in the air. Ask the child to exert pressure like he/she would when having a bowel movement, as it will help expose the anus.

Then, spread the butt cheeks to examine the anus with the help of a flashlight while the child is laying on his/her belly

Scotch Tape Test at Home

If you are still not certain about the presence of pinworms, you can do what is known as the Scotch tape test to get a better judgment.

• Apply a piece of Scotch tape on the anal area such that it extends 2 cm on either side of the anus.
• Press the tape firmly so that it picks up any pinworm eggs present on the site, and then remove it from the skin.
• Stick the tape to a glass microscope slide with the adhesive side down. You can easily get a glass slide from your physician if you do not have one.
• Your doctor will then observe the slide under a microscope for the presence of pinworm eggs that may have stuck onto the tape from the anus.

Medical Treatment for Pinworms

The standard pharmaceutical drugs used for the treatment of pinworm infection include:

• Mebendazole (2)
• Pyrantel pamoate
• Albendazole

At first, your doctor will prescribe a single dose of any of the above-listed medications and then another single dose of the same drug 2 weeks later. Of all these drugs, pyrantel pamoate is the only one available over the counter.

Even though these anthelmintic agents have a higher eradication rate than 90% against pinworms, they may fail to kill the eggs the pinworms spawn. These eggs then survive to produce new pinworms, which necessitates a second round of extermination to prevent reinfection. (3)

The treatment for reinfection is along the same lines as the first infection and maintains the same gap of 2 weeks between the first dose and the second.

If more than one member in your household becomes infected or if repeated symptomatic infections occur, it may be best to get all household members treated simultaneously.

The same rule applies to institutions or other group settings, wherein mass treatment of all the members conducted at the same time and repeated in 2 weeks can prove effective.

Early treatment is crucial to prevent the spread of pinworm infection to your family, friends, and virtually anyone in your vicinity. The longer you wait to address this contagious problem, the higher the risk of contamination.

Ways to Get Rid of a Pinworm Infection

Here are some natural treatment options for pinworm infection.

Practice Good Hygiene

Personal cleanliness is key in breaking the pinworm cycle and banishing the infection for good. This fundamental step involves keeping yourself and your living environment completely hygienic.

You can adopt the following measures to ensure that the recommended standard of personal and home sanitation is met:

Regularly Wash Your Hands

Pinworm eggs tend to latch onto your fingers as you scratch your itchy bottom, and then they are transmitted to others or reingested by yourself, perpetuating the cycle of infection.

The only way to break this pattern is to keep your hands clean at all times by washing them regularly with mild soap and warm water.

Proper hand sanitation is especially incumbent after using the toilet or changing a diaper and before you sit down for a meal or touch your mouth.

Bathe Daily

It is typical for pinworms to deposit their eggs around the anus at night, usually when you have drifted to sleep.

So, if you have a pinworm infection, it is advised that you shower every morning to rid your body of the eggs that the worms laid overnight.

Observe Proper Nail Hygiene

Keeping your hands clean also requires that you clip your nails from time to time. The eggs can get trapped inside your overgrown nails, and washing your hands may not be enough to dislodge them.

Thus, to minimize the risk of contamination, it is essential that you keep your nails short. Nail-biting is strongly discouraged if you wish to overcome this infection, and keeping your nails short will help in this regard too.

Wear Proper Underwear

Wear clean, dry, and well-fitted underpants every day.

Change Your Sleeping Clothes

Do not wear the same sleepwear on consecutive nights. Wash your night clothes in hot water the morning after before wearing them again.

Clean Floors

To keep your living environment free of pinworms, it is recommended to mop or vacuum the floors of your house regularly until the threat of contamination is effectively resolved.

If you have carpets or rugs on the floor, it is mandatory to vacuum them as well.

Clean Surfaces

Pinworm eggs can easily be transferred to commonly used surfaces, particularly in the kitchen and the bathroom.

It is therefore essential that you thoroughly clean your kitchen counters, fridge handle, faucet knobs, toilet seat, and flush handle daily.

Keep Your Home Illuminated

Pinworms lay their eggs at night primarily because these eggs are sensitive to light. Thus, ensuring that your room or living space has enough light during the day can naturally extinguish the eggs.

Do Not Scratch

Resist the urge to scratch your anal area, no matter how strong the itch. If at all, you should consider wearing gloves to gently pat down or rub the irritated site.

Directly touching the infected site will only transfer the eggs onto your fingers and increase the risk of further contamination.

Moreover, excessive or rigorous scratching can damage the skin around your anus and amplify your discomfort.

Instead of rubbing or scratching the infected anal skin, you are advised to wash it with warm water and soap. This may help disinfect the site and relieve the itch at the same time.

Clean Your Toilet Essentials

It is recommended to seal your toothbrush in a case to keep airborne eggs from landing on it.

Clean Toys

If you have a child in the house, you must clean his/her toys, too.

Eat More High-Fiber Foods

Consume a fiber-rich diet to make your stools bulkier. The more weight your stool has, the easier it will be to wipe away the pinworms in your gut along with the bowel movement.

To that end, you must increase your intake of fresh fruits and vegetables along with other sources of dietary fiber such as bran, wholewheat, and raisins.

Limit Your Carb and Sugar Intake

Parasites such as pinworms derive their sustenance from starches and sugar. So, cut back on foods that are high in sugar and carbohydrates to starve the pinworms into extinction.

Do Not Use the Bathtub

People with an ongoing pinworm infection should avoid taking baths in a tub as the still water can easily get contaminated with pinworm eggs.

It is for this same reason that infected people are strictly advised against sharing a bathtub with others for as long as their condition persists.

Showering is the recommended option for people with pinworms.

Decontaminate Used Linens, Underclothes, and Towels

Shaking the contaminated bed linens, towels, and underclothes may seem like a good way to rid them of pinworm eggs, but this will only let the eggs loose in the surrounding environment or transfer them onto some nearby surface.

Thus, you must avoid any such impulses and carefully place the infected items into a washer and launder them in hot water followed by running them through a hot dryer to kill any eggs that may have remained.

Anthelminthic treatment, which involves using antiparasitic medication to eradicate the worms from your body, is the primary strategy for dealing with this kind of infection.

However, the treatment will only bear successful results when performed in conjunction with the above-listed hygienic measures. Medical treatment with proper supportive care at home will help prevent autoinfection and recurrence. (4)

Preventive Tips

Pinworms are extremely contagious and hard to detect as they rarely present any symptoms.

So, even if a single member of your family is suffering from a pinworm infestation, it is necessary that everyone in your household gets medically examined and treated for worms, as there is a high risk of the infection spreading.

This precautionary measure applies even to those who do not have any symptoms of an infection.

Practicing strict and appropriate hygiene, both during treatment and for a few weeks afterward, is extremely critical to prevent the spread of pinworm eggs.

This includes personal hygiene and keeping your surroundings clean.

As pinworm eggs often get lodged onto the surfaces around your house, it is recommended to vacuum your furniture and living space regularly.

Also, make sure to wash your bathroom and kitchen from time to time thoroughly.

Risk Factors Associated with Pinworm Infection

The following risk factors can increase your chances of contracting pinworms:

• People who have been in direct contact with a person who has pinworms, most likely a family member or a child
• People who have been in contact with contaminated clothing, bedding, or objects that carry pinworms
• People who are regularly exposed to group environments such as schools, daycare centers, and other places where pinworms are generally found
• Young age (children aged 5-10)
• Uncontrolled anus-finger-mouth contact (ingestion of eggs/larvae)
• Nail-biting
• Poor unsupervised body hygiene
• An environment with poor sanitation
• Being in a long-term care/mental facility
• Incarceration with sexual acts
• Attending school or daycare centers

Complications of Pinworm Infection

A pinworm infestation is largely a non-threatening condition, but it can bring in its wake a number of discomforting symptoms that can cause irritability, particularly during the night.

Perhaps the most problematic of all its symptoms is the intense anal itching that is quite hard to ignore and tends to last as long as the condition remains untreated.

A pinworm infection, especially when left unattended, can lead to several complications:

Secondary Infection

Persistently and rigorously scratching the itchy region can break the skin barrier and pave the way for secondary bacterial infections, some of which can be difficult to treat.

Moreover, unless the infected individuals are properly treated for these worms, they can spread their eggs to uninfected individuals.

Urinary Tract Infections (UTIs)

An untreated case of pinworm infection can set the ground for a subsequent urinary tract infection (UTI), particularly in women.

However, this type of complication is not a common occurrence.

Weight Loss

If the colonization of pinworms is allowed to grow due to lack of proper treatment, these parasites will deplete your body’s reserve of essential nutrients over time.

This kind of continued nutrient loss can eventually lead to weight loss.

When to See a Doctor

Pinworm infection, particularly in children, calls for medical treatment. Even though adults often acquire immunity to these worms and are generally better at fighting off the infestation, a visit to the doctor becomes essential if:

• You notice adult pinworms in the feces.
• You experience excessive itching in the genitals or vagina.
• The skin around the anus becomes red, tender, and swollen, which may be a sign of secondary skin infection such as a strep infection.
• The anal itching persists for more than 1 week.
• It hurts when you urinate.
• There is blood in your stools.
• There is an increase in the frequency or urgency of urination such that you are unable to hold it in.
• You run a fever or develop abdominal pain along with the other symptoms; this may signal a potential complication.
• You have recently recovered from a pinworm infection and suspect reinfection.

Final Word

For any kind of treatment plan to work, whether it is natural remedies or medications, it is important that you do it properly and follow it all the way through.

The correct dosage, technique, and precautionary measures cannot be undermined if you wish to achieve desired results.

This is as true in the case of treating a pinworm infestation as it is for any other health condition. You must exercise patience and diligence to notice an improvement in your condition, instead of giving up on a particular treatment midway just because you do not see immediate results.

It is essential to improve sanitation within your environment, adhere to strict handwashing guidelines, and not ignore the symptoms in the hopes that the symptoms will just go away.