This is a topic most people don't like talking about because it makes us uncomfortable (literally!) ... it's like when you talk about nits your head gets itchy, talk about worms and, well, you know what starts to get itchy .....
However we NEED to have a chat about these guys.
Threadworms (Enterobius vermicularis), also known as pinworms or seatworms, look like short little pieces of white cotton thread which is how they got their name. These are the most common worms affecting human health in most developed countries including Australia.
These little buggers are really common when it comes to children, especially when they are young due to their often subpar hygiene practices! However they are also really common in adults as well!.
A few of the common myths around worms:
Could it REALLY be Worms?!
So we all know the itchy bum symptom, but as I mentioned above that is only in about 50% of the cases!
Some of the other symptoms can seem a little odd but these guys can migrate to other parts of the body
such as most typically the reproductive system of females. The more common clues that worms could be around include:
Itchy bottom or vaginal area, this can be at any time of the time but especially at night
Increased urinary frequency, irritation, pain or incontinence
Difficulty sleeping, or poor quality sleep e.g. restlessness, calling out, nightmares and terrors with increased frequency, waking unrefreshed, due to the nocturnally itchy bottom.
Teeth grinding at night (called bruxism – a good one for your next Scrabble game!)
Irritability and mood changes, possibly due to the negative impact on sleep
A new or renewed interest in nose picking, itching or rubbing
Loss of appetite
Pain mimicking appendicitis - rare but can happen!
How do you know for sure?
These guys don't come up in the regular stool tests - really the "gold standard" test for confirming worms is the sticky tape test. And yes, it is about as exciting as it sounds!!
How to perform the sticky tape test.
Yep, I knew you would want to know this!
As soon as you or your child wake up – before you use the bathroom, shower or get dressed firmly press the sticky side of a piece of sticky tape over and just a cm around the anal area for a few seconds. If there are eggs present they will stick to the tape.
You can then hold the sticky tape up to the light or look through a microscope (because we all have one of these at home 😉) to see if there are eggs – with good eyesight you can see these little pearly oval shaped things.
It is recommended to repeat the test for 3-6 consecutive days.
If there are no eggs after 6 days, the individual is very unlikely to have threadworms...in their digestive tract that is...
So HOW do we get worms?
The lifecycle of the threadworm begins with the eggs being ingested from contaminated water or food, or from scratching your bottom and then putting your fingers to your mouth when eating, biting nails or thumb-sucking.
They may also be inhaled from dust on fabrics, bedding etc. The eggs hatch in the small intestines. The male threadworm is about 5mm long and the female is about 10mm long. They migrate to the large intestines and mate. The male dies after mating and the female moves to the rectum about 1 month later. The female then comes out of the anus at night and lays eggs around the anal area. This is when the itchy anal area can start. After about 4 hours newly hatched baby worms can wriggle back into your bottom... eew!
Here is a great video on the lifecycle of threadworms:
How do you treat worms?
If this is the first time it should be very straight forward. Go to your local pharmacy and get yourself some off-the shelf worming tablets and follow the instructions on the packet, typically taking it once initially, then once more in 14 days to catch the next generation of worms that escaped the first dose. This part is really important to do (the re-worm) and where I see a lot of people unsuccessful with this treatment.
It is also important that you do things to ensure you get them everywhere and stop the cycle within the home. Other things to do include:
Thoroughly washing your hands and under the nails
Cut your nails (and your kids nails) short- this means that if scratching is happening the eggs don't caught under the nails and then ingested again (gross, I know)
Shower or bathe first thing in the morning. Helps to remove eggs laid during the night and ensure you wash thoroughly around the perianal area.
Wear fresh undies every day and after showering or bathing.
Wear undies to bed under your pjs - this makes it harder to "access" the area to scratch directly
No sharing of bath towels
Treat everyone in the family (including adults)
Stop them in their tracks! For young girls especially, who are at risk of migration of the threadworm from the perennial area into the vagina or bladder, using a barrier ointment nightly around the anus can stop those little critters from travelling the distance. I sell Bum Barrier cream online here and in my clinic to support this
Disinfect the toilet seat, toilet flush button and door handle regularly.
Vacuum and mop the floors in the house, especially the bedrooms and bathrooms.
Washing - with detergent wash all the bed sheets, towels, flannels or any other fabrics the family uses on a regular basis, like throws on the lounge.
Wash any security blankets or similar items.
Wash plastic toys that your children use regularly, especially bath toys!
They've come back!
If this is an ongoing issue or if you believe their could be infestation somewhere else (such as the vagina) I highly recommend working with someone trained in this area like myself.