How to Treat Pinworms: Your Most Common Questions Answered | The Survival Doctor

by James Hubbard, MD, MPH

I wrote a post on how to treat pinworms a few months ago and have had so many comments and questions that I thought I’d answer some of the most common here. You’ll still need to read the older post. This just adds to it.

Here, I’ll address embarrassment, complications, vaginal pinworms, and why the pinworms can keep coming back.

Question #1: I’m so embarrassed. I don’t want anyone to know, even my family. How can I treat pinworms without telling anyone?

You must, at least, tell your family. There’s no way around it. As you can see from the answer to question 2, everyone in the family must be treated. Many are embarrassed because they think they’ve done something wrong or will be perceived as being dirty. But even the cleanest person can get pinworms.

Here are some facts to consider: In the United States, about ten percent of the population (all ages) has pinworms right now. This goes up to about twenty percent in young people and can hit fifty percent in groups (like schools) if pinworms are going around.

Question #2: Why can’t get I rid of these little critters? I treat them, and a few weeks or months later, they come back (or never go away).
Key Points to Emphasize
  • There is a lag of a month or two between the time you ingest the eggs and when you start having symptoms (and become contagious).
  • The worms lay their eggs at night.
  • The eggs are microscopic, light, and sticky, and can end up just about anywhere.
  • The eggs can last outside your body for up to three weeks.
  • One dose of the over-the-counter or prescription treatment (mentioned in my other post) kills the adults but not the eggs. You repeat the dose two weeks after the first to kill any worms that have hatched. Usually that and cleaning is enough.

To treat pinworms, ideally, you must have an understanding of their life cycle:

  1. You ingest the eggs that have come from another person.
  2. After a couple of weeks, the eggs hatch in your intestine.
  3. After another month or two they become adults and mate.
  4. In a few more weeks, the males die and the females crawl out your anus, usually at night, and lay thousands and thousands of microscopic eggs. Why do they crawl out? The eggs need more oxygen than is in your intestine. Why at night? I don’t know, but it becomes important in treatment.
  5. After the worms lay their eggs, most shrivel up and die. Some travel back into the intestine, but it’s unclear how many. And no matter what, they all die within about thirteen total weeks max.
  6. The wiggly worms itch; you inadvertently scratch in your sleep. Now they’re under your fingernails.
  7. The eggs are very, very tiny and almost as light as air. But they have a sticky quality to them also. So they get attached to your underwear, your sheets. Some even float in the air, and you can breathe them in. They don’t affect your lungs, but you can swallow some.
  8. They have to get into your intestine to hatch and grow into adults and start the cycle all over again.

Other things you can do (see my older post for details) include:

  • Apply a little petroleum jelly and maybe a little garlic around your rectum at night to kill the worms and eggs.
  • Wear fairly tight fitting underwear to bed so the worms won’t scatter as much.
  • First thing in the morning, take a bath. Wash your underwear in hot water.
  • Wash your bed sheets and vacuum every day, at least for a few days after taking the first and second dose of medicine.
  • Wear a dust mask or scarf around your face and nose while cleaning.
  • Open the curtains. The eggs don’t do as well in sunlight.
  • Wash hands with soap and water, and clean under the fingernails.
  • Clip fingernails short.
  • Keep your fingers out of your mouth as much as possible.
  • Treat everyone in the family at the same time, unless there’s a reason not to (such as pregnancy). Many people with pinworms have no symptoms but can still spread the eggs.
  • Wash all toys, change the sandbox, wash the toilet and the doorknobs. Wash the pets. (Humans can’t get the type of pinworms animals have, but some human pinworm eggs can get on animals’ fur.)
  • Consider that you or your family member may be getting them from other people. If pinworm infections are going around daycares, for example, they are very to eliminate for good.
  • As a last resort, talk to your doctor about everyone in the family taking a medicine daily for a month. Don’t do this without your doctor’s consent. Even then, you can get them back after you’re finished with the medicine, if you come in contact with someone who hasn’t been treated.

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Question #3: Can pinworms cause complications?

Other than rectal itching and the sleep disturbance caused by it, complications of pinworms are very rare. Some people can have abdominal pain, and it can cause an infection in the intestine, but that’s extremely rare.

Question #4: What about vaginal pinworms?

Pinworms only live in the intestine. However, when they come out the anus to lay eggs, some can crawl into the vagina. Rarely, they can even get into your uterus or fallopian tubes. Even occasionally they can get in your urethra (bladder opening).

But they cannot live long in any of those places. They don’t reproduce there and they die. So pinworms in those areas are short-lived at best. However, while they’re there, rarely, they can cause inflammation, even scarring. And you could get a bacterial infection (even rarer) since these aren’t exactly the cleanest critters around.

 


As long as you’re around others with pinworms (remember they may not even know it), the worms may be impossible to eliminate. Sooner or later, you’ll be away from those people, and the pinworms will live out their cycle and die. Meantime, fortunately, the complications (other than itching at night) are rare.

One more thing: There are many other causes of rectal itching. If itching persists despite treatment, check with your doctor to rule out the multiple other causes. It may even be you’re getting irritated from whatever topical medicine you’re using to treat them.

Hope this answers some of your questions about how to treat pinworms. Can anyone add any advice? If so, please comment.

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