The comprehensive guide to threadworms/pinworms

The comprehensive guide to threadworms/pinworms

General facts:
Threadworms or pinworms (Enterobius vermicularis) are an extremely
common intestinal parasitic infection, particularly among schoolchildren. They
are much more common than head lice but much less talked about as parents
often find this embarrassing due to their location in the rectum/anus.
 While they may be bothersome they are one of the least dangerous  It is estimated that 20% of the entire population (adults included) will carry this at any one time with or without symptoms.  50% of children in the UK under the age of 10 will have had this at  The likelihood is that we would all have had a case of these at least on one occasion in our lives whether we knew about it or not  It is easy to treat with medication and hygiene measures but re- infection is extremely common by the way the little blighters operate, as you will see below.  Threadworm infections are particularly common in young children because they often forget to wash their hands after going to the toilet. Children can also have prolonged threadworm infections by swallowing new eggs. As they come into contact with other children and share toys, it is easy to become re-infected.  Having an infection is nothing to be ashamed or embarrassed about. It is not a reflection of having dirty children or a dirty house and it is ok to talk about it.  It has been carried down the generations since at least 7000BC or therabouts(the earliest documented finding of the organism in soil)  The eggs can be carried in the soil and on unwashed fruit and  Humans are the only host - animals and pets cannot pass them on unless the eggs have been transferred to their fur.  Threadworm eggs can survive on surfaces for up to three weeks.  Children can still go to school if they have threadworms. However if you think that your child has worms please inform your school so that a reminder of preventative measures can be enforced at both school and home to prevent the re-transmission of the eggs.  The likelihood is that your child will grow out of it as they get older.  The basic rules are; wash your hands after going to the toilet, after playing outside, or with animals and before eating meals, and to wash all fruit and vegetables in warm water before consumption (even if they do come in a plastic bag).
What do they look like?

They look like little white strings of cotton between 2mm and 1.5cm long.

How do they operate?

The eggs can be found in soil or on unwashed fruit and vegetables. Once the eggs are
swallowed they attach themselves to the intestinal wall and live on the contents of
your gut. As the host, what you eat they eat. They live inside the intestines for
approximately 5-6 weeks. The female worm takes about two weeks to mature. Once
copulation has taken place the male dies and the female moves down the intestine to
lay her microscopic eggs around the anus, typically in the early evening or while her
human host is asleep. She may lay up to 16,000 eggs in her brief lifespan. The mucus
that she secretes while laying the eggs can cause discomfort and itching, which can
disturb a child when they are sleeping. When the child scratches, the eggs are
transferred onto the fingers and nails that are then swallowed when fingers are put in
mouths. The mother worm has then done her job of ensuring the survival of her
species and once having discharged all of her eggs she too dies! And so the cycle of
threadworm infection repeats itself. The whole cycle may take between 4 -8 weeks.

What are the symptoms?

For some people there are no symptoms, however if your child complains of an itchy
bottom (particularly in the evening), or you find yourself saying ‘get your hands away
from your bottom’ frequently then this could be a likely cause. For girls they can also
travel to the vagina and cause itchiness there. You can check for threadworms in your
child’s anus in the evening before going to bed and you can quite often catch them as
they are laying their eggs. They can also be visible in faeces. A severe infection may
lead to your child complaining of tummy ache.
What is the treatment?
Treatment is simple and available as a chewable tablet or liquid. It can be bought
over the counter from your local pharmacy or prescribed via your GP.
Mebendazole and Piperazine are two medications that are commonly used to treat
threadworm infections. Mebendazole works by preventing the threadworms from
being able to absorb glucose, which means that they will die within a few days (two
years old and upwards only). Piperazine paralyses the threadworms until they are
passed naturally out of the bowel. It is combined with a laxative herb called senna,
which helpsto expel the worms more quickly. Piperazine can be used to treat children
who are between the ages of three months and two years old. This will kill the worms
between 24-48 hours and symptoms should disappear.
Whatever medication is used it is very important that the whole family is
treated at the same time even if they are not experiencing any symptoms (the
risk of transmission in family member can be as high as 75%).
A follow up dose for the whole family is required two weeks later to kill any
eggs that may have hatched in the meantime in the gut.

While this kills the worms it does not kill the eggs. Strict hygiene measure
should be followed after taking the medication to destroy the eggs for up to 4

 Children must wash their hands and nails after going to the toilet and before eating (same with mum and dad too!) snacks or meals or after playing outside or touching animals.  Discourage children from itching their bottoms  Wet-wipe the anal area every morning to wash any eggs off  Wash bed linen, towels and cuddly toys after taking the medication.  Ideally wear a fresh change of underwear at night and change and wash them in the  Rinse toothbrushes under hot water before and after use.  Discourage children from biting and sucking nails and keep the fingernails short.  Vacuum and damp-dust your home. Pay particular attention to bedrooms including vacuuming mattresses and areas where children play.  Have showers as opposed to baths or shared baths
I am pregnant/breastfeeding/ have a new born can I take the medication?

The answer is no. Hygiene measures alone and other natural remedies can be used
(see below). However, if you are concerned go and see your GP.
Are there any natural remedies – is there anything else I can do?
Yes there are! These can be taken in conjunction with the medication or as a
standalone treatment.

In addition to basic hygiene measures (i.e the washing of hands, discouraging hands
down the trousers, and washing all raw fruit and vegetables) the first thing to consider
especially if you are worried about repeated infection is diet:
1. As the host, remember that what you eat the worms eat and they love and thrive on glucose. So avoid sugary food as much as possible (i.e. treats, white bread, processed bread). Try to stick generally to wholefoods. 2. Worms hate garlic, chilli, ginger turmeric, cayenne pepper, lemon and lime. 3. Onions, apples, raw carrots, pineapple, coconut, figs, ginger, cinnamon, and 4. Pumpkin seeds deserve a special mention because they paralyze the worms,
(apparently up to 12 hours) which can give the chance for the body to expel the worms and stun their activity. Giving your child a handful of roast pumpkin seeds a day (especially mixed with raw carrot) for 3 weeks is recommended. 5. Raw fruit and vegetables, apart from providing plenty of vitamin C and nutrients to your immune system, will help regular bowel movements which help dispel the worms. Constipation is a gift to threadworms! 6. Grapefruit seed extract has a strong anti-parasitic action. Put 5-10 drops in water or apple juice three times a day for two weeks, rest for two weeks and then repeat. 7. Remember a child with a strong digestive tract will be able to reduce the frequency of worms and their effects. Antibiotics and repeated medication can destroy the ‘good’ bacteria in the gut which play a crucial role in the immune system. If you/your child has been taking antibiotics or multiple worm medication over a period of time you might want to take a prebiotic which will repopulate the mucosa of the gut lining with ‘good bacteria’ and help restore the immune system of the gut (once you have killed the worms). 8. Taking a probiotic yoghurt (i.e. Activia, Danone, Actimal) regularly is also a good way of maintaining a healthy gut flora and enhancing your immune system. It rebalances the population of ‘good’ and ‘bad’ bacteria in the gut and helps deter further worm infestations. In particular look for probiotics that that contain lactobacillus (a form of acidophilus) which has been shown to fight off intestinal parasites. 9. Add apple cider vinegar to the diet ( 1 teaspoon in a cup of water or juice) three times daily (also good for weight loss, headlice and diabetes!)
Cina 6c is the main remedy for threadworms.
Silica helps the body get rid of unwanted objects.
Teucrium or spigelia is useful if the symptoms don’t go away or the worms keep
Nat phos tissue salts renders the acidity levels in the digestive tract inhospitable to
worms – take morning and evening for a month.
Alternatively you can see a homeopath for a full consultation and classical treatment
based on the individual.
Essential oils
A couple of drops of rosemary, lavender (for irritation), eucalyptus or tea tree oil
dropped into a little olive or sunflower oil and then rubbed on the anus can be used at
bedtime to stop the itching and discourage the worms from laying eggs. Applying
cider vinegar infused with garlic added to oil will also do this. A cheap alternative
home remedy is to mix crushed garlic with Vaseline and apply to the anus for the
same result.
The herb Wormwood (artemisia absinthium) is a powerful remedy against
threadworm. (Other herbs include thyme, tansy and Mugwort). To avoid the
extremely bitter taste it is best taken in pill form or as a tea (2-3 grams dried herb in
one mug) mixed with honey or sweetened apple juice, peppermint or fennel. Drink the
contents of the mug on an empty stomach two-three times a day. You may find that
this may be more suitable for teenagers and adults. Try thyme tea and lemon juice
(yum) on an empty stomach for two weeks or/and liquorice tea (yum) or dandelion tea
(yuk) which acts as a laxative and can help speed up the expulsion of worms.

Are repeated infections harmful to my child’s health?

The answer is generally ‘no’. Containing an outbreak of threadworm is an extremely
difficult task due to the fact that the eggs can be easily transferred from the anus to
anything that you touch, including toys, bedding, toothbrushes, furniture etc. Also it is
not necessarily a bad thing if the immune system is invaded by a parasite. The
immune system is, and needs to be, constantly challenged. If you live in a world that
is too sterile and clean you can actually be doing your immune system a disservice.
According to the Hygiene Theory if you remove the daily challenges to the immune
system it gets out of practice with how to deal with them so that when an invader, like
a bad bacteria or parasite, comes along the immune system overreacts (instead of just
dealing with it quietly) and goes into hyper drive causing all kinds of allergic and
sometimes extreme allergic reactions. A child with a strong digestive tract will be able
to reduce the frequency of worms and their effects
If, however, in addition to threadworm your child is repeatedly getting colds or is off
school with illness frequently then this may generally be a reflection of a poor
immune system and measures at building up the immune system should be addressed
through diet and prebiotics (building up the good bacteria in your gut to help fight the
bad bacteria such as threadworm) and by seeing your GP to eliminate any other



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