Pinworm infection and sleep

Lets talk worms! Pinworms (Enterobius vermicularis – also known as threadworms), are a helminth infection common in young children, though it is not something most of us like to think about. Research suggests that over 30% of children worldwide are infected. Young children are notorious for poor body hygiene – poor hand washing, frequently putting their hands in their mouth and scratching their bottoms, thereby transmitting to others and/or re-infecting themselves.

Pinworm infection doesn’t always display symptoms but when it does it can cause things like

• itchy anus at any time, but especially at night
• bedwetting
• sleep difficulties and restless sleep
• increased nightmares and terrors
• grinding of teeth during sleep
• irritability and mood changes
• itching/redness around the vagina in girls
• loss of appetite
• nose picking or itching
• increased urinary frequency, irritation, pain or incontinence

In some individuals the worms like to travel and can go into places like the ear canal and eyes – ick right!

Now that I’ve grossed you out it may come as a surprise to know that exposure to helminths at a low level may actually not be so bad for us. A pinworm infection is one of the most common infections in the world and throughout history both helminths and bacteria have lived together in our intestines.

A pinworm infection has been found to be associated with increased intestinal microbial diversity, including more of the probiotics Bifidobacterium and Lactobacillus. (1, 2) This is an important finding as a growing amount of research is revealing that health is directly linked to the diversity or variety of different bacteria residing in our gut. Many disease states are now linked to a less diverse gut bacterial community. (3)

Studies have shown that individuals in developing nations, in particular in rural areas, have greater gut microbial diversity than those living in urban areas in developed countries. (3) This may be due to diet, however researchers postulate that rural areas in developing countries often lack adequate sanitation and have a higher prevalence of helminth infection. (3)

An infection is not always beneficial for human health. Helminth infections can impair nutrient absorption. (2, 3) They may also cause anaemia, and the loss of iron stores in the body has a significant effect on a child’s growth, development and sleep. Pinworms can also change our sleep patterns.

If your child frequently itches the perianal area during the night this strongly suggests a pinworm infection, especially if accompanied by other signs and symptoms. Worms can sometimes be seen on the skin near the anus or on the undies, pyjamas or sheets within 2-3 hours after falling asleep so grab a torch and go looking!

Three mornings upon waking (before washing or having a bowel movement) the adhesive side of clear tape can be pressed to the skin around the anus to collect eggs. Generally a microscope is needed to see the eggs, but if you hold the tape up to a light you may be able to spot some. A routine stool, urine sample or blood test is not helpful to diagnose a pinworm infection, though a PCR stool test can.

First I can tell you where they didn’t get them from. They didn’t get them from pets, nor from eating the occasional bit of dirt. Humans are the only host for pinworms, so they would have picked them up from coming in contact with pinworm eggs from another person. Sometimes pinworm eggs can be inhaled from dust on bedding etc.

Here is a great video that talks about the lifecycle of pinworms:

Most people think taking something like combantrin or vermox (mebendazole) kills the worms, however research has found taking such medication is strongly associated with a pinworm infection. (4) Why? Because while the medication kills the worm, it doesn’t deal with the eggs laid by the pinworm. It is not enough to just take the medication and not deal with the eggs.

You’d be surprised (and horrified) at where pinworm eggs can be found – floors, walls, bedsheets, towels. Eggs can survive on surfaces for 2-3 weeks and are not killed by hand sanitizer. Remember, they can also be inhaled. They can also be eradicated! Mebendazole can be paired with other treatment strategies described below.

Whatever treatment path you decide to go down, natural or pharmaceutical, a strict hygiene protocol is recommended for two weeks. A barrier cream can also be used around the anus at night to stop the worms from travelling! I sell a good barrier cream in my online shop and in clinic.

Hygiene protocol

• Wash bedsheets daily in hot water
• Clean bathroom(s), furniture and vacuum floors daily
• Wash cushion covers daily, or whatever else the kiddo sits on.
• Use towels only once, then wash. No sharing.
• Change underwear daily. If you can, when used underwear is washed put in a plastic bag and seal. Wait 7 days until you take them out of the bag to wear again.
• Keep nails trimmed. No nail biting.
• Wash anal region daily with mild soap and water
• Strict hand-washing after defecation and before meals

If you want to use a pharmaceutical like mebendazole to rid the household of pinworm infection a standard protocol involves retreatment two weeks after the first dose. Your health care provider may advise further treatments.

It is recommended that sugars, alcohol and processed foods be limited during treatment. There are a number of things that can be modified in the diet to help reduce the helminth infection. For example, ground papaya seed may be used to expel worms. (5) Tannins, such as those found in tea, yerba mate and oregano, and other foods that are bitter and astringent, have an anti-parasitic effect. (2) In addition, in animal studies eating lots of vegetables has an anti-parasitic effect which is thought to be derived from promoting beneficial gut bacteria that breakdown carbohydrates into short chain fatty acids. (2) This research suggests a healthy gut and microbiome is important for the management of a helminth infection.

As a naturopath I have a range of practitioner homeopathics, nutrients, herbs and probiotics that can be used with a hygiene protocol and mebendazole to help break the cycle of pinworm infection. If you need some help to rid your family of pinworms, book an appointment today. With the pinworms evicted, you may just find your child sleeps better!

Marturano, Matt. Pinworms. Continuing Education Workshop through HealthMasters Live.

1. Yang, C.-A., Liang, C., Lin, C.-L., Hsiao, C.-T., Peng, C.-T., Lin, H.-C., & Chang, J.-G. (2017). Impact of Enterobius vermicularis infection and mebendazole treatment on intestinal microbiota and host immune response. PLoS Neglected Tropical Diseases, 11(9), e0005963–e0005963. doi.org/10.1371/journal.pntd.0005963
2. Williams, A. R., Myhill, L. J., Stolzenbach, S., Nejsum, P., Mejer, H., Nielsen, D. S., & Thamsborg, S. M. (2021). Emerging interactions between diet, gastrointestinal helminth infection, and the gut microbiota in livestock. BMC Veterinary Research, 17(1), 62–62. doi.org/10.1186/s12917-021-02752-w
3. Zaiss, M. M., & Harris, N. L. (2016). Interactions between the intestinal microbiome and helminth parasites. Parasite Immunology, 38(1), 5–11. doi.org/10.1111/pim.12274
4. Park, M. K., Kang, S. Y., Kim, B. Y., & Yu, H. S. (2010). Parents’ knowledge about enterobiasis might be one of the most important risk factors for enterobiasis in children. The Korean journal of parasitology, 48(2), 121–126. doi.org/10.3347/kjp.2010.48.2.121
5. Kugo, M., Keter, L., Maiyo, A., Kinyua, J., Ndemwa, P., Maina, G., Otieno, P., & Songok, E. M. (2018). Fortification of Carica papaya fruit seeds to school meal snacks may aid Africa mass deworming programs: a preliminary survey. BMC Complementary and Alternative Medicine, 18(1), 327–327. doi.org/10.1186/s12906-018-2379-2