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Many people experience an itchy anus, and there are lots of possible causes, ranging from dietary factors to diabetes. This symptom can be bothersome, but treatment is usually effective.
In this article, we discuss the common causes of anal itching. We also look at some medical treatments and home remedies.
Pruritus ani is the medical term for intense anal itching.
Anal itching is a symptom and not a disease in itself. Many people feel embarrassed to seek help, but itching in this part of the body is a common problem, and treatment can usually resolve it.
In the meantime, it is important to avoid scratching the area. Doing this can make the itching worse, as it can break the skin, leading to further irritation on contact with moisture. Wiping too much after using the bathroom can also have this effect.
Often, avoiding scratching for a while will allow the skin to heal. Sometimes, however, there is an underlying problem that needs medical attention.
Causes of pruritus ani can be either primary, meaning that there is no sign of another condition, or secondary, which means that there is an identifiable underlying cause.
Possible underlying causes include:
- Hygiene: Washing too much or too little can cause irritation.
- Cosmetics: Soaps and other products can irritate the skin.
- Skin conditions: Dermatitis and psoriasis can cause itching.
- Anal or rectal disorders: Examples include conditions such as piles, anal fistulas, and anal fissures.
- Infections: Sexually transmitted infections (STIs), especially those that involve parasites, can lead to itching.
- Systemic conditions: Some conditions that affect the whole body can cause itching, including anemia, diabetes, inflammatory bowel disease (IBD), jaundice, leukemia, lymphoma, and thyroid disease.
- Incontinence: This condition can make it hard to control moisture and bacteria.
- Foods: Dietary irritants include chili peppers.
- Drugs: Pruritis can be a side effect of chemotherapy, colchicine (Colcrys), neomycin (Mycitracin), and corticosteroids.
Foods that may contribute to anal itching include:
- caffeinated drinks
- milk products
- citrus fruits
Foods may trigger itching by:
- reducing the strength of the anal muscle, as can happen with caffeine
- leading to exaggerated anal reflexes
- making the skin sensitive, as some undigested foods can do
- causing loose and frequent stools, which increases the chance of seepage and recurrent wiping
However, there is no evidence that avoiding a specific food will help reduce itching.
Dermatological (skin-related) causes
Skin irritation can result from various factors, such as:
- prolonged contact with feces, as with poor hygiene, fecal incontinence, and seepage
- high moisture levels, which can lead to increased sweating — for example, in hot weather
- persistent diarrhea, which can cause someone to wipe more and irritate the skin
- eczema, psoriasis, and idiopathic dermatitis
- keloid scars, consisting of hard, smooth scar tissue
- scabies, a very itchy rash that a microscopic mite causes
- allergic or contact dermatitis, which can flare up after using certain products
- yeasts infections, such as thrush
- bacterial skin infections
- viruses such as the human papillomavirus (HPV), which can lead to genital warts
- parasites, such as pinworm and hookworm
- small skin tags, which can trap moisture and make cleaning the area difficult
- proctitis, which is inflammation of the inner lining of the rectum
Gastroenterological (bowel) causes
Sometimes, a problem with the gastrointestinal system can cause itching. Potential issues include:
- hemorrhoids (piles)
- anal cancer
- conditions that involve diarrhea, including irritable bowel syndrome (IBS) and IBD, such as Crohn’s disease and ulcerative colitis
Some conditions that affect the whole body can involve anal itching.
Examples of these conditions include:
Anyone with persistent itching should see a doctor. To identify the cause, the doctor may ask about:
- how long itching has been present
- what makes it worse or better
- lifestyle factors, including diet, hygiene practices, and recent travel
- the severity of the itch and its impact on the person’s life
Other information that may help them identify the cause includes:
- past medical history — in particular, any history of anorectal surgery, hemorrhoids, or diabetes
- the presence of urinary or fecal incontinence
- other signs and symptoms, such as bleeding or stomach cramps
The doctor will then carry out a physical examination, in which they may look for signs of:
- cracked skin or other skin symptoms
- bleeding around the anal area
- swellings that could indicate hemorrhoids
- abnormal skin lesions, such as skin tags or warts
- fissures or fistulas
They may also carry out an internal examination called a digital rectal examination. The doctor will insert a gloved and lubricated finger through the anus into the rectum.
This procedure can help identify certain issues that need further evaluation, such as:
- rectal bleeding
- rectal masses
In some cases, the doctor may also recommend laboratory tests, such as:
- swabs to check for an infection
- a biopsy, if skin-related or other changes are present
- a stool culture if diarrhea is a symptom
- blood tests to rule out systemic conditions, such as liver disease
There are four stages of primary pruritis ani:
- Stage 0: The skin is normal.
- Stage 1: The skin is red and inflamed.
- Stage 2: The skin is thickened.
- Stage 3: The skin is thickened with coarse ridges and ulcers.
Some practical tips can help treat and prevent anal itching.
Home remedies and self-care
People can take steps to manage itching at home. These include:
- avoiding known irritants
- keeping the anal area clean and washing after emptying the bowel
- washing with plain warm water, drying the area well, and using an aqueous cream or emollient as a barrier
- drying the anal area by dabbing, not rubbing
- applying unscented powder to help keep the area dry
- eating plenty of fiber to promote regular bowel movements
- avoiding highly seasoned and spiced foods
- avoiding medicated, perfumed, or deodorant soaps
- using wipes instead of paper
- avoiding scratching
- avoiding straining when using the bathroom
- wearing cotton gloves when sleeping to prevent skin damage due to unconscious scratching
- wearing loose, breathable cotton underwear
- avoiding wearing underwear at night
- avoiding acrylic and nylon clothing, as these can trap sweat
- keeping the fingernails short and clean
- soothing irritated skin by soaking cotton balls in cold water and applying them to the affected area
The following treatments may be available from pharmacies with or without a prescription.
- Soothing ointments, such as bismuth subgallate or zinc oxide, can relieve symptoms.
- Corticosteroids can reduce inflammation.
- Emollients and barrier creams, such as aluminum hydroxide gel, cocoa butter, and glycerin, form a physical barrier to protect the skin.
- Hemorrhoid treatments, such as hydrocortisone (Anusol), may help.
People should apply any creams to clean, dry skin at night, in the morning, and after a bowel movement.
It is best to apply topical steroids thinly. People should limit their use to two applications a day for no more than 7 days.
In some cases, a doctor may prescribe oral antihistamines.
Some people have suggested the following, although there is not enough evidence to confirm that they help:
Anal itching is a common problem, and lifestyle choices or over-the-counter medications can usually resolve it. If treatment does not resolve the itching within 3–6 weeks, the doctor may refer the person to a specialist.
If the itching is persistent or severe, or it happens alongside other symptoms, a person should see a doctor. In rare cases, there may be an underlying condition that needs medical attention.
Treating an underlying condition can help stop the itching, and it may prevent further complications.