Anal itching, also called “pruritus ani”, is itching and burning of the skin around the anus. The itching may be intense and result in a strong urge to scratch. The itch/scratch cycle can lead to a worsening of symptoms.
Anal itching is a very common condition. Some may be embarrassed to speak about it, but proper treatment and self-care tips can provide relief.
Persistent anal itching may be related to a skin condition or other health problems that require medical treatment.
Causes of Anal Itching
Anal itching is usually the result of a harmless problem that can be treated at home.
Some common causes anal itching include:
- Excessive hygiene. Many people believe pruritus ani is caused by poor hygiene and are too aggressive in their attempts to clean the anal area. Excessive wiping with dry, harsh toilet paper or excessive scrubbing with harsh soaps can irritate the anal skin and worsen symptoms.
- Dry skin. Dry skin can result from aging skin or from vigorous use of toilet paper.
- Excessive moisture. Skin that remains moist for prolonged periods can become irritated and itchy. This may occur from excessive sweating, prolonged sitting, or from frequent bowel movements (diarrhea). Excessive sweating may also occur during times of stress.
- Chemical irritants. Some laundry detergents, douches and other skin care products contain chemicals that can irritate skin in and around the anus. Scented or colored toilet paper can be irritating to people with sensitive skin. Failure to completely rinse away soap after bathing can also cause irritation.
- Anal tears and fissures. An anal abrasion is a small tear in the anus caused by forced bowel movements through a tight anus. An anal fissure is a deeper tear. Both can cause anal itching, as well as painful bowel movements and bleeding that may be seen on toilet paper.
- Food irritants. Some foods contain chemical that can be irritating to the anal skin, including spices, hot sauces, and acidic foods, such as tomatoes and citrus fruits.
However, anal itching can be a symptom of a more serious medical problem. Possible causes of anal itching that require medical treatment include:
- Skin disorders. Skin conditions, such as psoriasis, atopic dermatitis, and seborrheic dermatitis can involve the anal skin and lead to itching.
- Yeast infections. Yeast infections, especially from Candida, can irritate the genital and anal areas.
- Bacterial infections. Some bacteria, including streptococci (streptococcal dermatitis) or corynebacteria minutissimum (erythrasma), can infect the anal area and lead to itching.
- Laxative overuse. Excessive or improper use of laxatives can lead to chronic diarrhea increase the likelihood of developing anal itching.
- Hemorrhoids. Hemorrhoids are engorged veins in the lower rectum and anal area that can cause itching.
- Medications. Anal itching may be a side effect of certain medications, such as antibiotics.
- Pinworms. Pinworms (enterobius vermicularis) are parasites that cause persistent anal itching that commonly occur in children. Adults in the same household can also be infected.
A rectal exam may be necessary to examine the health of the anal skin and rectal area. Other tests, such as proctoscopy or colonoscopy may be recommended in select cases to view the digestive tract.
In many cases, the exact cause of the anal itching may not be identified.
Treatments for Anal Itching
Successful treatment of anal itching depends on the underlying cause.
Self-care measures are the mainstay of treating and preventing anal itching. Key steps include:
- Avoid scratching. Scratching irritates the anal skin and leads to ongoing inflammation. To prevent itching and reduce the urge to scratch, consider applying a cold compress to the area or taking a lukewarm bath for immediate relief.
- Gently cleanse the anal area. Wash the anal area frequently. This includes washing the anal area upon awakening in before going to bed and immediately after each bowel movement. Wash gently (don't scrub) and avoid using soap.
- Dry skin thoroughly. After cleansing, pat the area dry with toilet paper or a towel. A small piece of cotton gauze may be placed in the anus to keep the area dry. Replace the cotton as necessary. Nonmedicated talcum or cornstarch powder also can help keep the area dry.
- Switch toilet paper. Use extra soft, unbleached, unscented toilet paper. Or consider unscented flushable bathroom wipes.
- Wear cotton underwear and loose clothing. Keep the anal area dry by avoiding use of pantyhose and other tight-fitting garments that can trap moisture. Change underwear daily and whenever it is soiled
- Avoid skin irritants. Avoid bubble baths and genital deodorants. Cut back or avoid beverages or foods that you know irritate your anal area. Avoid overuse of laxatives that increase diarrhea and the risk of anal irritation and itching.
Medications may be used to provide temporary relief of symptoms.
- Topical corticosteroids, such as those with hydrocortisone, can be used to provide temporary relief of itching. These should not be used for more than a few weeks without a doctor’s recommendation. Overuse of topical corticosteroids can lead to other medical problems such as the development of yeast infections.
- Anti-Itch Cream (Preparation H). These may be used sparingly to the affected area to reduce inflammation and itching.
- Protective ointments that contains zinc oxide (Desitin, Balmex).
- Antihistamines might be considered to reduce scratching at night.
With proper treatment, most people experience relief from anal itching in less than a week. Anal itching that continues for more than a few weeks needs to be evaluated by your doctor.
Reference: National Institutes of Health