Itching in the anal area, also known as pruritus ani, is an uncomfortable and often embarrassing condition that many people experience. Anal itching can be mild and occasional or severe and constant, leading to the urge to scratch the area around the anus. While anal itching may seem harmless, constantly scratching can damage the skin and lead to more irritation. Understanding the common causes of anal itching is the first step to finding the right treatments and relief.
What Causes Anal Itching?
Anal itching has many possible causes, most of which can be managed with over-the-counter treatments, prescription medications or simple lifestyle adjustments. Here are 7 of the most common culprits behind anal itching and discomfort:
One of the most common triggers of anal itching is irritation of the sensitive skin around the anus. Moisture, friction and chemicals found in certain products can cause irritation that leads to itching, redness and discomfort.
Common irritants that can cause anal itching include:
Fecal incontinence or long-term diarrhea - Constant moisture and contact with stool can irritate anal skin.
Harsh soaps, toilet paper or wipes - Perfumes, dyes and fragrances in bathroom products can trigger irritation and itching.
Vigorous wiping after a bowel movement - Too much wiping or wiping too hard can damage the thin anal skin.
Tight, non-breathable underwear and clothing - This can cause excessive moisture buildup and chafing around the anus.
Sanitary pads, panty liners and menstrual products - The plastic backing and moisture can irritate the anal area in women.
Hemorrhoids are swollen, inflamed veins located inside and around the anus. They often cause bleeding, discomfort and itching due to the sensitive nerves in the anal area.
There are two types of hemorrhoids:
External hemorrhoids occur under the skin around the anus. These are the type most likely to cause anal itching.
Internal hemorrhoids develop inside the anus and lower rectum. These don’t cause as much itching but can bleed and prolapse outside the anus.
Hemorrhoids can be caused by constipation and straining, diarrhea, obesity, pregnancy, aging and other factors that place pressure on the veins of the anus and rectum.
Pinworms are tiny parasitic worms that infect the intestines. The female pinworms move outside the body to lay their eggs, which often get deposited around the anus.
The eggs and worms cause extremely itchy anal and perineal (between the anus and genitals) areas, especially at night. Pinworms easily spread between people through contaminated surfaces, bedding and clothing.
Kids are especially prone to pinworm infections due to close contact at school and daycare. Good hygiene can help prevent transmission.
4. Yeast Infections
Candida yeast naturally lives in the body’s mucous membranes, including the anal and vaginal areas. However, certain conditions can trigger overgrowth of yeast, leading to infection and inflammation.
Anal yeast infections cause redness, irritation, and itching around the anus. Risk factors include antibiotic use, diabetes, obesity, and a weakened immune system.
While yeast thrives in moist areas, it’s a myth that it can be spread through contact with toilet seats. Sharing towels or underwear with an infected person can transmit yeast.
5. Skin Conditions
Many skin conditions that cause rashes and inflammation on other parts of the body can also affect the sensitive anal area. These include:
Eczema - Chronic, inflammatory skin condition marked by red, flaky and very itchy rashes.
Psoriasis - Autoimmune condition causing thick, scaly, itchy skin patches.
Lichen planus - Inflammatory rash characterized by purple, itchy bumps on mucous membranes and skin.
Lichen sclerosis - Chronic skin condition causing thin, white, itchy anal patches.
Good skin care, topical steroids and other medications can help manage these conditions and reduce anal itching.
6. Contact Dermatitis
Contact dermatitis refers to skin inflammation and rash due to contact with an irritating or allergenic substance. There are two types of contact dermatitis that can affect the anal area:
Irritant contact dermatitis - This develops as a reaction to direct damage of the skin, often by chemicals in products like soaps, wipes, detergents, perfumes, and fabrics. The anal area is very sensitive to irritation.
Allergic contact dermatitis - This is a delayed immune system reaction to substances like poison ivy, metals like nickel, rubber chemicals, topical antibiotics, and ingredients in personal care products. Common allergens that cause anal itching include neomycin, lanolin, benzocaine, fragrance mixes and formaldehyde resins.
Patch testing can help identify the specific irritants or allergens triggering contact dermatitis. Avoiding the source of irritation and using gentle skin care can help resolve symptoms. Topical steroids and antihistamines also reduce inflammation and itching.
7. Anal Fissures
Anal fissures are small tears or splits in the thin anal lining. Passing large, hard stools can rupture the anal tissue, leading to a fissure. The tear exposes sensitive nerves, causing pain and itching.
Anal fissures commonly cause bright red bleeding and a stinging or burning sensation during and after bowel movements. The anal spasm caused by the tear can also prevent the fissure from healing.
Treating constipation is key to allowing anal fissures to heal. Other remedies include sitz baths, topical pain relievers, prescription ointments and sometimes surgery for severe cases.
When to See a Doctor About Anal Itching
In most cases, anal itching resolves with over-the-counter treatments and lifestyle changes. See your doctor if:
- Anal itching is severe, constant and keeps you awake at night
- Itching is accompanied by bleeding, pain or stool leakage
- Symptoms persist after 1-2 weeks of self-treatment
- Signs of infection develop, like pus, fever or swollen lymph nodes
- You have risk factors for anal cancer, like age over 50, hemorrhoids or anal warts
- You recently engaged in unprotected anal intercourse
A doctor can properly diagnose the cause of anal itching using a physical exam, medical history review, and tests like:
- Visual exam of the anus and rectum
- Swabs of the anal area to check for infections
- Anoscopy to examine the anus and lower rectum
- Blood tests to check for diabetes or other conditions
- Pinworm test of the anal area for eggs
- Skin patch testing for allergies and irritants
How to Find Relief from Anal Itching
Treating the underlying cause of anal itching is the best way to find lasting relief. In the meantime, you can try these remedies to soothe irritation and discomfort:
Maintain Proper Anal Hygiene
- Clean the anal area only with mild, fragrance-free soaps and water. Avoid alcohol-based wipes.
- Gently pat dry instead of vigorous wiping after a bowel movement.
- Apply a protective barrier cream or ointment after cleaning.
- Wear loose, breathable cotton underwear and clothing.
- Change out of damp workout clothes or swimsuits right after activity.
- Over-the-counter hydrocortisone cream helps reduce inflammation and itching.
- Medicated powders like Zeasorb powder can help keep the anal area dry.
- Antihistamine pills help control allergic reactions and itching.
- Prescription steroid creams or immunosuppressants treat severe cases.
- Oatmeal or baking soda baths can provide relief from itching and irritation.
- Sitz baths in warm water soothe anal discomfort.
- Cold compresses, aloe vera gel and calamine lotion help relieve itching.
- Coconut oil and vitamin E oil hydrate and protect anal skin.
- Treat constipation with more fiber, fluids, exercise and stool softeners.
- Wear loose, cotton underwear and avoid tight pants and pantyhose.
- Change out of wet bathing suits and exercise clothes promptly.
- Practice good hygiene if you have pinworms to avoid reinfection.
- Manage chronic skin conditions carefully to prevent anal itching flares.
When to Seek Medical Care
If over-the-counter treatments and home remedies don’t provide lasting relief within 1-2 weeks, it’s important to see a doctor. They can properly diagnose the cause of anal itching and provide effective prescription treatment options.
For severe anal itching or discomfort that interferes with sleep and daily activities, promptly seek medical care. Anal itching accompanied by bleeding, pain or signs of infection requires immediate medical attention.
While anal itching can be embarrassing to discuss, don’t let discomfort or shame prevent you from getting the help you need. Doctors are very understanding and see cases of anal itching frequently. Treating the underlying cause is the only way to stop the itch cycle for good.
See your primary care physician or a colorectal specialist for a full evaluation if:
- Self-care strategies don’t provide improvement
- Anal itching persists longer than 2-3 weeks
- Itching is severe and constant, especially at night
- Itching occurs with bleeding or stool leakage
- Signs of infection like fever, swelling or pus are present
- You have pain sitting, moving bowels or anal spasms
After a physical exam and medical history review, the doctor can order tests like:
- Visual exam of the anus and possibly the lower rectum
- Swabs to check for bacterial, fungal or yeast infections
- Anoscopy to closely inspect the anal canal
- Allergy testing for potential irritants or allergens
- Blood tests to check for diabetes, immune disorders and other systemic diseases
- Stool analysis for parasites like pinworms
Once the cause of anal itching is determined, your doctor will recommend appropriate treatment options, which may include:
- Medicated creams, ointments and suppositories
- Oral medications like antihistamines or antibiotics
- Medicated baths and dressing changes
- Lifestyle changes to manage irritants, moisture and hygiene
- Treatment of underlying conditions like hemorrhoids, diabetes or obesity
- Surgery for severe cases like anal fissures or fistulas
With the right diagnosis and treatment plan, you can successfully manage anal itching and discomfort. Don’t hesitate to reach out to a doctor if symptoms persist or you have any concerns about your anal health.