- Anal itching is itching around the anus.
- Examples of possible causes of anal itching include hemorrhoids, anal fissures, pinworms (Enterobius vermicularis), spicy foods, and medications.
- Additional symptoms associated with anal itching include burning and pain if the anal skin is traumatized by scratching.
- The diagnosis of the cause of pruritis ani requires examination of the anus for common anal problems such as hemorrhoids or fissures, skin conditions such as psoriasis or cancer, infectious diseases such as pinworms or yeast, and leakage of stool.
- Treatment of an itchy anus depends on the cause.
What is anal itching (pruritus ani)?
Anal itching (known medically as pruritus ani) is irritation of the skin at the opening of the anal canal through which stool exits the body that leads to itching. The skin surrounding the opening is known as the anus. The itching is accompanied by the desire to scratch. Although itching may be a reaction to chemicals in the stool, it often implies that there is inflammation of the anal area. The intensity of anal itching and the amount of inflammation increases with the direct trauma of scratching and the presence of moisture. At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness.
Anal Itching Symptoms
Anal itching is due to irritation of the skin around the anus accompanied by a desire to scratch. The intensity of itching increases with moisture, pressure, and sitting.
Some people may experience the following related anal itching symptoms and signs:
- Blood In Stool
- Rectal Bleeding
- Penile Itching
What are common causes of anal itching?
- An itchy bottom can be caused by irritating chemicals in the foods we eat, such as are found in spices, hot sauces, and peppers.
- Anal itching also can be caused by the irritation of continuous moisture in the anus from frequent liquid stools, diarrhea, or escape of small amounts of stool (incontinence or fecal soilage). Moisture increases the possibility of infections of the anus, especially yeast, particularly in patients with diabetes or HIV.
- Treatment with antibiotics can lead to a yeast infection and irritation of the anus.
- Psoriasis can irritate the anus.
- Abnormal passageways (fistulas) from the small intestine or colon to the skin surrounding the anus can form as a result of medical conditions (such as Crohn’s disease), and these fistulas bring irritating fluids to the anal area.
- Rarely, tumors of the anus (anal cancer) may be the cause of itching.
Other problems that can cause anal itch include:
- Tears of the anal skin (fissures), and
- Skin tags (abnormal local growth of anal skin).
What are additional symptoms associated with anal itching?
- The intensity of anal itching and the amount of inflammation increases from the direct trauma of scratching and the presence of moisture.
- At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness, especially during and after bowel movements.
- There also may be small amounts of bleeding.
What kind of doctor treats anal itching?
Although anal itching can be evaluated by a family practice or internal medicine physician, it most often is evaluated by a colorectal surgeon (proctologist) and sometimes by a gastroenterologist.
How do medical professionals diagnose the cause of anal itching?
Anal itching is first evaluated with a careful examination of the anus for such abnormalities as hemorrhoids, anal fissures, skin tags, moisture, and excoriations (breaks in the skin from scratching).
A rectal examination with a finger inserted into the anal canal can identify rectal tumors. For a closer look at the anal canal, a proctoscope can be used. A proctoscope is a short tube that is inserted through the anus and into the rectum so that the anal canal can be examined visually If pinworms are suspected, they and their eggs can be identified using the pinworm test, a test in which the worms and eggs are recovered from the anus using transparent adhesive tape.
What are treatment options and home remedies for anal itching?
Initial self-care for simple itching is directed toward relieving symptoms, like burning and soreness. It is important to clean and dry the anus thoroughly and avoid leaving soap in the anal area.
- Cleaning efforts should include gentle showering without direct rubbing or irritation of the skin with either the washcloth or towel.
- After bowel movements, moist pads (such as baby wipes, flushable moist wipes, and flushable anal cleansing wipes) should be used for cleaning the anus instead of toilet paper.
- If there is constant moisture present in the anus or stool incontinence, it may be necessary to clean the anus with wet wipes between bowel movements.
Many over-the-counter (OTC) products are sold for the treatment of an itchy anus and are available as ointments, creams, gels, suppositories, foams and pads. These products often contain the same drugs used to treat hemorrhoids.
- When used around the anus, ointments, creams, and gels should be applied as a thin covering.
- When applied to the anal canal, these products should be inserted with a finger using finger cots (latex covers for the fingertips) or a “pile pipe.” Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion.
- Suppositories or foams do not have advantages over ointments, creams, and gels.
Most products contain more than one type of active ingredient. Almost all contain a protectant in addition to another ingredient. Only examples of brand-name products containing one ingredient in addition to the protectant are discussed in this article.
Local anesthetics temporarily relieve pain, burning, and itching by numbing the nerve endings. The use of these products should be limited to the perianal area and lower anal canal. Local anesthetics can cause allergic reactions with burning and itching. Therefore, the application of anesthetics should be discontinued if burning and itching increase.
Examples of local anesthetics include:
- benzocaine 5% to 20% (Americaine Hemorrhoidal, Lanacane Maximum Strength, Medicone)
- benzyl alcohol (Itch-X) 5% to 20%
- dibucaine 0.25% to 1.0% (Nupercainal)
- dyclonine 0.5% to 1.0%
- lidocaine (Xylocaine) 2% to 5%
- pramoxine 1.0% (Fleet Pain-Relief, Procto Foam Non-steroid, Tronothane Hydrochloride)
- tetracaine 0.5% to 5.0%