Itchy Anus: What’s Behind It?

Common symptoms of an itchy anus

The medical term for an itchy anus is pruritus ani. Occurring four times more often in men, it’s caused when there is irritation to the skin of the perineum. Unfortunately, once the skin is irritated, scratching is often used to momentarily relieve the irritation, ultimately causing further damage and complicating any treatment efforts.

The level of irritation caused by pruritus ani is broad, and symptoms may be constant or come and go. Some sufferers report mild irritation, while others may report severe burning pain. It is not uncommon for symptoms to be worse during or after bowel movements or exercise. Occasional bleeding is sometimes present; though it is usually small and noticed only when wiping.

The irritation of the rectal skin is classified in stages:

Stage 0: Normal skin

Stage 1: Reddened, inflamed skin

Stage 2: Thick, leathery skin

Stage 3: Lichenified skin with erosion and ulceration

Possible causes of anal itching

The causes of an itchy anus can be divided into two classes: secondary causes and idiopathic (unknown) causes. Often a singular cause for the itching can’t be determined.

Secondary anal itch

Secondary anal itch occurs when the itching is the result of another existing condition or problem. The secondary causes can be subdivided into five groups: local irritation, infection, inflammation, systemic diseases, and neoplasms.

• Local irritation: Local irritation is one of the most common causes of an itchy anus. This irritation is caused by increased moisture in the perianal area, which can occur with exercise, prolapsed hemorrhoids, fistulas, fissures, and skin tags. Stool leakage and diarrhea, often caused by certain dietary choices, can also be a cause of local irritation. Local irritation is often exacerbated by excessive hygiene habits, such as over-washing, which can aggravate the skin. The use of wet wipes or baby wipes can introduce irritating chemicals to the skin, causing an additional breakdown in an already compromised area.
• Infections: There are a variety of infections that can cause an itchy anus.
• Candida: A candida infection is relatively common. This is a fungal infection that occurs in moist areas of the body, including skin folds. Tight-fitting clothing can also create problem areas.
• Streptococcus/Staphylococcus: These are bacterial infections that can occasionally occur in the perianal region.
• Pinworms: Pinworms infection is a rare cause of anal itch in adults.
• Sexually transmitted infections (STIs): Herpes and genital warts are both a common cause.
• Chronic inflammatory disorders: Causes of chronic inflammation in the perianal area are often systemic, affecting other body areas as well.
• Psoriasis: Psoriasis is an idiopathic, chronic inflammatory skin condition that can occur in many places of the body. It presents as dry, red, scaly patches, sometimes covered with white or silver scales. It often has a butterfly-like shape when it is located in the perianal region.
• Eczema: Eczema is an allergic body response. It also presents as dry, scaly redness on the skin, with occasional skin lesions.
• Lichen sclerosus: This is also an idiopathic condition that largely affects women. Skin appears white, atrophic, and wrinkly. Lichen sclerosus is associated with squamous cell carcinoma in 5–6 percent of cases.
• Systemic diseases: There are many systemic diseases that can cause both generalized itch and anal itch. Some common diseases with this symptom are iron-deficiency anemia, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, end-stage renal disease, and liver disease.
• Neoplasms: Up to half of people who suffer from perianal Paget’s disease and Bowen’s disease experience anal itch. Any neoplasm of the anus or perianal area can cause itching, so it is important to biopsy when appropriate.

Idiopathic anal itch

When there is no cause for the rectal itch, it is considered a primary condition.  Typically, these people have stool leakage, excess moisture, loose stools, poor hygiene habits, or poor diet choices. Self-care remedies can prove extremely effective for this type of itch.

Tips for dealing with an itchy anus

There are a variety of different treatments for anal itch, many of which are a combination of proper hygiene and medication. Available medications for treatment may be over the counter (OTC) or prescribed by a care provider.

• Topical medications: Steroid creams and ointments containing 1% hydrocortisone are often prescribed to relieve itching and irritation. Topical anesthetics (like lidocaine) may also relieve discomfort. Zinc oxide creams and petroleum jelly can also be used to protect the skin.
• Oral medications: Commonly prescribed oral medications include antibiotics or antifungals if an infection is present.
• Methylene blue injection: Also known as anal tattooing, methylene is injected under the skin in the perianal region. It works by deadening the nerve endings in the area of the dye.

Self-care tips at home

Regardless of whether your provider has prescribed you medications or not, there are some self-care tips that you can incorporate into your daily routine. While they will not fix any underlying conditions, they can help you keep the anal itching under control.

• Practice good hygiene habits: Keep the area clean and dry, using water instead of soap to cleanse. Pat or blot after using the restroom — don’t wipe! A gauze cotton pad can also be used during the day to keep the perianal area dry.
• Eliminate scented toiletries: Pay attention to the labels in your medicine cabinet. Avoid adding any extra chemicals to the irritated skin via bubble baths, lotions, powders, perfumes, or creams.
• Resist the urge to scratch: For some, the urge to scratch is stronger at night. You may need to wear soft cotton gloves to bed.
• Change your diet: Eat high fiber foods. Avoid foods that irritate your GI system. This may include coffee, chocolate, citrus, tomato-based foods, spices, and dairy.
• Avoid constricting undergarments: Make sure your underwear fits properly. Change sweaty clothes immediately after exercise. Invest in cotton underwear — it absorbs moisture best.
• Change your detergent: Make sure you are washing your clothing in fragrance-free detergent.
• Avoid anal sex: Eliminate this practice during periods of exacerbation. Give the skin time to heal.
• Maintain regular bowel movements: If this is a problem for you, you may need to begin taking OTC stool softeners or add fiber to your diet.

When it’s time to see a doctor

Typically, anal itching doesn’t need treatment from a care provider. However, it is important to see your care provider if any of the following are true.

• Anal itching is severe or persistent.
• You notice anal bleeding or stools that are dark.
• You are unable to control leaking stool.
• You believe your anal area is infected.
• Self-care has been ineffective, and you aren’t sure of the cause of the anal itch.

The takeaway

As uncomfortable as it may be to talk about, anal itch is even more uncomfortable to deal with. If this is a struggle of yours, rest assured you are not alone. Changing your self-care habits may go a long way towards treating this condition. If you continue to struggle despite changing your routines, reach out to your care provider and allow them to help you determine the next best steps.