Anal Itching (Pruritis Ani)

What is pruritus ani?

This is a condition related to the urge to scratch the skin near the anus. The anus is the opening where bowel movements leave the body. The skin around the anus can easily become irritated and inflamed. You may feel burning, soreness, and intense itching. This can make you want to scratch the area. Many factors lead to anal itching. Causes of anal itching include:

Common causes of anal itching include:

  • Skin problems such as abscesses or infections (fungal or from parasites like pinworms)
  • Extra moisture on the skin near the anus from washing or sweating too much
  • Stool remaining on the outside of the anus after bowel movements
  • Hemorrhoids
  • Anal fissures and fistulas
  • Rectal polyps or cancer
  • Alcoholic beverages
  • Foods such as caffeine, dairy products, chocolate, spicy foods, and acidic foods (like tomatoes and citrus)

How is it treated?

A doctor can ask you questions to help figure out the cause of your anal itch. You may need an exam and have lab tests done. The doctor may need to do a rectal exam and look into the anus or the rest of the large intestine. Stool tests may also be done. These help the doctor decide how best to treat the problem.

The treatments below often help relieve the problem. These may take 4-6 weeks or more to work. If your itching does not get better, tell your doctor. You may need more exams and testing.

Clean and dry: The cause is not from poor cleaning but from irritation. In fact, excessive cleaning with soap, and too roughly rubbing or wiping with tissue or a washcloth, can make it worse. But, it is very important to keep the area clean and dry. 

  • When showering or bathing, clean the area gently using a mild soap, unscented baby wipe, wet cloth, or wet toilet paper. Do this each morning and night and after every bowel movement. Avoid using scented soaps, genital deodorants, and bubble baths. 
  • Rinse the area well to remove all the soap. Dry the area gently. Do not scratch or rub the area with a towel – this irritates the anus and makes itching worse. You may use a hairdryer on a cool setting. 
  • Shower after exercise to rinse sweat from the anal area. Dry gently.

After a bowel movement: Wash the anal area with water, a wet piece of cotton, or unscented mild baby wipe. Use unscented toilet paper. You may also use sitz baths, showers, or a 'bidet" (a special toilet with a washing system). But be sure to carefully pat the area dry – moisture can worsen the problem.

Cotton: Too much moisture can cause itching. If so, placing a small thin wafer of cotton up against the anus can be very helpful. Changed it when it gets damp and after each bowel movement. A sanitary napkin is not a substitute. Also wear cotton underwear and loose-fitting clothes. Avoid pantyhose and tight pants. Change underwear every day.

Medicines: Your healthcare provider may prescribe medicines. These can relieve pain and itching to help the affected skin heal. These medicines may include skin ointments, steroid creams, or antihistamines. Follow the provider’s instructions for using these medicines. 

  • Ointments and creams: Gently apply the cream to the itchy area with your finger. Then apply the cotton wafer. Some creams come with a plastic applicator – do not use this. Just used your fingertip to apply the ointment.
  • Hydrocortisone creams (brand names include Cortaid and Preparation H anti-itch): These can be applied to the affected area. Only use a steroid cream for a short time – using them too long can can make the problem worse.
  • Barrier creams (zinc oxide) (brand names include Calmoseptine, Desitin, and Balmex): Most diaper-rash type ointments can be used to protect the skin from moisture, especially during the summer or during heavy activity or exercise.
  • Lidocaine ointment or jelly: This can also help by numbing the area and decreasing the urge to scratch. It is very short-acting. Your doctor can prescribe this.

Foods: Many food produce gas, indigestion, loose bowel movements, or secretions. These may irritate the anal area. To start, avoid all the foods below for 2 weeks. To determine which foods you are sensitive to, slowly introduce them back, one at a time. Eat more fiber in your diet. Don’t use laxatives unless your provider tells you to.

Foods to avoid:

  • Foods with seeds or kernels (for example: popcorn, nuts, berries)
  • Highly acidic foods (for example: oranges, tomatoes)
  • Spicy foods (for example: barbecue, hot sauces)
  • Caffeine (for example: chocolate, coffee, colas)
  • Tea or coffee - Herb tea may be substituted for regular tea
  • Beer and ales
  • Cheese

Adjust the management program based on your symptoms. The use of the cotton wafer should be the last measure stopped and the first to restart. Itching often comes back, especially during the summer.

Follow-up care

Follow up with your healthcare provider, or as advised.

When to seek medical advice

Call your healthcare provider right away if you have any of these:

  • Fever of 100.4°F (38°C) or higher
  • Stool leaking from the anus
  • Increase in pain, rash, swelling, or itching after using prescribed medicine
  • Blood in stool
  • Small worms (pinworms) in the stool or around the anus.
  • Bleeding from the anus that doesn’t stop
  • Foul-smelling discharge from the anus that is not stool