Anal Itching - Causes, Symptoms and Treatment

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What is Anal Itching?

There is hardly a more significant discomfort and annoyance than having to scratch your butt area relentlessly due to anal itching. Anal itching, pruritus ani, is a medical condition characterized by persistent itching and scratching of the anal area. Anal itching is also referred to as perianal itching, anorectal itching, or anal pruritus.

The constant scratching of the nether region is often embarrassing. The anus is an opening at the end of the digestive system that allows for egestion. The skin around the anus is thin and susceptible to tears. Constant scratching of this region breaks the skin into tiny fragments that itch in the presence of humidity and moisture.

The itching is unabated during the night when the victim is subconsciously asleep. Nightwear often allows unrestricted access to the itching area. In women, pruritus ani can be severe. When they pass out urine, some fluid may come into contact with these skin cuts, causing a tingling experience, which they alleviate by vigorous wiping with toilet paper. This vigorous wiping causes the skin to break further.

Types of Anal Itching

  • Primary (idiopathic) pruritus ani
  • Secondary pruritus ani

Primary (idiopathic) Pruritus Ani

This type has no significant cause of itching. It is the most common case of anal itching.

Secondary Pruritus Ani

This type of itching attributes to several underlying conditions. Dermatological infections, systemic illnesses, among others, are the primary culprits of secondary pruritus ani.

Is Pruritus Ani prevalent?

According to NCBI, 1-5% of the population suffers from anal itching. It is four times more common in men aged between 40 and 60.

What Causes Anal Itching?

The typical causes of an itching bottom can be grouped into these broad classes:

  • Colorectal Disorders
  • Anal fissures and cracks
  • Infections
  • Dermatological Irritations
  • Poor Personal Hygiene
  • Mental Factors
  • Diet and Medication
  • Systemic Causes

Colorectal Disorders

Hemorrhoids are swollen veins in the rectum that cause inflammation and itching. They often occur due to strained egestion or pressure during pregnancy. Hemorrhoids are managed by drinking plenty of water and normalizing in a sitz bath.

Anal fissures and cracks

Anal fissures are small cuts on the inside of the anus arising from constipation and long-term diarrhea. Vigorous wiping of the affected skin creates a stinging sensation.

Anal Fistula is a duct connecting an infection spot or abscess to the opening of the anal skin. It causes fluid leakage that irritates and stings the anal area.


Anal warts arising from the Human Papilloma Virus (HPV) cause itching of the anal area. These warts grow inside the anus and spread towards the genitalia. If left untreated, they may cause anal cancer.

Pinworms occur from ingestion or inhalation of the pinworm eggs. They cause itching when the female lays eggs within the anus. Pinworms are common in children. Pinworms inhabit bed linen, toys, and bathroom fittings, resembling slices of white thread.

Dermatological Irritations

Scabies is a common skin infection that causes anal itching. The scabies mite delves into the epidermis layer of the skin and inhabits there. They are popular within the anal region, causing inflammation and itching of the area. Similarly to pinworms, scabies is transmitted through skin-to-skin contact.

Psoriasis is another primary culprit of pruritus ani. Psoriasis is characterized by red, non-scaly patches on the skin. These patches sting mercilessly during bowel movement.

Dermatitis also causes a rash where the sun does not shine. Other skin infections, such as seborrhea and eczema, cause perianal itching.

Poor Personal Hygiene

Failure to wipe well after bowel movement causes stinging and itching due to the accumulated residual matter. Be sure to clean your bottom with a soft toilet paper.

Being excessively clean may also have an adverse effect. Do not wipe vigorously or apply deodorants to your bottom. Deodorants and sprays infiltrate and destroy the protective oily layer in the perianal region.

Super tight underwear is a disservice to your genitalia. Tight-fitting fabric impedes humidity and moisture circulation down there. Stuffy underwear causes sogginess of the perianal region, softening the skin and causing it to break. It will greatly help to wear cotton undergarments for their excellent moisture absorption. Perfume in garments will also adversly affect your anal skin.

It is natural to react to an itch. However, excessive scratching of your butt only breaks your skin and causes pruritus ani.

Mental Factors

Psychological imbalances such as depression, stress, and anxiety may escalate anal itching. When you are stressed, you may experience an outrageous urge to scratch your butt.

Diet and Medication

Pepper often causes an urge to scratch the anal region. Chocolates, spicy meals, citrus fruits, nuts, beer, and tomatoes largely trip the urge to scratch oneself down there.

Excessive caffeine also causes the anal muscles to slacken and could result in stool leakage.

Laxatives may also cause anal itching, loose stool and increased bowel movement.

Strong antibiotics can fight off the useful bacteria in your colorectum, thus causing pruritus ani. These bacteria maintain a homeostatic balance between the inside and outside of your anus.

Systemic Causes

Some conditions affecting your whole body may cause pruritus ani. They include:

  • Anemia

  • Hyperthyroidism

  • Kidney failure

  • Liver disease- Hepatitis, jaundice

  • Diabetes

  • Leukemia

What Are the Signs and Symptoms of Anal Itching?

Besides an itching butt, the following signs are evident:

  • Inflammation
  • Ulcers
  • Red skin
  • Skin rash
  • Swollen perianal region
  • Sore butt
  • Dull perianal skin
  • Blood spots in fecal matter
  • Pus discharge in the anus
  • Bulging hemorrhoids

When to See A Doctor

Pruritus ani is easily manageable and is seldom an emergency. However, if you notice the discharge of pus in your underwear, bleeding, or loose stool, seek medical assistance urgently. It would be best if you also were on the lookout for drastic skin changes.

Diagnosis of Pruritus Ani

A visit to the doctor commences with some questions on your anal health. The doctor may inquire about the frequency of your skin rash, probe your dietary practices and hygiene measures.

They will then examine your skin tone and texture, looking out for the cuts and lesions. A physical examination follows to deduce the exact problem. The rectum and anus are examined for traces of cancer or other colorectal infections. There are two tests which are commonly done; the Scotch tape test and the digital rectal examination.

The scotch tape test is done to children to investigate the presence of pinworms. The doctor inserts a surgical scotch tape around the child's anus just before bedtime. Pinworms resurface at night. In the morning, the tape is removed and examined for the presence of eggs or actual worms.

In the digital rectal examination, the doctor inserts their lubricated finger in a glove through a patient's anus into their rectum. This digital exam pinpoints the symptoms of constipation or cancer.

The doctor may also ask you to constrict your butt. This clenching aims to diagnose anal sphincter.

The doctor may then collect any necessary swabs, specimens, or blood for detailed laboratory tests. Depending on your case diagnosis, the doctor then administers the appropriate treatment.

How to Treat Anal Itching?

Treatment of pruritus ani can be medicinal or home-based remedy.

Medical treatment

Some medical drugs to cure anal itching include:

  • Antihistamines
  • Vasoconstrictors
  • Astringents
  • Mild Anesthetics
  • Protectants
  • Ointments
  • Methylene Blue


Histamines are chemical compounds that cause a hypersensitive reaction within the body (allergy). Antihistamines are drugs to curb the allergic reaction. Doctors often recommend antihistamines if the itching is due to an allergic reaction.

Antihistamines are best used before sleep for enhanced comfort during the night.


These drugs constrict blood vessels and are used to treat hemorrhoids. Hemorrhoids are a result of swollen blood vessels in the rectal region. Vasoconstrictors also help to alleviate the sting effect.


These are chemical compounds that catalyze protein aggregation within the body cells. Proteins aid in skin health. These proteins thus dry out the skin and recede the inflammation and itching around the perianal area.

Mild Anesthetics

Local anesthetics relieve pain and inflammation temporarily. They are often used at night.


These compounds form a protective barrier between the skin and any foreign contact. Cocoa and glycerin are popular protectants.


Some rubbing medicines are applied to the perianal region to relieve the pain. The EMUAID® First Aid Ointment is a versatile and advanced ointment for anal itching.

Methylene Blue

An injection of methylene blue treats sophisticated cases that do not respond to topical medicines. The doctor injects the methylene blue into the perianal skin. The methylene blue soothes pain by deadening the nerves around the anus.

Home Remedy and Self Care

Home remedy and self care to cure anal itching include:

  • Cease Scratching
  • Antidepressants
  • Get Chilly
  • Top-notch Toiletries
  • Dietary Overhaul

Cease Scratching

Prolonged scratching will only escalate the issue. Extensive scratching tears up your perianal skin, paving the way for prospect infections.

Trim your nails to avoid damaging your skin. Adopt comfortable clothes, especially underwear, to deter inflammation and itching.


Antidepressants secrete serotonin that soothes the nerve endings around the perianal region. This creates a relieving experience, especially at night.

It would also be best if to adopt a healthy lifestyle to manage stress and depression.

Get Chilly

A bag of ice could be used to cool off the tingling. Shun off from hot water at the perianal region as hot water irritates the itching skin.

Top-notch Toiletries

Adopt high-quality jelly and moisturizers that hold water in the epidermis layer of the skin. A moisturized skin feels hydrated and relieves itching.

Use soft and moist toilet paper in your bowel movement. Be mindful when wiping yourself and avoid too much pressure while brushing.

Avoid scented soap, deodorants, and jelly on your perianal region.

Dietary Overhaul

Drink plenty of water to aid in the digestion process. Avoid pepper and highly seasoned foods that may promote itching.

Eat foods rich in fiber. Fiber helps to prevent constipation and loose stool. Fruits, vegetables, and whole cereals are good sources of fiber. Oatmeal is also an outstanding source of fiber.

Pruritus ani is easy to manage. Just adopt the no scratching rule and abide by a balanced diet. Being too clean may be harmful to your nether regions. Remember, your perianal area deserves utmost care, just like the rest of your body.

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