Anal Itching (Pruritus Ani)

Overview

What is anal itching?

Anal itching (pruritis ani) is a skin (dermatological) condition that causes itching in your anal area. Itching may worsen at night or after pooping.

What are the types of anal itching?

There are two main types of anal itching:

  • Primary (idiopathic) pruritis ani: This type of anal itching has no obvious cause. It’s the most common type of pruritus ani.
  • Secondary pruritis ani: This type of anal itching may have many different causes. Causes may include infections, systemic diseases, contact dermatitis and other dermatological conditions.

Who does anal itching affect?

Anal itching can affect anyone. However, you may be more likely to have an itchy anus if you’re:

  • Between the ages of 40 and 70.
  • A man or assigned male at birth.

How common is anal itching?

Approximately 1% to 5% of the population has anal itching. Men and people assigned male at birth are about four times more likely to have an itchy anus.

How does anal itching affect my body?

Anal itching usually causes an uncontrollable urge to scratch your anus. However, scratching doesn’t provide long-lasting relief.

Scratching your anal area causes further irritation and may worsen the itching instead of providing relief. Your skin in this area is sensitive, and your nails are much stronger than your skin. Scratching with your fingernails may cause skin damage or an infection. If the itch-scratch cycle persists, it can lead to extreme discomfort, soreness and burning.

Symptoms and Causes

What are the symptoms of anal itching?

Symptoms of anal itching may include:

  • Itchiness.
  • Irritation.
  • Burning.
  • Soreness.
  • Scratches (excoriations).
  • Thick or leathery skin on or around your anus (perianal area).

What causes anal itching?

Anal itching has many causes.

The skin in your perianal area is sensitive. Scented soaps, powders, lotions, creams and ointments can cause an allergic reaction. You may also irritate your skin if you wipe with rough toilet paper or use a rough washcloth or hot water to clean the area.

It’s important to thoroughly wipe your anus after pooping. Your perianal area may itch when poop remains in the folds of your anus. How often you poop and its form may also play a role in anal itching. You’re more likely to have anal itching if you poop three or fewer times a week (constipation) or if you have diarrhea.

What you eat and drink may also cause anal itching, including:

  • Dairy products.
  • Carbonated drinks.
  • Caffeinated beverages (coffee, tea and soda pop).
  • Acidic or spicy foods (tomatoes, citrus fruits, hot peppers and raw garlic).

Your clothing can also affect the skin in the area. Tight underwear or pants can trap heat and moisture (sweat) around your anus, making itching even worse.

Other causes of anal itching include:

Hemorrhoids

Hemorrhoids are swollen, enlarged veins that form inside and outside your anus and rectum. Large hemorrhoids outside of your anus (external hemorrhoids) can make it difficult to wipe away poop after using the bathroom. Hemorrhoids inside your rectum (internal hemorrhoids) may cause bleeding or a leaky anus (fecal soiling or incontinence), which can irritate your skin.

Yeast infections

A fungal body (yeast) called candida causes yeast infections. Yeast is a type of fungus, and candida is a specific type of yeast. Yeast infections may start in your vagina or anus. They may also cause discoloration, swelling or small cuts or cracks in your skin in the area.

Anal fissures

Anal fissures are tears in the lining of your anus or anal canal (the opening through which poop passes out of your body). Trauma to the area is the leading cause of anal fissures. Trauma may include constipation, straining while pooping, long periods of diarrhea, anal sex or anal stretching.

HPV and Warts

Human papilloma virus (HPV) is a very common virus that can affect your genitals as well as your rectum and anus. HPV causes genital warts.

Genital warts are a type of sexually transmitted disease (STD). The disease causes small bumps or growths (warts) to form in and around your genitals and perianal area. Genital warts may also cause mild bleeding, discomfort and a burning sensation.

Pinworms

Pinworms (threadworms) are tiny white or light gray worms. Pinworms are parasites, which means they depend on other living things (hosts) to get nutrients so they can grow and multiply. Parasites cause harm to their hosts.

Pinworms live in the intestines and rectums of infected people. They lay their eggs around your anus at night, which causes the area to itch.

Diagnosis and Tests

How is anal itching diagnosed?

Your healthcare provider will perform a physical examination to identify possible causes of your itchy anus, such as dermatological conditions or illnesses. They’ll visually inspect your perianal area and note any changes in skin color, skin texture, rashes or lesions.

Your healthcare provider may ask you questions, including:

  • Are you taking any medications?
  • How often do you poop?
  • What’s the consistency of your poop?
  • What kinds of foods do you eat?
  • What kinds of beverages do you drink?
  • What kind of soap do you use in the shower?
  • What kind of toilet paper do you use?
  • Do you usually wear tight underwear or pants?
  • Do you have any food allergies?

If your healthcare provider can’t determine the cause of your itchy anus, or if you don’t respond to treatment, they may refer you to a dermatologist.

What tests will be done to diagnose anal itching?

A tape test is an easy way to determine if pinworms are causing your or your child’s anal itching.

Pinworms are active at night. If you suspect your child has pinworms, you can place a small piece of tape near your child’s anus before bedtime. After your child wakes up in the morning, remove the tape from their anus and look for pinworms are eggs.

Management and Treatment

How is anal itching treated?

Treatment for an itchy anus usually first focuses on establishing good anal hygiene. Thoroughly clean your anus after pooping, dry the area and apply nonmedicated talcum powder.

If you have secondary pruritis ani, your treatment depends on the specific cause.

Treatments may include:

Creams and ointments

Over-the-counter (OTC) hydrocortisone is a corticosteroid combined with an anesthetic pain reliever that you rub on your affected area two to three times each day.

Studies suggest capsaicin topical cream is a good alternative to corticosteroids if you have chronic (long-lasting) anal itching.

Antibiotics and antifungal medications

Your healthcare provider may prescribe antibiotics or antifungal medications if they suspect an infection is causing your itchy anus.

Methylene blue injection (anal tattooing)

If your body doesn’t respond to other treatments, your healthcare provider may treat your itchy anus with a methylene blue injection. Your healthcare provider will inject methylene blue under the skin in your perianal area. Methylene blue relieves pain and itching by deadening the nerve endings in the injected areas.

Are there any home remedies that may help relieve anal itching?

Several home remedies may help relieve anal itching, including:

Dye-free, unscented toilet paper

Some toilet paper products contain dyes or scents, which can irritate your skin. Look for terms such as “dye-free,” “unscented,” “unbleached,” “hypoallergenic” or “only contains natural ingredients” on the packaging.

Avoid harsh soaps, scents and deodorants

Harsh soaps, scents and deodorants may contain allergens or chemical irritants, which can make your symptoms worse.

Wear cotton underwear

Cotton underwear absorbs moisture. Make sure your underwear fits properly and change it often. Use fragrance-free detergents to wash your underwear.

Avoid certain foods and drinks

Dairy products, carbonated drinks, caffeinated beverages and acidic or spicy foods may cause anal itching. It’s best not to avoid all of these foods and drinks at once. Gradually removing one of these items every few days can help you determine which food or drink is causing your itchy anus.

Outlook / Prognosis

What can I expect if I have an itchy anus?

With proper hygiene and treatment, the outlook for people with anal itching is good. Your symptoms usually clear up within one to three weeks, though severe cases make take longer to treat.

Living With

How do I take care of myself?

If you have an itchy anus, self-care tips include:

  • Resist the urge to scratch. The itching may seem worse at night, and you may unconsciously scratch the perianal area with your fingernails while you’re asleep. Wear clean, soft cotton gloves at bedtime to prevent irritation or infection.
  • Keep your perianal area clean and dry. Use clean water from a showerhead or bidet, moistened toilet paper or baby wipes to clean your perianal area after pooping. After pooping or bathing, gently pat the area until it’s dry with toilet paper or a towel, or use a hairdryer on a low setting.
  • Apply products that absorb moisture. A small amount of cornstarch, unmedicated talcum powder or a piece of cotton help absorb moisture.
  • Be gentle. Avoid using soap when cleansing your perianal area. Don’t scrub the area with toilet paper or a washcloth.
  • Avoid scented products. Scented creams, lotions, bubble baths, powders and other products may cause irritation.
  • Eat foods high in fiber. A healthy diet can help prevent constipation or diarrhea and ensure regular bowel movements.
  • Use topical creams and ointments as directed. Don’t apply the cream or ointment more than recommended. Discontinue use if the itching doesn’t go away or it gets worse.

When should I see my healthcare provider?

Call your healthcare provider if your itchy anus doesn’t improve with treatment, your itching gets worse after treatment or the area looks infected (discolored skin, irritation or swelling).

What questions should I ask my healthcare provider?

  • Do I have primary pruritus ani or secondary pruritus ani?
  • If I have secondary pruritus ani, what’s the cause?
  • What medications do you recommend?
  • Do the medications have any side effects?
  • What at-home treatments do you recommend?
  • Is there a cream or ointment that you can prescribe?
  • Should I see a dermatologist or another specialist?

Frequently Asked Questions

Why is my anus itchy at night?

Pinworms can cause itching and irritation in your perianal area. They’re more active at night, which is why your anus may be itchier at night than other times during the day.

Should I be worried about an itchy anus?

In most cases, you won’t need to see a healthcare provider if you have an itchy anus. Proper anal hygiene and OTC medications provide relief for most people.

A note from Cleveland Clinic

Anal itching is an unpleasant condition. It’s annoying and embarrassing, and it may be so unbearable that it’s difficult to think of anything else. However, relief is available. Proper hygiene, medications and gentle care will help relieve an itchy anus. If your symptoms don’t go away after treatment, contact your healthcare provider right away.

Last reviewed by a Cleveland Clinic medical professional on 04/18/2022.

References

  • American Society of Colon and Rectal Surgeons. Pruritus Ani Expanded Version. (https://fascrs.org/patients/diseases-and-conditions/a-z/pruritis-ani-expanded-version) Accessed 4/18/2022.
  • DermNetNZ. Itchy Anus. (https://dermnetnz.org/topics/itchy-anus) Accessed 4/18/2022.
  • Kwaan MR, Stewart Sr DB, Dunn K. Colon, Rectum, and Anus. In: Brunicardi F, Andersen DK, Billiar TR, et al., eds. Schwartz's Principles of Surgery, 11th Edition. McGraw Hill; 2019. Accessed 4/18/2022.
  • McAninch S, Smithson III CC. Gastrointestinal Emergencies. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment: Emergency Medicine, 8th Edition. McGraw Hill; 2017. Accessed 4/18/2022.
  • Siddiqi S, Vijay V, Ward M, et al. Pruritus Ani. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647235/) Ann R Coll Surg Engl. 2008; 90(6): 457-463. Accessed 4/18/2022.
  • The Abdomen, Perineum, Anus, and Rectosigmoid. In: Suneja M, Szot JF, LeBlond RF, et al., eds. DeGowin’s Diagnostic Examination, 11th Edition. McGraw Hill; 2020. Accessed 4/18/2022.

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