How is pruritis ani (anal itching) treated?

Usually treatment focuses on establishing and maintaining a routine for proper anal hygiene. If a secondary or underlying cause is found, the treatment will depend on the specific condition.

  • Topical medications: Topical steroids, such as creams or ointments containing 1% hydrocortisone, may help to relieve itching and irritation. The cream or ointment may be applied two or three times to the affected area each day. Topical capsaicin has been studied as an alternative to steroids for patients with chronic pruritis ani.
  • Oral medications: Antibiotic or antifungal medications may be prescribed if an infection is present.
  • Methylene blue injection (anal tattooing): This technique may be used to treat more advanced cases that do not respond to topical medications. Methylene blue (a dye) is injected under the skin in the perianal region. It is thought that the methylene blue relieves pain and itching by deadening the nerve endings where the dye is injected.

What are some tips for self-care?

  • Resist the urge to scratch. The itching might seem worse at night, so people might unconsciously scratch the anal area with their fingernails during sleep. Wear clean, soft cotton gloves at bedtime to prevent irritation and infection.
  • Keep the perianal area clean and dry. Use clear water instead of soap or moistened toilet paper to clean the perianal region after a bowel movement. A shower head or bidet may be used to gently clean the perianal area. Use a hair dryer on a low setting to dry the area. If using toilet paper or a towel, gently pat or blot the area until it is dry.
  • Apply a small amount of cornstarch or piece of cotton to the area to keep it dry during the day. A small cotton gauze pad can be used instead.
  • Do not use soap when cleansing the anal area or scrub vigorously with toilet paper or a washcloth.
  • Avoid using perfumed creams, lotions, bubble baths, powders, or other products that may cause irritation to the area.
  • Eat foods high in fiber. A healthy diet can help prevent diarrhea or constipation and ensure regular bowel movements. Avoid any foods that might promote itching, such spicy or acidic foods or caffeinated beverages.
  • Avoid wearing tight or constricting underwear. Cotton underwear can help to absorb moisture better than synthetic fabrics. Make sure underwear fits properly and change it frequently. Wash clothing with fragrance-free detergents.
  • Use topical medications as directed. Apply the cream or ointment sparingly and discontinue use if the itching does not subside or gets worse.

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