Anal itching

Anal itching is a common condition. The itch in or around the anus is often intense and can be embarrassing and uncomfortable.

Anal itching, also called pruritus ani (proo-RIE-tus A-nie), has several possible causes. They include infections, hemorrhoids and ongoing diarrhea. Skin inflammation, also called dermatitis, is another cause.

If the symptoms don't clear up with self-care, talk with your health care provider. With treatment, most people get complete relief.

Symptoms of anal itching may include intense itching, inflammation, burning and soreness. The itching and irritation may be short lived or more persistent, depending on the cause. Anal itching often is worse at bedtime or in hot, humid weather.

When to see a doctor

Medical care isn't needed for most anal itching. But see your health care provider if:

• Anal itching is severe or constant
• You have anal bleeding or stool leakage
• The anal area seems to be infected
• You can't figure out what's causing a constant itch

Possible causes of anal itching include:

• Irritants. Fecal incontinence and long-term diarrhea can irritate the skin. Or your skin care routine may include products or behaviors that irritate the skin. Examples include using harsh soaps or wiping too hard and too often.
• Infections. These include sexually transmitted infections, pinworm infections and yeast infections.
• Skin conditions. Sometimes anal itching is the result of a specific skin condition, such as dry skin, psoriasis or contact dermatitis.
• Other medical conditions. These include diabetes, thyroid disease and hemorrhoids.

Often the cause of anal itching isn't known.

Your health care provider may be able to diagnose the cause of your itching by asking about your symptoms, medical history and personal habits. You may need a physical exam, including a rectal exam. You might have a test for pinworms if a pinworm infection is suspected.

If the cause of your itching isn't obvious or your itching doesn't respond to treatment, your health care provider may refer you to a specialist in skin conditions. This type of doctor is called a dermatologist. In many cases, the cause of the itching isn't known, but the symptoms can be treated.

Treatment of anal itching depends on the cause of the problem. It may include taking self-care measures such as using an anti-itch cream or treating an infection or fecal incontinence.

If symptoms are worse at night, an oral antihistamine might be prescribed. This is medicine that you take by mouth. It can help give relief until an anti-itch cream takes effect.

With proper care most people get relief from anal itching. See your health care provider if the itching lasts.

Prevention of anal itching mainly involves a careful washing routine that keeps the area clean, cool and dry, while avoiding irritating the skin.

If you already have anal itching, try these self-care steps to ease your symptoms:

• Cleanse gently. Clean the area around the anus when it's soiled or after each bowel movement when possible. This may involve a quick shower, a bidet, a sitz bath or a squeeze bottle. Moist toilet tissue can help. Avoid scrubbing or rough cloths. Pat dry with a cloth or dry the area with a hair dryer on fan-only setting. Using the heat setting could further irritate this delicate area.
• Don't scratch. Scratching provides only short-term relief from itchy skin. It further irritates your skin. You may find some relief by applying a moist, room-temperature compress to the area or taking a lukewarm oatmeal bath. Trim your nails short and wear cotton gloves to bed to prevent scratching while you're sleeping.
• Wear white cotton underwear that doesn't bind. This helps keep the area dry. Avoid wearing pantyhose and other tight-fitting garments because these can trap moisture.
• Avoid irritants. Avoid bubble baths, genital deodorants, scented toilet paper, personal cleansing wipes, and harsh or perfumed soaps. Cleansing with a gentle soap and water and not using any other products is usually the best.
• Change your diet. Cut back on or avoid the following items until your symptoms clear up: tea, coffee, cola, alcohol, citrus fruits, pepper, dairy products, spicy foods, tomato sauce and tomatoes. Avoid overuse of laxatives.
• Apply ointments, creams or gels. Protect the affected skin from moisture by applying a thin layer of a zinc oxide ointment (Desitin, Balmex) or petroleum jelly (Vaseline). If needed to ease inflammation and itching, apply hydrocortisone 1% cream 2 to 3 times daily for a week or two.
• Eat more vegetables, whole grains and noncitrus fruits. This will help with maintaining regular bowel movements. Other sources of fiber are beans, nuts and seeds. Fiber supplements such as psyllium (Metamucil) and methylcellulose (Citrucel) may help.

Most people won't need to see a health care provider about anal itching. But if the itching doesn't stop even after taking self-care measures, seek help. Your care provider may refer you to a skin doctor called a dermatologist, or to a doctor who specializes in treating rectal and anal problems. This type of doctor is called a proctologist.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Symptoms you are having, including any that may seem unrelated to anal itching
• How long you've had your symptoms
• All medicines, vitamins and supplements you take, including the doses
• Questions to ask your care provider

For anal itching, some basic questions to ask your care provider include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• Is this problem temporary?
• What treatments are available? Which do you recommend?
• Do you think I need to see a specialist?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, such as:

• Have your symptoms been continuous, or do they come and go?
• How severe are your symptoms?
• Have you had recent changes in your bowel movements, such as diarrhea?
• What type of soap or other products do you use on your body?
• Does anything seem to improve your symptoms?
• What, if anything, worsens your symptoms?
• Have you noticed any other changes in your general health?
• Are others in the home experiencing a similar itch?

What you can do in the meantime

Cleanse the anal area gently right away after bowel movements and dry thoroughly. Wear cotton underwear and loose clothing. Try not to scratch.