The sensation of itchiness is generally unpleasant regardless of where it occurs on your body, but there are some places that are more sensitive than others. In addition to being more sensitive, itchiness around the anal area can be potentially embarrassing and awkward. It may even be infuriating to endure the itching without knowing the cause or what can be done about it. Fortunately, in all likelihood, your itchy bottom is the result of a benign condition that can be easily treated.  

What is Anal Itching (Pruritus Ani)?  

The technical, medical term for anal itching is pruritus ani, and it generally refers to any irritation of the skin on or around the anus. Anal itching isn’t a condition in itself but rather a symptom of a number of other possible conditions. Most of the time it can be explained by the presence of some kind of irritant, but there are times when a specific cause can’t be identified. Anal itching is fairly common around the United States, and some estimates suggest that around 5% of the population suffers from it at any given time. 

What are Common Causes of Anal Itching?

There are a wide variety of possible causes of anal itching, and so having the symptom alone isn’t enough to fully diagnose the condition that’s causing it. Nevertheless, there are numerous common (and not so common) causes that tend to be responsible: 

Irritants

One of the most common causes is a foreign substance coming into contact with the anus. Just like the skin on any part of the body, some chemicals or other substances can cause an allergic reaction and the skin will become inflamed and eventually itchy. Some examples of these irritants:   

  • Dyes or scents present in toilet paper
  • Laundry detergent 
  • Soap or deodorants 
  • Skin care products 
  • Feminine hygiene products 
  • Talcum powder 
  • Medications (creams, ointments, suppositories, etc.)

Stool Residue 

Sometimes, when the anus isn’t cleaned properly after passing stool, residual fecal matter remains on the sensitive anal skin. Over time, even trace amounts of this material can become encrusted and abrasive.

Friction

Not all toilet paper is created equal, and that means that particularly rough toilet paper rubbing against the anus can cause the skin to become raw and chapped, much like how skin on any other part of the body might respond to friction.

Dietary Choices

The actual contents of the stool that gets passed through the anus can also potentially lead to anal itching, and this is strongly related to the foods we eat. Foods and beverages that are spicy or acidic have components that can actually remain partially undigested and pass all the way through the gastrointestinal system; then, after a bowel movement, those substances can remain on the skin surrounding the anus and potentially cause itching. Here are some foods and drinks that might be problematic: 

  • Citrus fruits
  • Tomatoes
  • Chocolate
  • Spicy foods 
  • Coffee
  • Tea
  • Cola
  • Alcohol

Antibiotics

Surprisingly, antibiotics can possibly cause anal itching because of how they affect bacteria. Used primarily to eliminate bacterial infections in the body, antibiotics can also inadvertently kill the kinds of “good bacteria” that aid in the digestion process. Broad spectrum antibiotics like tetracycline and erythromycin are both examples of antibiotics that can disrupt the balance of the microbiota that live in the digestive tracts of all humans. These disruptions in turn can lead to inflammation and anal itching. 

Medical Conditions

There are some diseases that are localized to the lower parts of the gastrointestinal system, which have anal itching as a symptom: 

  • Hemorrhoids
  • Anal fistula
  • Anal fissures
  • Anal cancer (this is very rare, however)

Infection

Some infections can lead to anal itching. This often includes bacterial or viral infections, but there are also (disturbingly) a few known parasites that cause anal itching because of egg-laying habits:

  • Pinworms
  • Scabies
  • Condyloma acuminata
  • Genital warts
  • Gonorrhea 
  • Herpes
  • Anal lice

Skin Problems

Various skin conditions can cause precisely the sort of inflammation that leads to anal itching if it spreads to the skin around the anus: 

  • Psoriasis 
  • Eczema 
  • Seborrhea 
  • Contact dermatitis 

What are Additional Symptoms Associated with Anal Itching?

Besides the primary symptom of an itchy anus, there are additional symptoms that may add into the mix. Most often, the same irritant that causes the itching also causes the skin to be reddish, sore, or an accompanying burning sensation. If the itch remains over a longer period of time (when it becomes classified as chronic), the skin around the anus may eventually become thick and leathery. 

How is Anal Itching Treated?

For many causes of anal itching, the best treatment is avoiding the problem in the first place; this means practicing good anal hygiene as well as being wary of using soap and other products that might have irritating chemical components. For some people, even just examining their diet and making some modifications may be enough to prevent a problem or help it go away on its own. 

Other treatment options will be based on the underlying cause of the itchiness or the severity and duration of the itchiness. If a doctor determines an infection is the culprit, they may prescribe antibiotics or another medication to deal with a virus, fungus, or parasite. For an itch related to simple inflammation because of an irritant or friction, the doctor might prescribe a steroidal ointment for the area. Some conditions, like hemorrhoids, require specialized treatment such as banding. 

For most people, though, a case of anal itching won’t even require a visit to a doctor. If your itching is relatively mild and seemingly not related to another problem, there are a series of home remedies that can easily bring relief for the itch: 

  • Use moistened toilet paper to clean the area after a bowel movement
  • Apply petroleum jelly or over-the-counter hydrocortisone cream with zinc oxide to the area
  • A dusting of non-medicated talcum powder  
  • Wear looser-fitting, cotton underwear 
  • Avoid scratching!  
  • Avoid using a washcloth to clean the area
  • After washing, pat dry or use a hair dryer rather than rubbing the area with a scratchy towel  

When to See a Doctor

As noted earlier, anal itching is a common ailment that generally isn’t cause for alarm. Most people who experience this kind of itching will be able to use self-care remedies and it will clear up within a day or so. If the itching persists for longer than a week or two, it may be time to make an appointment to investigate what underlying condition could be the cause of the irritation.  If you’ve been experiencing intense itching and it just doesn’t seem to be going away, contact Cary Gastroenterology Associates to make an appointment. Although a skin irritation like this might seem like a dermatological problem, the proximity to the rectum (and the numerous digestion-related conditions that could potentially be related) makes it an appropriate concern to talk with a gastroenterologist about and get excellent medical advice.