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Diseases and Conditions
Special to CNN.com
Anal itching is an intense itching around your anus — the canal that's the outlet for your rectum. The itch, located in your anus or on the skin just around your anus, may be accompanied by a strong urge to scratch. It can be an embarrassing and an uncomfortable situation.
Also called pruritus ani, anal itching has many causes. Numerous factors may cause anal itching to be more intense — including moisture, the abrasion caused by your clothing, and the pressure of sitting. Symptoms may be worse at night or right after a bowel movement.
Anal itching is a common problem that many people have experienced. Don't be afraid to talk with your doctor about this condition. With proper treatment and self-care measures, most people can achieve complete relief from anal itching.
Signs and symptoms
Anal itching is associated with other similar symptoms in and around the anus, including:
The itching and irritation in and around your anus may be a temporary condition, or it may be a more persistent and bothersome problem. For some people, the irritation is so intense that the urge to scratch is both irresistible and a source of embarrassment.
Most cases of anal itching are caused by a harmless problem. Occasionally, however, anal itching can be a sign of more serious medical issues. Possible causes include:
- Dry skin. As you age, skin in and around your anus is more prone to dryness. Dry skin can cause persistent, intense anal itching.
- Too much moisture. Moisture around your anus from excessive sweating or from moist, sticky stools can be irritating. Anal itching can also be caused by frequent diarrhea or the escape of small amounts of stool (fecal incontinence).
- Excessive washing. Excessive wiping with dry, harsh toilet paper or excessive scrubbing with harsh soaps can cause or aggravate anal itching. Failure to rinse away the soap completely also may cause irritation.
- Chemical irritants. Certain laundry soaps, colognes, douches and birth control products contain chemicals that can irritate skin in and around your anus. Scented or colored toilet paper can be irritating to people with sensitive skin.
- Food irritants. Anal itching may be the result of irritating chemicals in some foods, such as those found in spices and hot sauces. Similarly, some foods may directly or indirectly irritate your anus as they exit your colon. Common culprits include chocolate, fruits, tomatoes, nuts and popcorn. Consuming certain beverages, including milk or caffeinated drinks, may cause some people to experience diarrhea followed by anal itching.
- Medications. Anal itching may be a side effect of certain medications, including some antibiotics, that can cause frequent diarrhea.
- Overuse of laxatives. Excessive or improper use of laxatives can lead to chronic diarrhea and the risk of anal irritation and itching.
- Hemorrhoids. Hemorrhoids are engorged veins located just under the membrane that lines the lowest part of your rectum and anus. They often occur as a result of straining during a bowel movement. Anal itching can be a symptom of hemorrhoids. However, most hemorrhoids don't itch.
- Infections. Sexually transmitted diseases may also involve the anus and can cause anal itching. In children, the parasite that causes pinworms can cause persistent anal itching. Other parasites may cause similar itching.
- Skin disorders. Common skin problems — such as psoriasis, seborrhea and eczema — can involve and irritate the area in and around your anus.
- Yeast infections. This common infection, which usually affects women, can irritate your genital and anal areas.
- Anal abrasions and fissures. An anal abrasion is a small tear in your anus, usually caused by forced bowel movements through a tight anus. An anal fissure is a deeper tear. Both conditions can cause anal itching, as well as painful bowel movements and bleeding.
- Anal tumors. Rarely, benign or cancerous tumors in or around the anus may be a cause of anal itching.
- Other causes. Anal itching may be related to anxiety or stress. Sometimes, the cause remains undetermined.
Although anal itching is almost never a problem of cleanliness, your own actions may contribute to the problem. Whatever the cause of anal itching, your natural reaction is to scratch the area. But scratching worsens the problem by removing superficial layers of skin. In addition, the natural tendency in response to an irritation is to wash the area frequently with soap and a washcloth. However, excessive washing can aggravate the condition by removing your skin's natural protective oils.
When to seek medical advice
Most anal itching doesn't require medical care. However, if anal itching is severe or prolonged or if it can't be easily explained, see your doctor. Persistent anal itching may be related to a skin condition or other health problem that requires medical treatment.
Screening and diagnosis
Your doctor may be able to pinpoint the cause of your itching simply by asking you questions about your symptoms.
If the cause of your itching isn't obvious, your doctor may refer you to a dermatologist or a doctor who specializes in treating rectal and anal problems (proctologist) for further evaluation. A rectal exam may be all that's required for you to get an answer — and a solution — to a very uncomfortable problem.
Other tests, such as proctoscopy or colonoscopy to view more of the digestive tract, are sometimes needed to identify an underlying cause of anal itching. However, the precise cause of the itching may never be identified.
Treatment of anal itching depends on the cause of the problem. It may include self-care measures, changes to your diet, treatment of infections or, rarely, surgery to correct an underlying problem.
Medications also may be part of your treatment plan. An over-the-counter (OTC) cream or ointment containing hydrocortisone (Cortaid, Preparation H), applied sparingly to the affected area may reduce inflammation and itching. A protective ointment that contains zinc oxide (Desitin, Balmex) also may help. If your symptoms are worse at night, your doctor may also prescribe an antihistamine to reduce itching until topical treatments take effect. With proper treatment, most people experience complete relief from anal itching in less than a month.
Prevention of anal itching mainly involves washing properly and avoiding irritants. If you already have anal itching, try these self-care measures:
- Cleanse gently. Wash the area in the morning, at night and immediately after bowel movements. But don't scrub and avoid using soap. Instead, use a wet washcloth, wet bathroom tissue, unscented flushable bathroom wipes, cotton balls moistened with water, unscented baby wipes or a small squeeze bottle of water to cleanse the area.
- Dry thoroughly. After cleansing, pat the area dry with toilet paper or a towel. Or dry thoroughly with a hair dryer. Once dry, place a dry cotton ball or a piece of cotton gauze against the anus. Replace the cotton as necessary. Nonmedicated talcum powder also can help keep the area dry.
- Use over-the-counter treatments correctly. Apply OTC creams sparingly. Don't use these treatments unless directed by your doctor. For some people, creams or ointments may cause more irritation, and they may mask a persistent problem.
- Don't scratch. Scratching further irritates your skin and leads to persistent inflammation. If you can't tolerate the itching, apply a cold compress to the area or take a lukewarm bath to find some immediate relief. Keep busy to distract yourself from scratching.
- Switch tissue. The skin around your anus may be sensitive to bathroom tissue that contains dyes or perfumes. Use unbleached, unscented tissue. You may want to use tissue that's moistened or made extra soft for comfort, or unscented flushable bathroom wipes.
- Wear cotton underwear and loose clothing. This helps keep the area dry. Avoid wearing pantyhose and other tightfitting garments because these can trap moisture. Change your underwear daily and whenever it's soiled.
- Avoid irritants. Avoid bubble baths and genital deodorants. Cut back or avoid beverages or foods that you know irritate your anal area. Avoid overuse of laxatives that increase diarrhea and the risk of anal irritation and itching.