A persistent need to scratch your bottom, also called pruritus ani, is a relatively common complaint. There are a number of reasons why anal itching occurs and, more often than not, it can be successfully treated.
In this article, we will discuss the common causes of anal itching, medical treatments, and home remedies.
Fast facts on anal itching
Here are some key points about pruritus ani. More detail and supporting information is in the main article.
Anal itching may be embarrassing – but it is a common problem seen by doctors
Too much or too little cleansing can lead to itchiness around the anus
Some foods and drinks are associated with pruritus ani
Skin conditions, infections, anorectal disorders, whole-body medical conditions, and drugs are all potential causes
What is anal itching?
Scratching an itchy bottom can make the problem worse.
Pruritus ani is the medical term for anal itching or itchy bottom. It is defined as intense itching around the anus. Other terms include:
The anus is the opening at the end of the gut or digestive system, allowing us to expel solid waste from the body. Pruritus ani refers to itching around the anus.
Anal itching is a symptom, not a disease in itself; it is a surprisingly common problem, which many people are too embarrassed to see their doctor about.
Pruritus ani can happen to anyone but is said to be more common in men than women and more common in adults than children or the elderly.
What can begin as a brief irritation can soon become a chronic problem as the scratch-itch cycle continues.
Scratching causes tiny little breaks in the skin that are intensely itchy when the usual moisture and humidity of the perianal area comes into contact with them. This causes more scratching and further tiny itchy cuts.
This scratch-itch cycle is made worse by nighttime scratching when the sufferer is half asleep and unaware that they are scratching, especially as loose nightclothes allow easier access.
When urine passes over the cuts in women, it causes stinging, which is then relieved by over-vigorous wiping with toilet paper, again further damaging the skin.
Often the condition can be cured by a strict no-scratching period, which allows the skin to heal and breaks the cycle. However, a physician should examine the skin and lower bowel to make sure there are no medical problems.
Causes of anal itching
Pruritus ani can have a primary or secondary cause:
Primary cause – the itching is not the result of another condition
Secondary cause – the itching has an underlying condition that causes the itching
The list of secondary causes can be collected into broad groups:
Hygiene – too much or too little
Skin irritants – such as soaps
Skin conditions – such as dermatitis and psoriasis
Anal or rectal disorders – piles, and anal fistulas and fissures, for example
Infections – including parasitic and sexually transmitted
Systemic (entire body) medical conditions – including aplastic anemia, diabetes, inflammatory bowel disease, jaundice, leukemia, lymphoma, and thyroid disease
Foods – dietary irritants, such as chilli peppers
Drugs – including chemotherapy, colchicine, neomycin, and quinidine
Some foods may make the itching worse, so identifying and avoiding these may help. Examples include:
Citrus fruits, such as oranges
Excessive liquids, such as milk, beer, or wine
Often, no cause is identified for the itching – in these instances, the pruritus is labeled idiopathic.
Dermatological (skin) causes
Prolonged contact with feces can cause irritation.
People who have fecal incontinence (little or no control over bowel movements) can have leakage, which can cause irritation and itching.
Persistent diarrhea can cause irritation by nature of the frequency or bowel opening and wiping clean.
Eczema and idiopathic dermatitis can affect the anal area. This is inflamed skin of no known cause.
Keloid scar of skin – these are hard, smooth growths that develop when scar tissue develops excessively.
Scabies – a skin infection.
Allergic dermatitis may be due to allergic reactions to creams, lotions, bubble baths, washing powders, wet wipes, etc. Sometimes, creams that are used to soothe or treat the itch cause a worsening of the problem because of the chemicals they contain.
Yeasts (thrush, candida), bacteria (beta hemolytic streptococci, staph aureus) and viruses such as the genital wart virus (HPV) can cause skin infections in the anal region.
Pinworm is a very common cause of itchy bottom in children and families with young children. Female pinworms lay eggs in the folds of the anus; this can cause itching.
Hookworm infection – these are parasites that can affect the lungs and small intestine.
Small skin tags – may hide fecal residue or trap moisture, causing itching.
Some sexually transmitted infections can cause itching in the region.
Psoriasis is a chronic skin condition; it can also affect the perianal area.
Proctitis – the inner lining of the rectum becomes inflamed.
Gastroenterological (bowel) causes
Hemorrhoids (piles) can cause local irritation
Anal cancer should always be considered and checked for
Inflammatory bowel disease can cause frequent diarrhea and irritation
Systemic (whole body) causes