Anal itching, also known as pruritus ani, is a common symptom that can have many causes, including poor hygiene, hemorrhoids, intestinal worms, recent antibiotic use, allergies, or irritation from certain foods. Spicy foods, coffee, soda, and alcohol are frequent triggers that may worsen discomfort in the anal area.
Anal itching often involves persistent itching along with other symptoms like bleeding, mucus discharge, skin thickening, burning, or altered skin sensitivity. These symptoms can signal various underlying conditions, so medical assessment is typically required to pinpoint the cause.
Anal itching is usually treatable once the cause is identified, and management often involves gentle hygiene, avoiding irritants, and using topical treatments such as corticosteroids, zinc oxide, or antifungal creams when indicated. Depending on the cause, treatment may also include dietary changes, medications, or targeted therapies for conditions like infections, hemorrhoids, or skin disorders.
Symptoms quiz
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Common causes
The main causes of anal itching are:
1. Poor hygiene
Not cleaning well after a bowel movement can leave tiny stool particles on the skin and mucous membranes, causing irritation and itching. When mixed with sweat, this residue can promote fungal overgrowth, intensifying the itch.
What to do: wash the anal area after using the bathroom with water and a mild, fragrance-free soap to remove residue. If you can’t wash right away, wipe gently with soft toilet paper and wash as soon as possible.
In some cases, a short course (up to 1 week) of topical products such as hydrocortisone, zinc oxide, camphor, or witch hazel may be used to relieve discomfort, depending on the cause and medical guidance.
2. Excessive cleaning
Frequent or excessive cleaning of the anus, such as frequent wiping or using wet wipes after bowel movements, can dry out the skin and cause irritation, which may lead to intense itching.
What to do: use soft toilet paper or fragrance-free wipes without added chemicals, and clean gently to reduce friction. When possible, washing with water can be less irritating than repeated wiping.
Always dry the area well before putting on underwear, since moisture can promote fungal growth and lead to more itching.
3. Diet
Some foods can irritate the digestive tract, especially when eaten frequently or in large amounts, and this can contribute to anal itching.
Foods and drinks that may trigger symptoms include spicy foods, coffee, chocolate, citrus fruits, tomatoes and tomato sauce, soda, and alcoholic drinks such as beer, wine, and spirits.
What to do: reduce or avoid foods and beverages that seem to worsen digestive irritation.
Symptoms often improve within 2 to 3 days after stopping these triggers. If itching or other symptoms continue, see a colorectal specialist to identify the cause and start the most appropriate treatment.
4. Worms
Anal itching, especially in children, is very common with pinworms. The itching is often intense and tends to be worse at night, when the female worm moves to the anal area to lay eggs.
Pinworms can spread through contaminated water or food, or by touching objects contaminated with worm eggs. They can also spread through fecal-oral transmission, such as scratching the area, not washing hands, and then touching the mouth.
What to do: pinwormtreatment should be guided by a primary care provider, pediatrician, or gastroenterologist and commonly includes antiparasitic medicines such as albendazole or mebendazole. Household members with close contact usually need treatment as well.
During treatment, wash hands after using the bathroom and after scratching, clean children’s toys, wash clothes and bedding separately, and vacuum to help remove possible eggs from the environment.
5. Antibiotic use
Current or recent antibiotic use can disrupt the normal bacterial balance in the gut and around the anus, which can allow Candida albicans to overgrow and cause a yeast infection, leading to significant itching.
Antibiotics can also cause diarrhea in some people, and diarrhea can irritate the anal skin and trigger itching.
What to do: if you develop anal itching or diarrhea while taking antibiotics, contact the prescribing clinician so they can advise the best next steps.
Treatment may include a short course of topical corticosteroids for irritation or antifungal ointments if a yeast infection is present.
Probiotics, including Saccharomyces boulardii, are sometimes used to support gut balance, and kefir or unsweetened plain yogurt may also be helpful for some people.
6. Allergy
Allergic reactions to hygiene products such as scented or dyed toilet paper, feminine hygiene sprays, talc, or scented soaps can irritate the skin and sometimes cause small sores, leading to itching.
Waxing, materials in sanitary pads, or certain underwear fabrics can trigger allergic reactions, leading to irritation and itching.
What to do: a short course of a topical corticosteroid may be used to ease discomfort and reduce the allergic reaction, under medical guidance.
To prevent recurrence, use soft, fragrance-free, dye-free toilet paper and avoid feminine hygiene sprays, talc, and scented soaps.
7. Hemorrhoids
Hemorrhoids are swollen, inflamed veins under the skin and around the anus that can cause pain and bleeding with bowel movements as well as itching. They can also make it harder to clean the area thoroughly, which may worsen itching.
What to do: topical anesthetic products or corticosteroid ointments may help relieve itching, depending on the situation and medical guidance.
Other treatments for hemorrhoids that may help include warm sitz baths for 10 minutes after bowel movements or applying ice packs.
It can also help to avoid frequent wiping and instead wash the area after bowel movements, then dry gently with a clean, soft towel.
8. Yeast infection
Yeast infections can cause anal itching when normal skin and gut flora become disrupted. Triggers include poor hygiene, weakened immune systems, heavy sweating, obesity, and antibiotic use.
What to do: treatment should be guided by a clinician and commonly includes antifungal medicines, such as clotrimazole ointment or oral medicines such as fluconazole or itraconazole.
Sitz baths with chamomile and other home remedies for a yeast infection may also help soothe symptoms.
9. Scabies
Scabies is caused by infestation with the mite Sarcoptes scabiei and can cause intense itching, including around the anus. It may also cause reddish patches in the area and itching elsewhere on the body.
What to do: a dermatologist may recommend topical treatments such as permethrin or crotamiton, or oral medication such as ivermectin, depending on the case.
During treatment, maintain good hygiene, shower at least once daily, avoid sexual contact, and wash clothes, sheets, and towels that had direct skin contact in hot water.
10. Pubic lice
Pubic lice are caused by the louse Phthirus pubis, which can infest pubic hair and cause intense itching in the pubic region and around the anus.
What to do: a dermatologist or primary care provider may recommend removing lice and nits with tweezers or a fine-tooth comb and using shampoos, lotions, or creams containing permethrin, malathion, or pyrethrins.
For extensive or severe infestations, the doctor may recommend an oral antiparasitic medication.
11. Sexually transmitted infections
Anal itching can be a symptom of some sexually transmitted infections (STIs) such as HPV, genital herpes, syphilis, and gonorrhea.
Along with itching, these infections can also cause warts, blisters, or sores around the anus, bleeding, and swollen lymph nodes in the groin.
What to do: treatment depends on the infection and may include wart removal or prescription medicines such as antibiotics (for example, ceftriaxone or azithromycin), antivirals such as acyclovir, or benzathine penicillin G given by injection.
12. Anal fissure
An anal fissure is a small tear or sore in the anus that can cause itching, pain, discomfort, mild bleeding, and burning during bowel movements.
It can happen after passing very dry, hard stool, with constipation, severe diarrhea, anal intercourse, or after anal surgery, for example.
What to do: treatment includes gentle hygiene and warm sitz baths for 5 to 20 minutes after bowel movements to calm burning and reduce pain.
A clinician may also recommend topical medicines such as lidocaine (anesthetic) or nitroglycerin ointment (a vasodilator), depending on the case.
13. Anal cancer
Anal cancer is rare, but it can cause symptoms such as itching and burning, anal pain (especially during bowel movements), bright red blood in the stool, swelling in the anal area, and a lump or mass.
What to do: treatment is managed by a colorectal surgeon and oncology team and may include chemotherapy and radiation therapy over the course of 5 to 6 weeks.
In some cases, surgery may be recommended to remove small tumors or, in more severe cases, to remove the anal canal, rectum, and a portion of the colon.
14. Genital psoriasis
Anal itching can be one symptom of genital psoriasis. This autoimmune condition can also cause smooth, reddish patches with a dry appearance on areas such as the anus, buttocks, thighs, penis, armpits, and vagina.
What to do: a dermatologist may recommend topical corticosteroid creams to reduce inflammation and relieve discomfort.
If lesions do not improve with creams or if other body areas are affected, the doctor may recommend phototherapy or medicines such as dapsone or methotrexate.
15. Perianal eczema
Perianal eczema is a type of eczema that can cause redness, swelling, itching, or changes in the skin around the anus, between the buttocks.
It is associated with factors such as older age, fecal incontinence, limited mobility, excessive sweating, obesity, and poor anal hygiene, which can weaken the skin barrier and promote inflammation.
What to do: treatment recommended by a clinician may include creams containing corticosteroids, calcineurin inhibitors, antibiotics, or antifungals, depending on the cause.
It is also important to clean the area gently with warm water, avoid scratching, limit spicy foods if they worsen symptoms, and avoid very tight clothing or synthetic fabrics.