So you’re really itchy—in one of the most private and difficult to talk about places on your body. And while it may feel mortifying to even type the words “anal itching” or "itchy butthole" into your search engine, it’s actually a common problem. The “it” we’re referring to is pruritis ani, the technical term for irritation around the anus that causes the desire to scratch.
On the other hand, too much wiping—or the wrong kind of wiping—can also lead to irritation and itching. Parswa Ansari, MD, assistant professor of surgery at the Donald and Barbara School of Medicine at Hofstra/Northwell in New York, refers to this common problem as “overzealous hygiene.”
In a 2016 paper in the journal Clinics in Colon and Rectal Surgery, Dr. Ansari explains: “The use of soap [in the perianal region], particularly scented ones, should be avoided,” he writes. “Warm water alone can be used, and the area should not be scrubbed vigorously during bathing or after toileting.”
Chronic conditions like psoriasis and eczema can cause inflammation and itching anywhere on the body, including the perianal region.
Psoriasis—which causes itchy red patches and silvery, flaky scales to form on the skin—is responsible for about 5% to 8% of anal itching cases referred to colon and rectal surgeons, according to Dr. Ansari. And while psoriasis can’t be cured, a dermatologist can help keep it under control by prescribing a brief course of topical steroids and longer-term doses of other topical medications. Ultraviolet light therapy may also be helpful.
According to a 2014 review in the International Journal of Clinical Practice, doctors are “frequently confronted” patients suffering from anal eczema, “and the need for efficient and safe therapies is high.” Eczema (also called atopic dermatitis) can be treated with steroids and other anti-itch ointments or creams.
Another skin condition that can cause anal irritation—especially in women—is called lichen sclerosus. This condition causes white, wrinkled skin changes in the labia and in the perianal region, and it usually responds to a 6- to 8-week dose of topical steroids. These lesions have been associated with skin cancer, so they should be biopsied if they don’t respond to treatment.
Anal itching is sometimes associated with tight clothing or materials that don’t breathe well, says Dr. Kim. “We know that sweat can cause irritation anywhere on the body with prolonged exposure, and in this area especially it can cause a lot of itching or even a yeast infection,” he says.
What you eat can definitely affect how you feel down there, especially during and immediately after pooping. “Maybe you have an unusual diet—like it’s very acidic, or you eat a lot of a certain irritant,” says Dr. Kim. “A lot of people believe that making dietary adjustments can improve itching down there.”
Certain foods can also contribute to diarrhea or anal leakage, which can make it more difficult to wipe thoroughly and can cause irritation and itching in itself. According to Dr. Ansari’s research, foods that have been associated with anal itching include coffee (both caffeinated and decaf), tea, chocolate, citrus fruit and juices, tomatoes and tomato paste, cola, alcoholic beverages, and dairy products.
These tiny white parasites were in the news recently, when actress Kristen Bell revealed that both she and her daughter were infected with pinworms after an infestation at her daughter’s preschool. “It was very itchy,” Bell said on an episode of The Joel McHale Show with Joel McHale.
The term yeast infection may make you think of the vagina, but this type of fungal infection can also occur in the perianal region—especially in people who are elderly, obese, have a compromised immune system, or are taking antibiotics.
According to a 2013 paper in Gastroenterology Clinics of North America, yeast infections play a role in 10% to 15% of cases of anal itching. They usually can be treated with anti-fungal powder or lotion, although oral anti-fungal drugs may be needed for severe cases.
Anal itching can also be a symptom of sexually transmitted infections, including herpes and anal warts caused by the human papilloma virus (HPV). Symptoms usually occur around the anus (instead of the vaginal area) when a person has received anal sex. Anti-viral medication can help keep herpes under control, while treating anal warts may require topical creams, cryotherapy, or even surgery.
Scabies is a common skin condition caused by a tiny bug called the human itch mite. It’s very contagious, requires a prescription medication to treat, and can result in an itchy rash and sores all over the body—including around the anus and genitals.
On the other hand, if you only have itching in the perianal area, it’s probably not scabies. “It usually affects the groin, the armpits, the belly button, the rest of the body,” says Dr. Kim. “If you’re really looking for a specific cause of isolated anal itching, it’s most likely something else.”
Some diseases, like iron-deficiency anemia, kidney or liver disease, and certain types of cancer, can also cause generalized itching throughout the body, according to a 2008 study in the American Journal of Clinical Dermatology. Treating the underlying condition is the best way to stop these types of symptoms, but doctors sometimes recommend oral or topical medications specifically to relieve itching, as well.
“We have some suspicion that some of this type of itching is neurologic,” says Dr. Kim. “As patients get older, a lot of them have lower back injuries and many people probably have minor damage to the nerves coming out of their spinal cords.”
These problems can cause twinges of pain or a nagging itch in the area around the buttocks and anus, Dr. Kim adds. Treatment for this type of nerve damage varies, he says, but may include physical therapy, surgery, or behavior modification.
Where to start
Because the causes of anal itching are so broad and wide-ranging, it can be hard to know where to start if you do have a problem. Talking to your primary care doctor is always a good option, says Dr. Kim; you could also check with a dermatologist if you think your problem is more skin-related, or a gastroenterologist if it seems more digestive in nature.
Whatever you do, don’t suffer in silence. “This type of itching can be so debilitating, I’ve had patients who were thinking about quitting their jobs,” says Dr. Kim. “And any type of scratching can be embarrassing, but scratching in that area is even more socially unacceptable.”
A chronic itch can be extremely frustrating, especially if you don’t know what the root cause is. Fortunately, says Dr. Kim, many factors that contribute to anal itching can be identified and treated, so patients can get back to living their lives without distraction or irritation.
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