Pruritus ani is itching of the anus and skin around the anus. The intensity of the itchiness increases with moisture, pressure, or rubbing caused by motion or clothing. The discomfort can become intolerable, often accompanied by burning or soreness. About 5% of the US population is estimated to experience this type of discomfort.
Causes of anal irritation can stem from:
- Anal perspiration
- Intestinal parasites
- Frequent liquid stools
- Residual stool deposits
- Fecal incontinence leaving small amounts of fecal matter
- Yeast/Candida or fungal infection
- Psoriasis in the anal area
- Allergic reaction to sanitary wipes or soaps
- Hemorrhoids that prevent thorough cleaning after bowel movement
Other less common problems contributing to anal itching include pinworms, tears of the anal skin near the mucocutaneous junction (region of body where mucosa transitions to skin such as a fissure), or skin tags (abnormal local growth on anal skin). Sometimes the initial cause has passed but an itch-scratch-itch cycle has ensued to that scratching the itch releases inflammatory chemicals which intensifies itchiness.
People should see a doctor if itching has lasted for more than a few days. The following symptoms are cause for particular concern among those suffering from anal itching:
- Pus draining from the anus or around it
- Bloody diarrhea
- Bulging or protruding hemorrhoids
- Perianal (area around anus) skin soiled with fecal material
- Dull or thickened perianal skin
Our specialists perform a physical exam and discuss medical history. The exam is focused on the appearance of the anus and perianal skins, specifically dullness or thickness, signs of irritation, hemorrhoids, lesions, fistulas, or pinworms. If there are visible abnormalities, a scraping of the perianal skin may be taken to rule out fungal infection. If pinworms are suspected, eggs can be collected from the anal region with sticky tape to confirm diagnosis. The anus may also be examined with a short, rigid tube or anoscopy.
Treatment begins by reducing irritation and trauma to the anal area. Cleaning and drying the infected area after each bowel movement and at night is a starting point while avoiding soap and premoistened wipes. In some cases, especially when the snowball effect has occurred, pruritus ani can be treated by simply keeping the area clean with water and patting it dry whenever the urge to itch is felt. If the urge to scratch continues, our doctors may recommend applying a topical steroid cream with antibiotic and antifungal properties or injecting methylene blue.
Trials have shown that capsaicin cream may relieve itching. This medication is used to treat minor muscle and joint aches. The drug works by decreasing a natural substance in the body that helps pass pain signals to the brain.
Drugs are prescribed for parasitic infections such as pinworms, and creams can be applied for fungal or yeast infections. If itchiness is secondary to another condition like an infection or psoriasis, these are directly treated.