Itchy anus

The main symptom of an itchy anus is an intensely itchy bottom that you’re desperate to scratch. It may get worse at night or after you’ve opened your bowels. Scratching makes the itch worse and can cause a skin infection, so it’s important to resist.

An itchy anus is a very common condition and can happen to anyone at any age.

In most cases, an itchy anus lasts a short time and clears up on its own without treatment.

An itchy anus that’s severe — lasts more than a few days or keeps coming back — could be a sign of an underlying medical condition and can cause anal pain.

An itchy anus is common, however it isn't known exactly how many people have it at any one time. It has been suggested that one to five people in every 100 have an itchy anus. It is more common in men than women and while it can affect anyone at any age, including children, it most often affects people aged 40-60.

Different conditions can cause an itchy anus. If a cause is identified, an itchy anus is medically called secondary pruritus ani. If a cause is not identified, it is medically called idiopathic pruritus ani. 

Many things can irritate the skin around your bottom (perianal area) and trigger an itchy anus. These include:

• Anxiety or stress
• Irritation from contact with wool or heat
• Leaking urine (urinary incontinence)
• Sensitivity to perfumes and dyes used in soaps, toilet paper and wipes
• Sweating a lot
• Your stools being in contact with your perianal area — either due to not washing or drying your perianal area thoroughly or due to bowel incontinence

An itchy anus can also be a symptom of these common conditions:

• Anal fissures — small, painful tears in the skin around your anus
• Diarrhoea or bowel incontinence — leaking watery stools or passing stools without control
• Infections — other symptoms of infection may include discharge, irritated and/or lumpy skin, soreness and swelling; infections include: 
• Herpes — a sexually transmitted infection (STI) caused by a virus
• Scabies — caused by tiny mites burrowing into the skin
• Thrush — a fungal infection which is more common in those with diabetes; fungal infections thrive in airless, moist, warm areas 
• Warts — small, rough growths on your skin
• Itchy piles (haemorrhoids) — other symptoms include small lumps around your anus, pain and bright red blood when you pass a stool
• Skin conditions — these will usually cause itching on other parts of your body too and are responsible for half of all cases of secondary pruritus ani; they include:  
• Eczema
• Lichen planus
• Lichen sclerosus
• Dermatitis — this includes: 
• Allergic or irritant contact dermatitis which can be caused by cleaning your perianal area too much or not cleaning it properly, excess sweat or moisture around your anus, ingredients in certain creams, ointments, perfumes or soaps, or dyes in toilet tissue; having a hairy bottom may put you at greater risk
• Seborrhoeic dermatitis
• Psoriasis
• Threadworms — four in 10 children have threadworms at some point; threadworms live in the gut and lay eggs around the anus that causes itching; they can be passed to others in the household and symptoms include:
• Itchiness that worsens at night
• Threadworms in the stools — these look like small pieces of thread

There are other less common conditions that can cause an itchy anus. They usually make you feel unwell and cause other symptoms too. These include:

• Certain cancers eg anal cancer, bowel cancer, lymphoma or rectal cancer — these are rare causes of an itchy anus
• Certain liver diseases
• Diabetes
• Iron deficiency anaemia 
• Thyroid gland problems

Certain foods and drinks can cause an itchy anus if they aren't digested properly. These include:

• Beer in large amounts
• Caffeine eg in coffee, cola or tea
• Chillies and spices
• Fruits — specifically citrus fruits and grapes
• Milk
• Tomatoes

Some medications can also cause an itchy anus. These include: 

• Certain antibiotics that cause diarrhoea as a side effect — diarrhoea can irritate the skin around your anus, causing itchiness
• Certain gels and ointments for treating anal fissures
• Colchicine — used to treat gout
• Long-term use of medications that weaken your immune system eg steroids — these increase your risk of skin infections, which can affect the skin around your anus
• Long-term use of peppermint oil — used to treat bloating and wind
• Medications applied to the skin around your anus eg to treat haemorrhoids — they can cause contact dermatitis 

Scratching an itch irritates the skin and makes it more itchy. This can trigger a vicious cycle. Other factors can contribute to this cycle. You may clean an itchy anus with a scented soap, which contains an ingredient that irritates your skin and worsens your itch. You may consequently clean your anus more with the same soap, triggering a vicious cycle.

See your GP if: 

• You are worried or you can't sleep well because of your itch
• You have itching elsewhere on your body
• Your bottom seems infected
• Your itch has lasted more than a few days
• Your itch is severe 
• Your itch keeps recurring

They’ll examine your bottom and ask about your medical history and everyday habits.

If they’re not sure what’s causing your itchy anus, they may refer you for an internal examination of your bottom, such as a colonoscopy.

See your GP urgently if you’re bleeding from your bottom, have bloody diarrhoea or a discharge of pus, as well as an itchy anus.

In most cases, you won’t need medical treatment for an itchy anus. Things you can do to treat and prevent an itchy anus include:

• Avoiding excessive sweating — if you do sweat a lot, place a cotton tissue in your underwear to absorb the sweat
• Gently cleaning the area with warm water and drying it carefully with non-coloured, plain toilet tissue after passing a stool and before going to bed — if you are not at home, try using a wet wipe and then patting dry with tissue 
• Having cooler, shorter baths or showers daily — aim for under 20 minutes
• Keeping the area cool by wearing loose-fitting, cotton underwear that you change daily as well as loose, cotton clothing — avoid bedding and clothing that makes you overheat
• Keeping your stools firm and regular by eating a fibre-rich diet — foods rich in fibre include fruits, vegetables, and wholegrain bread, cereal and pasta 

Make sure you do not: 

• Eat spicy foods, or drink lots of alcohol or caffeine 
• Scratch —  to reduce your risk of scratching, keep your fingernails short and wear cotton gloves at night
• Strain when passing a stool or urinating
• Use perfumes or powders near your anus
• Use scented bath oil, bubble bath, creams or soaps 
• Wipe your bottom after passing a stool — wash it with warm water and pat dry instead; do not put your underwear back on until the area is dry

If these don’t work, your GP may recommend:

• Antihistamine tablets to relieve symptoms so you don’t scratch at night
• Medication to treat the underlying problem, such as treatment for itchy piles or a fungal infection
• Mild corticosteroid creams to reduce swelling

If you are using creams or ointments to treat your itchy anus, don't use more than one cream or ointment at the same time. Also, don't use any cream or ointment for more than a week as they can irritate your skin, which can cause itchiness.

If the cause of your itchy anus is known, it is easier to identify the most appropriate treatment and relieve your symptoms. Most people respond well to treatment. However, some people can develop a persistent problem with the itchiness recurring.