Learn the top 5 causes of (and remedies for) one of the most intense and distressing symptoms that people are afraid to talk to their doctor about.
A family member of mine recently came to me in great desperation. “I’m so embarrassed to ask you this, but I’ll go bonkers if I don’t figure this out,” she said. After reassuring her that it would just stay between us (and thousands of QDT listeners – no worries, I asked her if it would be okay first), she finally disclosed that she’s been experiencing the most intense itching in her anus. It’s so bad that she can’t sleep at nighttime, when it seems to be the worst.
“I’ve been too embarrassed to ask my own doctor, can you help me?” she pleaded.
Believe it or not, I hear this complaint from patients regularly. Many patients live with this intense discomfort for many years, enduring the distress in shame. It’s one of those common health problems that people seem to be most afraid to talk to their doctor about. But there’s no need to be shy or embarrassed to ask your doctor—that’s what we’re here for!
Since so many patients are reluctant to talk about it, I thought I’d devote this episode to pruritis ani, the fancy medical term used to describe itching in and around the anus.
5 Top Causes of Anal Itching
In order to help alleviate the itching, we first need to figure out what is causing it. An exam can help your doctor determine the cause of the itching.
Here are 5 of the most common causes:
Feces: Insufficient wiping or cleansing after a bowel movement can leave remaining feces that acts as an irritant to the surrounding skin. There is also a muscle surrounding the anus called the “anal sphincter” that tends to be weaker in some people, leading to fecal soiling. Wiping thoroughly, using baby wipes, showering after a bowel movement, or even using a bidet if you are lucky enough to have one in the home, are some of the ways to combat this. After cleansing, application of talcum powder will help absorb any escaping feces.
Hemorrhoids: Hemorrhoids are protrusion of the blood vessels in the anus due to pressure. This pressure could be caused by pregnancy or heavy lifting, but is most commonly due to constipation. Anyone can get them at any age. And they can itch. The best treatment is prevention – keep your stool as soft as toothpaste by ingesting lots of fiber and fluids daily. If there’s itching, you can use an over-the-counter or prescription hemorrhoid creams that contain hydrocortisone, a mild steroid to help calm temporary itching due to hemorrhoids. But be careful not to overdo it on the steroid creams, as they can cause thinning of the skin if used excessively or long term.
Fissure: Fissures are small cuts in the lining of the anus that are also caused by constipation. They can be painful, especially when having a bowel movement. And they also can itch. Treatment is similar to hemorrhoids – prevent constipation. Your doctor should be able to see this on exam.
Fungus: Factors such as prolonged moisture or sweat and diabetes can predispose some patients to fungal infections of the skin, called “Candida.” With fungus, your doctor will be able to see an area of redness, sometimes even beefy red, around the skin of the anus. Over-the-counter antifungal creams, such as miconazole or clotrimazole, used for up to one month can help alleviate Candida. It’s also important to keep the area as dry as possible and, if you are a diabetic, to control your blood sugars. Make sure to also listen to my previous episode on 10 Things Every Diabetic Should Know.
Pinworms: Pinworms is what almost every patient with anal itching is afraid of having. However, it’s by far the least common. It tends to mostly affect kids. If multiple family members have it, it may be more of a possibility. Stool testing is not always accurate. A simple anti-parasitic prescription medication typically eradicates them, along with washing of all underwear and bedding in the household in hot water.
There are also other possibilities, such as psoriasis, eczema, allergic reactions, and seborrheic dermatitis (a condition of dandruff on the skin that I have previously covered). Anxiety, stress, and scratching can all exacerbate the symptoms.
The Physical Exam – What is the Doctor Going to do?!
Although you might be ashamed to tell your doctor about this, it is very important that you go to your doctor for an exam to determine the cause of the itching. Just so you know what to expect, the doctor will likely have you undress from the waist down, lie on your side on the exam table, and examine the skin around your anus using a light (and gloves). Please do not be embarrassed! This is our job, and we see this kind of thing all the time.
Note: skin cancer can also be a rare cause of anal itching, so please make sure you get examined by your doctor.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Man Scratching His Bottom image courtesy of Shutterstock