Anal itching, or itching of the anus, is an annoying complaint. Peri-anal itching is also called pruritis ani. Most people do not go to the doctor if they experience itching in the anus, but try to combat the itching themselves. For many people it is an embarrassing problem that they are ashamed of. Anal itching can have many causes, including skin conditions like psoriasis and eczema, internal diseases like diabetes, excessive sweating, etc. The treatment for anal itching depends on the cause of the problem. With an itchy anus, it is first and foremost important to remove the triggering factors. If desired, the itching can be controlled with ointment or cream. The doctor can prescribe several types of medicines. You can also take a number of measures to combat anal itching, such as wearing loose-fitting and breathable cotton underwear, keeping the anal area clean with warm water and avoiding factors that trigger anal itching.
- Anal itching or itching of the anus
- Triggering factors and occurrence
- Causes of anal itching
- Dry skin
- Excessive perspiration
- Excessive perianal hygiene or wetting
- Fecal incontinence
- Anal itching due to medications
- Excessive use of laxatives
- Insufficient ventilation
- Allergic contact dermatitis
- Skin conditions
- Fungal infections
- Anal fissures and fistulas
- Sexually transmitted infections (STDs)
- Worm infections
- Internal diseases
- Anxiety, stress and depression
- Anal itching due to food
- Consult your GP if you have an itchy anus
- Examination by the GP
- Treating anal itching with ointment and cream
- Treat underlying condition
- Good hygiene
- Home remedies and self-care
- Prognosis of itching of the anus
Anal itching or itching of the anus
Anal itching is itching around the anus – the opening of the rectum or rectum. The itching can be located around the anus or spread, is often intense and may be accompanied by a strong urge to scratch. This can create a vicious circle of itching, burning and scratching, causing traumatic dermatitis (inflammation of the skin) that in turn causes itching. Itchy skin around the anus is also called ‘pruritus ani’.
Anal itching can have many causes, including skin conditions such as psoriasis and eczema, diseases such as diabetes or liver disease, skin tags (marishes), fistulas, worm infections and the use of soaps or disinfectants. Many people experience anal itching from time to time. Don’t be ashamed to talk to your doctor about it. With the right treatment and self-care measures, anal itching can be adequately controlled in most cases.
Heavy alcohol consumption is a risk factor / Source: Istock.com/karelnoppe
Triggering factors and occurrence
An itchy anus is a common problem, but the exact number of people who develop this complaint is unknown in 2023. Some sources suggest that about 1 to 5 in 100 people experience anal itching. It appears to be more common in men than in women. It usually affects people between the ages of 40-60. However, it can affect people of all ages, including children. The incidence of perianal itching in general practice is one per thousand patients per year. Slightly more men than women approach their GP with this complaint. Triggering factors are:
- a sedentary job;
- great psychological tension; and
- heavy alcohol and coffee consumption.
Causes of anal itching
Most cases of anal itching are caused by a harmless problem. However, sometimes anal itching can be a sign of an abnormality or medical condition. Possible causes of anal itching include:
As we age, the skin in and around the anus becomes more sensitive to dryness. Dry skin can lead to persistent, intense itching of the anus.
Moisture around the anus due to excessive sweating. Obese people are more susceptible to this.
Excessive perianal hygiene or wetting
Due to ineffective hygiene, such as cleaning too much with dry and hard toilet paper or wiping the buttocks roughly, or cleaning too little, leaving fecal residue behind. Too much cleaning of the anus with wet wipes, etc. can also cause irritation.
Anal itching can also be caused by frequent diarrhea or the escape of small amounts of stool (fecal incontinence or fecal incontinence).
Anal itching due to medication / Source: Jarmoluk, Pixabay
Anal itching due to medications
Some antibiotics can cause diarrhea. Persistent diarrhea can irritate the anal skin and cause an itchy anus. The use of corticosteroids or other immunosuppressants (drugs that suppress the immune system) weaken the immune system, putting you at increased risk of developing skin infections that can affect the skin around the anus. Other medicines such as colchicine (for gout) and peppermint oil (for flatulence and bloating) can also have anal itching as a side effect. Medicines applied to the skin near the anus to treat problems such as hemorrhoids can irritate the anal skin and cause a form of dermatitis.
Excessive use of laxatives
Excessive or inappropriate use of laxatives can lead to chronic diarrhea and this increases the risk of anal irritation and itching.
Inadequate ventilation due to poorly breathable underwear, plastic chairs and excess weight can also cause anal itching.
Allergic contact dermatitis
Allergic contact dermatitis occurs as a result of an allergic reaction due to hypersensitivity to certain substances in, for example, moist toilet paper.
Common skin problems, such as seborrheic dermatitis and psoriasis, can cause anal itching.
A mariske is a flap of skin around the anus. This harmless phenomenon is believed to be a remnant of a hemorrhoid and can lead to itching complaints, especially when residual fecal matter remains around the flap.
A fungal infection can cause significant itching.
Anal itching can be a symptom of hemorrhoids.
Anal fissures and fistulas
An anal fissure or a small tear in the anus is usually caused by constipation. A perianal fistula is a connection or ‘passage’ between the rectum and the skin. It can arise after an inflammation in an anal fold or anal gland.
Sexually transmitted infections (STDs)
Sexually transmitted infections (STDs) can cause anal itching.
Worms are mainly seen in children and can also cause anal itching.
Internal diseases that may be associated with anal itching include diabetes mellitus, hypothyroidism (a deficiency of thyroid hormones), uremia (blood poisoning due to insufficient kidney function), jaundice (jaundice) and hematological diseases. Often the disease is already known and perianal itching is not the first symptom that occurs in the patient.
Anxiety, stress and depression
Anxiety, stress and depression are known to worsen anal itching. Often the itching will disappear as soon as the depression clears up or the anxiety decreases.
Hot peppers can cause anal itching / Source: Holbox/Shutterstock.com
Anal itching due to food
Some foods can cause anal itching, such as spices and chili peppers. There are also foods that can make anal itching worse, so identifying and avoiding these products can help keep the itching at bay. Examples are:
- spicy food
- citrus fruits, such as oranges
- dairy products
- caffeine in coffee, cola and energy drinks
Tomatoes / Source: Vlad Teodor/Shutterstock.com
- large amounts of milk, beer or wine
Consult your GP if you have an itchy anus
It is wise to consult your doctor if there is severe anal itching, if the symptoms persist or worsen, if there is blood loss and if the cause cannot be determined.
Examination by the GP
It is wise to consult your doctor if there is severe, persistent and/or worsening anal itching, if there is blood loss or if the cause cannot be determined. The GP focuses his examination on detecting an underlying disease or condition. The doctor asks questions about the duration and timing of the itching complaints, about toilet hygiene, about the frequency and consistency of stools, etc. The doctor also examines the perianal region. If the cause of the itching is not clear, additional testing can be performed. Referral is rarely necessary.
Avoid soap for anal itching / Source: Pezibear, Pixabay
Treating anal itching with ointment and cream
The treatment for anal itching depends on the cause of the problem.
Treat underlying condition
First of all, it is important to remove the triggering factors. If there is underlying suffering, the condition or disease will have to be treated adequately.
It is also important to observe good hygiene: preferably use a toilet shower, or alternatively dab with wet wipes that do not contain alcohol or perfume and then dry the skin thoroughly. Do not wear tight trousers or tights, but preferably wear loose-fitting cotton underwear (wash at a minimum of 60 degrees Celsius). Avoid using soap or foam baths. Scratching is strongly discouraged.
The doctor can prescribe an inert remedy for anal itching, such as zinc ointment or cetomacrogol Vaseline cream. If this does not have the desired effect, a 1% hydrocortisone ointment is a good alternative. Other medications that may be prescribed include:
- Antihistamines: If itching is particularly bothersome at night, the doctor may prescribe an antihistamine. Antihistamines can be used for allergic skin conditions where itching is a major complaint.
- Soothing ointments: for example, bismuth subgallate and zinc oxide, which are prescribed for some skin problems such as hemorrhoids.
Medication for anal itching / Source: Stevepb, Pixabay
- Corticosteroids: short-term local drug treatment in the form of a mild corticosteroid (for example hydrocortisone) can help with inflammation of the perianal skin. However, some studies have shown that cleaning and good hygiene as a first step in treatment can be as effective as corticosteroids.
- Local anesthetics: these can temporarily relieve pain and itching; these include benzocaine, benzyl alcohol, lidocaine and pramoxine.
- Vasoconstrictors: These constrict blood vessels and can reduce swelling. They also act as mild anesthetics. These include ephedrine sulfate and epinephrine.
- Astringents: these have an astringent effect on the skin; they constrict the blood vessels and inhibit the secretion of fluid.
- Protective agents: These form a physical barrier between the skin and potential irritants. They include aluminum hydroxide gel, cocoa butter and glycerin.
- Keratolytics: agents that thin and soften the stratum corneum of the skin, allowing medical ointments to penetrate deeper layers.
Home remedies and self-care
Take the following measures to combat anal itching:
- avoid spicy and spicy foods
- clean the anal area after defecating, for example with a toilet shower
- avoid medicated, perfumed or deodorizing soaps
Drink enough fluids every day / Source: Luminast/Shutterstock.com
- only use warm water to clean your anus
- avoid leaving the anal area moist and dry it gently by dabbing, not rubbing
- use drying powders, but not medicinal or scented powders
- avoid scratching, which causes more trauma and makes the problem worse
- Wearing socks or cotton gloves on the hands can reduce the harm of unconscious scratching during sleep
- wear loose-fitting, breathable clothing, avoiding materials such as acrylic and nylon, which trap sweat
- wear clothes made of natural materials, such as cotton or linen
- keep fingernails short
- eating fiber-rich food and drinking enough (both ensure good bowel movements)
Prognosis of itching of the anus
If there is no underlying cause, the outlook is often good. Once the skin has healed, you can expect a full recovery. To prevent you from experiencing an itchy anus again, it is important to prevent triggering factors.
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