Itchy anus (pruritus ani)

An itchy anus (bottom), also known as pruritus ani, is characterised by a constant urge to scratch your anus. An itchy anus can be an embarrassing and uncomfortable problem.

If you have an itchy anus, your scratching may trigger an 'itch-scratch-itch' cycle. This is when you feel itchy, so you scratch to make it feel better. Scratching can cause more irritation, which creates a cycle of itching and scratching.

There are many treatments that can help relieve your symptoms, including lifestyle changes and using a low-strength steroid cream.

The symptoms of an itchy anus will depend on how long the itch has lasted and what is causing it.

The most common symptom of pruritus ani is red, itchy skin around your anus.

If your itch is chronic (long-term), symptoms may include thickened skin and small breaks around your anus.

If itchy anus is caused by threadworms, your itch may be worse at night. You might be able to see small white worms in the area.

There are many possible causes of an itchy anus.

Sometimes your diet or lifestyle can cause an itchy anus. This may be due to:

• certain food intolerances
• eating some foods such as tomatoes, spices and citrus fruits
• drinking caffeine or alcohol
• over-cleaning or scrubbing your anal area, especially with soap
• having leakage of poo (stool) due to diarrhoea, constipation or laxative use

Sometimes an itchy anus is caused by an underlying medical condition, such as:

• skin conditions including eczema, psoriasis and contact dermatitis
• sexually transmitted infections (STIs) including genital herpes, syphilis or chlamydia
• conditions affecting your anus including haemorrhoids, abscesses or anal fissures
• infections including bacterial infection, tinea or threadworm
• diabetes
• underactive thyroid

Some strong antibiotics can disrupt your bowel health, which can also cause itching around the anus.

You should see your doctor if:

• you have anal bleeding
• the area around your anus seems infected
• you have an itch that doesn't go away
• you have blood in your stool (poo)
• you notice a change in your bowel habits
• you notice a change in the skin around your anus

Your doctor can diagnose pruritus ani. Your doctor will do a physical examination and may recommend further tests, including:

• biopsy (a small sample of tissue is taken and tested) — this is to check for cancer
• blood test — this is to check for diabetes
• allergy testing — this is to check if your itch is due to an allergic reaction

To help confirm the cause of your itchy anus, your doctor may refer you to a specialist such as a:

• dermatologist (skin specialist)
• colorectal surgeon (bowel and rectum specialist)

If your itchy anus is caused by a medical condition, your treatment will focus on managing that condition. Lifestyle changes can also help with your symptoms.

Avoid scratching

• Repeatedly scratching and rubbing can cause the skin around your anus to thicken. This makes the itchiness worse.
• Try and break the itch-scratch-itch cycle, so your skin can start to heal. Ask your doctor or pharmacist for advice on how to do this.

Diet

• A high fibre diet may be helpful if loose stool is causing your itchy anus.
• It may help to avoid caffeine, alcohol, tomatoes, spices and citrus fruit. Ask a dietitian for advice on which foods are right for you.

Clothing

• Wear loose clothing made from natural fibres, such as cotton.
• Avoid wearing nylon underwear.

Personal hygiene

• Avoid harsh wiping or rubbing after going to the toilet. Some people find that wiping with cotton balls dipped in warm water is more comfortable than using toilet paper.
• Keep showers short and not too hot. Some people find a quick shower after going to the toilet is helpful.
• Choose sensitive skin care products, such as perfume-free creams and toilet paper.
• Try using soap substitutes. Ask your pharmacist for a recommendation.

Medicines

• Your doctor may prescribe a low-strength steroid cream to help reduce itchiness.
• If threadworms are causing your itchy anus, your doctor will recommend over-the-counter medicines from your pharmacy. Your whole family will need to be treated.

If your itchy anus becomes chronic (long-term), this may cause:

• thickened skin around your anus
• breaks in your anal skin that can lead to infections

Early diagnosis and treatment of an itchy anus can help reduce your risk of complications.

You can't always prevent an itchy anus. Here are some tips on how to reduce your chance of having an itchy anus:

• Avoid scratching the anal area.
• Eat a high-fibre diet.
• Avoid foods that you are intolerant to.
• Wear loose, cotton clothing.
• Use perfume-free products and soap substitutes.

Read about itchy anus (Opens in new tab) on The Australasian College of Dermatologists (Opens in new tab) page.

Learn more about the ingredients in personal care and other cosmetic products (Opens in new tab) on the Australian Industrial Chemicals Introduction Scheme (Opens in new tab) (AICIS) page.

The healthdirect website offers more information about conditions that can cause itchy anus, including:

• haemorrhoids
• anal fissures
• abscesses
• diarrhoea

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.