Anal Itching

June 12th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

It sooner or later happens to all of us. That’s right, an intense itching sensation of the anus. It can be maddening, especially if you are in public place. And nobody is going to want to scratch it for you! What causes this annoying sensation?

What is Anal Itching?

Doctors refer to anal itching as anal pruritus. Most of the time, it is caused by fecal soiling of the anus. For one reason or the other, fecal matter somehow leaks out and soils the anus leading to irritation.

What Causes Anal Itching?

Anal itching or pruritus can be related to a variety of factors including:

  • Hemorrhoids
  • Anal fissures
  • Skin problems like psoriasis
  • Lactose intolerance or other dietary problems
  • Anal sphincter function problems
  • Anal or rectal cancers (especially if noted with a change in bowel habits or other symptoms like weight loss or fatigue)
  • Infections, sexually transmitted diseases

As you can see, most of the causes lead to fecal soiling. For example, in lactose intolerance you have problems with diarrhea and flatulence. This can lead to the leaking of fecal matter and soiling. In other cases, the anal anatomy can be altered which can lead to soiling, such as in the case of symptomatic hemorrhoids and anal fissures.

How is Anal Itching Treated?

First of all the underlying problem should be diagnosed. This requires a visit to your doctor for a complete interview and exam. Anything suspicious can be biopsied. If there are any other signs or symptoms, such as bleeding, a colonoscopy might be ordered.

Treatment of the underlying cause comes first. For symptom control, it is important to know that excessive cleaning and wiping makes things worse since this irritates the anal area. After a bowel movement, you should clean yourself very gently with a moistened cloth or baby wipes. You can even try sitz baths after bowel movements.

In sitz baths, you simply soak your buttocks and anal area in warm water for about 10 to 15 minutes. Then you pat yourself dry gently. You can even dry yourself with a blow dryer.

Other treatments can include steroid creams to reduce inflammation. It is important not to use these creams for more than two weeks because this can cause the skin to become thin and damaged. Talcum powder with no added medications can be used to keep the area dry.

For particularly resistant cases that do not respond to other treatment, the injection of methylene blue has been tried. This kills the nerve endings, so it is only used in very difficult cases that cause a lot of discomfort. Side effect to this treatment can be urinary retention and fecal incontinence. Finally, anal area numbness is usually a permanent side effect of methylene blue injection.

Others practitioners have tried the use of a special capsaicin cream preparation to treat anal itching.


Anal itching is a very common problem. In most cases, the cause is not serious and treatment can be conservative. If symptoms persist or reoccur, then more serious disease should be considered. Finally, there are many options to treating anal itching.

Take a look around The H Doctor website. Here you will find the most current information about hemorrhoid treatment and other digestive health topics.

Make every day count.


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