Anal Itching (Pruritus ani)

The medical term for anal itching is pruritus ani. Anal itching can be caused by multiple factors, but most often itching is related to excessive moisture at the anal opening and excessive wiping after a bowel movement. Additionally, there are certain skin conditions and infections which may contribute to anal itching. Your surgeon will also evaluate for enlarged hemorrhoids, anal fistula or anal fissures, all of which may contribute to your anal itching or pruritus ani. Certain foods such as caffeine, alcohol, spicy foods or acidic foods may aggravate anal itching. Rarely, allergies may also contribute to pruritus ani.

To relieve anal itching, patients should avoid excess moisture on the skin surrounding the anus. Basic measures include showering daily with a non-fragrant soap and water, patting the skin dry and using dry pads as needed to limit moisture from contacting the skin. Alcohol- based wipes should be avoided, and excessive wiping after bowel movements is not beneficial. Both of these will dry the skin and cause microabrasions. These microabrasions and dry skin cause itching that leads to scratching, which further escalates the symptoms. A barrier ointment such as zinc oxide or calmoseptine may provide some relief from anal itching. Regulating bowel movement frequency and consistency is important for patients with anal itching. Taking an over-the-counter fiber supplement (e.g. Metamucil) on a regular, daily basis poses little risk to patients and often improves symptoms dramatically.

After evaluation by your physician, specific topical ointments or creams may be prescribed to help relieve the underlying condition that is causing your anal itching. In general, prolonged use of over-the-counter ointments should be avoided, particularly if they contain a steroid or other anti-inflammatory, as these agents may weaken the skin and actually worsen the pruritus ani or itching symptoms. Additional effective measures are to minimize wiping and using a soft, nonabrasive toilet paper. On occasion, surgical intervention of the underlying condition may be indicated; this will be discussed with you by your treating surgeon.

Washington University Colorectal can provide care and treatment options for anal itching. Meet our specialists below. 

Kerri Ohman, MD

Paul Wise, MD

Steven Hunt, MD

Matthew Silviera, MD

Matthew Mutch, MD

Radhika Smith, MD