Why Hemorrhoids Itch and What to Do About It

Hemorrhoids often itch when swollen veins in the anus or rectum trigger inflammation. Inflammation, in turn, stimulates the release of a chemical called histamine that causes itching of the anus (pruritus ani). Scratching can make things worse by causing even more inflammation.

Fortunately, there are things you can do to alleviate the itch of a hemorrhoid, including hydrocortisone creams, a sitz bath, topical anesthetics, and improved anal hygiene.

This article discusses why hemorrhoids cause itching and what you can do about it. It also looks at other causes of anal itching.

Why Do Hemorrhoids Itch?

Pruritus ani is common with internal or external hemorrhoids. It is a complex sensory reaction involving the immune system and other biological and physical factors.

Inflammation

Hemorrhoids cause inflammation mediated by a hormone-like substance called prostaglandin. While prostaglandins do not cause itching, they can cause immune cells within the skin, called mast cells, to break open.

Mast cells contain chemicals known as histamine. These are the same chemicals that cause allergy symptoms in other parts of the body. When histamine is released in tissues, itching can develop and get worse the more that you scratch or rub. This includes wiping with toilet paper.

Local nerves in the skin can also become overly stimulated with repetitive rubbing or scratching.

Passing Stools and Moisture

Studies have shown hemorrhoid symptoms generally improve after stool (feces) has been cleaned from anal tissues. This suggests that stool is an irritant that causes itching.

Passing stools can also cause inflammation and irritation as they scrape past hemorrhoids during bowel movements. This is especially true if the person has constipation. Diarrhea can also irritate the skin, particularly if the skin is not thoroughly washed after a bowel movement.

Mucus leakage is also a common symptom of hemorrhoids. Because mucus is so thick, it can trap moisture in skin folds in the anus, causing moisture-related skin damage (maceration) and inflammation. Excessive sweating can do the same.

On the flip side, overzealous washing strips away body oils, causing skin dryness, irritation, and itching.

How to Stop Hemorrhoids From Itching

There are several ways to relieve hemorrhoidal itching as part of an overall treatment plan. These include:

• Good hygiene: After a bowel movement, gently clean with a wet cloth or an unscented baby wipe. Do not rub aggressively. You might also consider using a bidet. After cleansing, pat dry.
• Avoid fragranced soaps: Scented or dyed soaps, bath bombs, shower gels, baby wipes, and skin lotions can irritate the skin and should be avoided.
• Hydrocortisone: This is a low-potency steroid cream that relieves inflammation and helps shrink hemorrhoids. These are available over-the-counter in potencies of 1% to 2.5%.
• Oral pain relievers: Over-the-counter painkillers like Tylenol (acetaminophen), and Advil (ibuprofen) can provide short-term relief of anal itching and pain.
• Numbing creams: These include over-the-counter anesthetics like lidocaine, xylocaine, dibucaine, and benzocaine.
• Sitz bath: This involves soaking the buttocks in a plastic tub or sitting in a bathtub filled with a few inches of water. Regular 20-minute sitz baths can help relieve itching and irritation. Dab the skin dry afterward with a soft towel.
• Stool softeners: These over-the-counter products reduce irritation caused by passing stools. Also known as emollient laxatives. they contain the active ingredient docusate sodium.
• Witch hazel: This is a liquid distilled from the leaves, bark, and twigs of the witch hazel plant. It has astringent and anti-inflammatory properties that can help soothe hemorrhoids.
• Zinc oxide: This a medicated cream, ointment, or paste sold over the counter that may help relieve skin irritation,
• Aloe vera: Aloe vera gel or cream is soothing and can be helpful if there is skin dryness or irritation.
  

Treat the Hemorrhoids

It is equally important to get to the root of the problem and treat the hemorrhoids themselves. This may include medications, specialist procedures, and surgeries like:

• Hemorrhoid creams or suppositories: These topical medications contain ingredients like phenylephrine (a vasoconstrictor that helps shrink blood vessels) and pramoxine (an anesthetic that helps ease anal pain and itch).
• Rubber band ligation: This involves the placement of a tiny rubber band around the base of a hemorrhoid to cut off the blood flow, causing it to wither and fall off within a week.
• Sclerotherapy: This is a chemical injection of a solution (called a sclerosing agent) into the hemorrhoid. The solution irritates the vein, causing it to harden and collapse.
• Coagulation: This specialist procedure uses heat, lasers, or infrared light to harden and shrink bleeding hemorrhoids.
• Hemorrhoidectomy: This is the surgical removal of a hemorrhoid. Depending on the size and severity of the hemorrhoid, it may be done with local anesthesia, a spinal block, or general anesthesia.

Other Causes of Anal Itching

Hemorrhoids are only one of many causes of anal itching, some of which may be serious. This is why it is important to see a healthcare provider if symptoms are persistent, severe, or worsening.

Anal Fissures

An anal fissure is a tear in the lining of the anus often caused by a hard bowel movement. It may cause symptoms such as pain or itching. If left untreated, an anal fissure can lead to a bacterial infection which can spread to the bloodstream and become serious.

Fungal Infections

Anal itching can be caused by a fungal infection such as a yeast infection. Itch from an anal fungal infection may be helped by practicing good hygiene and wearing loose, breathable clothing.

Prescription antifungal medications may also help. Over-the-counter antifungal creams are not recommended for anal yeast infections.

Viral Infections

Anal warts are caused by the human papillomavirus (HPV), a common sexually transmitted infection. The warts start as small growths and can grow larger. Anal warts can cause symptoms such as itching, bleeding, mucus discharge, and feeling like there is a lump in the rectum.

Genital herpes can affect the anal region as well as the genitals. It is caused by the herpes simplex virus. Anal itching is often followed by the outbreak of painful blisters and sores.

Proctitis

Proctitis is inflammation of the rectal lining that can occur with:

• Inflammatory bowel disease (IBD)
• Radiation therapy
• Bacterial infections, including sexually transmitted infections
• Injury to the anus or rectum
• Side effects of certain medications
• Lack of blood flow to the rectum

Psoriasis

Psoriasis is a chronic inflammatory skin disease that causes symptoms such as itching. It can occur in the genital and anal areas. In addition to itching, it can cause cracking, scaly, and bleeding skin on the buttocks and anus.

Parasites

Pinworms are small parasites that can live in the colon and rectum. They are more common in children than adults. Many people have no symptoms, but, for some, they can cause intense itching that interferes with sleep.

Scabies is a skin condition caused by tiny mites that burrow into the outer layers of the skin. It can also cause intense itching.

Food Sensitivities

Food sensitivities can also cause anal itching in some people. Some of the more common culprits begin with the letter "C," including:

• Cola
• Coffee
• Chocolate
• Citrus
• Calcium (in calcium-fortified food)
  

Anal Cancer

While a less common cause of anal itching, anal cancer should be explored as a possible cause of your symptoms.

Anal cancer is a rare cancer associated with HPV. Signs include bleeding from the anus or rectum. There may also be a lump near the anus that can be easily mistaken for a hemorrhoid. Itching and anal discharge are common.

Summary

Hemorrhoids can cause itching due to inflammation, poor anal hygiene, excess moisture, or excessive anal cleaning. Scratching or rubbing can make the itching worse.

Keeping the area clean and dry can help soothe itch and irritation. Hydrocortisone cream, oral painkillers, sitz baths, and stool softeners are just some of the ways that help ease anal itching from hemorrhoids.