Causes of Anal Itching

Itching of the skin, also called pruritus, is a common problem experienced by many people. The itching may or may not come along with a rash, which can be limited to small areas of skin or can occur over the entire body. When a rash does occur, it can be a clue as to the cause of the itching. Itching can be a minor nuisance or can be a major disruption and severely impact a person’s quality of life. When the itching involves the area around the anus, it’s referred to pruritus ani, and can be an embarrassing problem.

Doctor reviewing medical record with patient examination room
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Pruritus ani can affect up to 5% of people and is more common in men between 40 to 60 years of age. There are many causes of pruritus ani, the majority of which can be linked to a certain medical problem, such as hemorrhoids or anal fissures. Other common causes include irritation from fecal material, infections, contact dermatitis, reactions to food and clothing, medication side effects, colorectal and anal cancer, dermatologic conditions, as well as other medical and psychological conditions. The treatment of pruritus ani depends on the cause of the symptoms.

Fecal Contamination

The skin coming into contact with fecal material, either in large or small amounts, is a common cause of pruritus ani. This may be as a result of direct irritation of the skin, or possibly as an allergic cause. People with frequent bowel movements, loose stools, and those consuming large amounts of coffee (which lowers the anal sphincter's muscle tone) may be at increased risk for fecal contamination as a cause of pruritus ani. Increasing stool consistency, such as by decreasing coffee intake, increasing bulk-forming agents, and taking medications such as loperamide (to decrease diarrhea) may improve symptoms.


Infections of the peri-anal skin may also cause pruritus ani. These include pinworms (Enterobius vermicularis), fungal and yeast infections (such as with Candida albicans), and bacterial infections (such as with Streptococci and Staphylococci). Scotch tape tests are useful for diagnosing pinworm infection, and cultures are helpful for the diagnosis of fungal and bacterial infections. Treatment depends on the type of infection that is found.

Contact Dermatitis

Contact dermatitis of the anal region can also result in pruritus ani. Causes include toilet paper dye and fragrances, cleansing wipes, soaps, laundry detergents, and any topical medications placed in the region in an attempt for symptom relief. Patch testing may be useful in diagnosing contact dermatitis, and treatment with topical steroids, especially those in an ointment form, can be helpful.

Foods and Medicines

Various foods are known to cause or worsen symptoms of pruritus ani, especially when those foods increase the amount of stool frequency or result in loose stools. Examples of these foods include caffeinated beverages (especially coffee and tea), alcohol, chocolate, tomato products, and—less likely—dairy products, nuts, spices, citrus, spicy foods, prunes, and figs. Most of these reactions are not from an allergic cause, as other symptoms would be expected from food allergies, especially skin symptoms such as hives and itching over the entire body. A trial of eliminating the above foods from your diet for two weeks may be helpful to reduce symptoms of pruritus ani.

Certain medications can cause pruritus ani, including laxatives, colchicine, peppermint oil, and various antibiotics. These medications cause pruritus ani, not through an allergic cause, but more likely as a result of direct irritation or as a result of loose stool consistency and increased bowel movement frequency.

Colorectal Diseases and Dermatological Conditions

Underlying medical problems of the colorectal and anal area, such as hemorrhoids, can worsen pruritus ani. Other more serious causes of pruritus ani include anal and colorectal cancers. Various skin disorders can cause pruritus ani; these include psoriasis, lichen sclerosis, and different forms of skin cancer. These conditions are often diagnosed with the help of a skin biopsy.

Miscellaneous Causes

Some people with pruritus ani may be suffering from an internal medical condition, such as diabetes mellitus, liver disease, kidney disease, leukemia, lymphoma, iron deficiency anemia, and hyperthyroidism. Psychological factors can also cause pruritus ani, such as anxiety and stress. Treating these underlying medical and psychological problems may help your symptoms improve.

Given the wide range of causes of pruritus ani, including some that can be dangerous, it's best to seek the advice of a healthcare professional rather than to attempt to treat this condition yourself.

Frequently Asked Questions

  • What causes anal itching at night?

    Hemorrhoids, anal fissures, anal fistula, sweat, pinworms, and certain food items like coffee, beer, carbonated drinks, and dairy products can cause anal itching at night. Additionally, cleaning the anal area using a scented soap or lotion can sometimes cause irritation and lead to itching. If you are unsure of where to start, a doctor can help identify the cause of itching so that it can be treated.

  • Is there treatment for pruritus ani?

    Yes, there is treatment for pruritus ani. However, since there are many causes of it, specific treatment can vary. Until you identify the cause, there are a few itch-relieving measures that can be followed:

    • Eat a healthy number of foods with fiber, like fruits, vegetables, and whole grain bread.
    • After using the toilet, gently wash and dry the anus.
    • Take cool, short showers no longer than 20 minutes and avoid scented soaps.
    • Avoid scratching the itch.
    • When going to sleep, avoid overheating by wearing loose-fitting clothes and light bedding - sweat can amplify itchiness.

    If these home care remedies are followed and itchiness persists, it may be time to contact a healthcare provider. Try not to be embarrassed by it - doctors help people with issues like pruritus ani all of the time.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Tivoli YA, Rubenstein RM. Pruritus: an updated look at an old problem. J Clin Aesthet Dermatol. 2009;2(7):30-6.

  2. Song SG, Kim SH. Pruritus ani. J Korean Soc Coloproctol. 2011;27(2):54-7. doi:10.3393/jksc.2011.27.2.54

  3. Ansari P. Pruritus ani. Clin Colon Rectal Surg. 2016;29(1):38-42. doi:10.1055/s-0035-1570391

  4. Hadasik K, Bergler-czop B, Miziołek B, Salwowska N, Skrzypek-salamon A. Pruritus ani and perianal eczema as a manifestation of systemic contact dermatitis. Postepy Dermatol Alergol. 2017;34(2):174-176. doi:10.5114/ada.2017.67085

  5. Siddiqi S, Vijay V, Ward M, Mahendran R, Warren S. Pruritus ani. Ann R Coll Surg Engl. 2008;90(6):457-63. doi:10.1308/003588408X317940

  6. American Society of Colon & Rectal Surgeons (ASCRS). Pruritus Ani.

  7. National Health Service. Itchy Bottom.

By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.