What causes anal itching and how to treat it
Anal itching is a common symptom that many people find not only uncomfortable and bothersome, but also embarrassing. Although it is a widespread issue that many individuals experience at some point in their lives, it is often treated as a taboo topic. The causes of anal itching can vary – from poor hygiene and the use of overly aggressive hygiene products to digestive disorders. It can also be triggered by infections, such as gonorrhoea, a common sexually transmitted infection. Have you ever suffered from this symptom and want to learn more? In this article, you will find out what anal itching is, what causes it, and how it can be treated or prevented.
Table of contents
- What is anal itching?
- What additional symptoms occur with pruritus ani?
- What are the causes of itching in the anal area?
- How is anal itching diagnosed?
- How is itching in the anal area treated?
- Summary
What is anal itching?
Anal itching (pruritus ani) describes an unpleasant itch around the anus, ranging from occasional discomfort to persistent irritation. Two main types are distinguished: primary pruritus ani, which occurs without an identifiable cause, and secondary pruritus ani, which is triggered by conditions such as haemorrhoids or infections and accounts for 75% of cases (Siddiqi et al., 2018). Men between the ages of 40 and 70 are particularly often affected (Cleveland Clinic, 2022).
What additional symptoms occur with pruritus ani?
Anal itching is itself a symptom that can manifest in different forms, but it is often accompanied by other symptoms. The severity of the itching and the accompanying symptoms can vary individually and depend on the underlying cause. General symptoms that may occur in the context of anal itching include:
- Severe itching: The itching around the anus may be temporarily relieved by scratching or rubbing.
- Burning sensation: Especially during bowel movements or after prolonged sitting, a burning sensation may occur in the anal area.
- Soreness and redness: The skin around the anus may be sore and visibly red.
- Sensation of moisture: A persistent feeling of wetness or moisture may be present in the anal area.
- Worsening at night: Symptoms often worsen at night and may disrupt sleep.
Source: Mayo Clinic, 2022
What are signs that anal itching may be more serious?
Many people occasionally experience mild anal itching, which usually is not a cause for concern. However, there are situations in which this itching may point to more serious health problems. These include:
- Bleeding: The presence of blood, whether on toilet paper or in underwear.
- Persistent itching: Itching that lasts for several weeks.
- Accompanying symptoms: The appearance of warts or unusual discharge.
- Signs of infection: Redness and swelling in the anal area.
If you suffer from persistent or severe anal itching, especially if you notice any of these symptoms, you should see a doctor to determine the underlying causes (Mayo Clinic, 2022).
What are the causes of itching in the anal area?
Below you will find an overview of the possible causes of anal itching. Read on to find out more details.
1 – Inadequate hygiene
The skin around the anus is very sensitive and prone to irritation. Inadequate hygiene can quickly lead to problems when:
- … the anal area is not properly cleaned after a bowel movement. This can leave irritating stool and sweat residues on the skin that cause itching.
- … the anal area is not properly dried. This can lead to the accumulation of moisture (moisture build-up), which creates an ideal environment for skin irritation and itching.
Proper hygiene means that this area must not only be clean but also dry (MSDManuals, 2023).
2 – Medical conditions
The following medical conditions may contribute to itching in the anal area:
Haemorrhoids
Haemorrhoids are swollen blood vessels in the anal area that can occur internally (inside the rectum) or externally (around the anus). They are often caused by factors such as obesity, pregnancy, digestive issues like constipation or diarrhoea, and straining during bowel movements. More than half of Germans over the age of 30 experience problems with haemorrhoids during their lifetime (AOK, 2022). Typical symptoms include intense itching, burning, and pain in the anal area. A primary goal of treatment is to promote consistently soft stools to minimise pressure on the affected areas (NHS, 2022).
Anal fissures
Anal fissures are small tears in the skin around the anus, often caused by constipation, diarrhoea, haemorrhoids, anal sex, or infections. These tears result in burning and itching in the irritated anal area and may also cause pain and bleeding if more severely damaged. Treatment of anal fissures generally involves measures to regulate stool and keep it soft. In chronic cases, surgical treatment may be necessary (NHS, 2021).
Diabetes mellitus
Although it may not be immediately suspected, systemic diseases—meaning conditions that affect the entire body—such as diabetes mellitus can be associated with anal itching. Diabetes, often referred to as a widespread disease due to its prevalence, is a metabolic disorder in which blood sugar levels remain permanently elevated. Causes of itching often include reduced blood circulation, dry skin, and increased susceptibility to yeast infections.
Want to test your blood sugar levels from home? Try Homed-IQ’s Blood Sugar Test, which shows your average blood sugar (HbA1c) over the past three months and helps you determine whether measures are needed to manage your glucose levels.
3 – Infections
Infections are diseases caused by microorganisms such as bacteria, viruses, fungi, or parasites. These pathogens can lead to inflammation and irritation, which are often accompanied by itching. Below are common infections that are relevant in the context of anal itching:
Sexually transmitted infections (STIs)
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Human papillomavirus (HPV)
HPV is one of the most common viral infections affecting the skin and mucous membranes. Up to 80% of sexually active individuals will become infected with HPV at some point in their lives. There are over 100 types of HPV, which are classified into high-risk and low-risk types. High-risk types can lead to various types of cancer, while low-risk types often cause genital and anal warts that may trigger itching. Additionally, an HPV infection may increase the risk of developing anal fissures, which can further cause itching and pain. To reduce the risk of HPV infection, condom use and vaccination are recommended. Regular testing is essential to avoid unknowingly transmitting the infection (Mayo Clinic, 2021).
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Chlamydia and gonorrhoea
Chlamydia and gonorrhoea are bacterial infections caused by the pathogens Neisseria gonorrhoeae (gonorrhoea) and Chlamydia trachomatis (chlamydia). Both infections can be transmitted through vaginal, oral, and anal sex with an infected partner and can directly affect the anal area. They can also be transmitted without full penetrative sex and even when condoms are used. Both infections can cause anal symptoms such as pain, discharge, bleeding, and itching. These infections often start without noticeable symptoms and can therefore be transmitted unknowingly or cause long-term complications. Regular testing is essential to protect yourself and your sexual partners and to prevent the spread of infection (WHO, 2024; CDC, 2024).
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Herpes simplex virus (HSV)
Herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV). There are two types: HSV-1, which typically causes oral infections, and HSV-2, which primarily causes genital and anal infections. Anal herpes can be transmitted through anal sex with an infected person or through oral-anal contact (rimming) if the partner has cold sores (HSV-1). Although herpes is not curable and the virus remains in the body, antiviral medications can help relieve symptoms and reduce the frequency of outbreaks (WHO, 2023).
Yeast infections
Yeast, particularly Candida, is a common cause of anal itching. These fungi thrive in warm and moist environments. About 75% of women experience a vaginal yeast infection at least once in their lives, which can spread to the anal area. It can also occur in men, although less commonly. These infections often appear after antibiotic use, in cases of uncontrolled diabetes, or due to increased estrogen levels—for example, when taking birth control pills. Careful hygiene can help reduce the risk of infection and relieve itching (Frothingham, 2021).
Pinworms
Pinworm infections are characterised by intense anal itching, mainly caused by the nighttime activity of the worms. These small, white or light-grey parasites live in the intestines and rectum of infected individuals. They lay their eggs near the anus at night, causing severe itching. Infection typically occurs through ingestion of the eggs, which can be transmitted via contaminated hands, food, or surfaces. Without treatment, pinworms do not usually go away on their own and require an oral deworming medication (CDC, 2024).
Get tested regularly
Have you had unprotected sex, experienced occasional itching in the anal area, or simply want an overview of your sexual health? Since many sexually transmitted infections (STIs) initially cause no or only subtle symptoms, regular testing is essential. Unfortunately, many people avoid going to the doctor out of shame, which can lead to infections going undetected and being passed on. Homed-IQ offers a discreet and safe way to test for sexually transmitted infections from the privacy of your own home. All test results are analysed in certified laboratories. Protect yourself and your sexual partners and take your sexual health into your own hands.
4 – Skin conditions
The following skin conditions may cause itching in the anal area. If the itching persists or is accompanied by severe pain, bleeding, or other unusual symptoms, you should consult a doctor.
| Condition | Description |
|---|---|
| Eczema (e.g. contact dermatitis) | Eczema includes skin conditions that cause inflammation and itching. Contact dermatitis is a type of eczema triggered by direct contact with irritating or allergenic substances. The skin may become red, flaky, and extremely itchy, with symptoms worsened by friction and moisture. Treatment usually involves special creams. |
| Psoriasis | Psoriasis is an autoimmune skin condition characterised by excessive production of skin cells. This results in thick, red, scaly plaques that may itch and hurt. Psoriasis has a genetic component and has been found in 5–55% of people with pruritus ani (Siddiqi et al., 2018). |
Sources: NHS, 2023, Mayo Clinic, 2024
5 – Irritating foods
Certain foods can cause anal itching when remnants remain in the stool and irritate the skin, disrupting its natural protective barrier and making it more sensitive. Foods can also trigger digestive problems. Frequent wiping and cleansing, as well as constipation (fewer than three bowel movements per week) and diarrhoea, increase the risk of anal itching by further straining the sensitive skin. Allergens or irritating substances in food can also trigger allergic reactions or skin irritation. Such foods include spicy seasonings, citrus fruits, tomatoes, caffeinated beverages, chocolate, dairy products, and alcoholic drinks (Cleveland Clinic, 2022).
6 – Other irritants
Irritants are substances that can damage the skin and lead to itching and inflammation. The following table provides an overview of common irritants that may cause anal itching. Avoiding these substances may help prevent or relieve symptoms.
| Hygiene products | Medications | Physical irritants |
|---|---|---|
| Scented or coloured toilet paper | Broad-spectrum antibiotics (e.g. tetracyclines, erythromycin) | Tight clothing or underwear (especially synthetic fabrics) |
| Scented and harsh soaps | Some over-the-counter haemorrhoid treatments | Excess moisture in the anal area |
| Bubble baths | Aggressive cleaning/wiping after bowel movements | |
| Genital deodorants | Prolonged sitting | |
| Wet wipes (especially those containing alcohol) | Excessive sweating | |
| Feminine hygiene sprays |
Source: Mayo Clinic, 2022
How is anal itching diagnosed?
Diagnosing anal itching typically involves two key steps:
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Medical history: During a detailed conversation, the doctor will ask about your health and lifestyle habits. Questions like “What type of soap do you use when showering?” or “How often do you have bowel movements?” help to identify potential triggers of the itching.
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Physical examination: In addition, a thorough physical exam of the anal area is conducted to assess skin colour, texture, and any signs such as rashes or lesions that may indicate specific conditions.
If the cause remains unclear, referral to a dermatologist may be necessary. In cases of suspected pinworm infection, a tape test is often performed by placing a piece of adhesive tape near the anus overnight to detect eggs or worms ((McGill, 2024).
How is itching in the anal area treated?
Treatment for anal itching depends on the underlying cause and can therefore vary. However, one of the most important general measures is proper anal hygiene.
What measures help to prevent and reduce anal itching?
The graphic below outlines the most important tips for maintaining healthy anal hygiene.
Source: MedlinePlus, 2023
What medical treatments are used for anal itching?
- Topical treatments: These are medications applied directly to the skin. Examples include hydrocortisone creams, which reduce inflammation and relieve itching, and zinc oxide ointments, which protect the skin and soothe irritation. Antifungal creams are commonly used to treat yeast infections.
- Oral medications: These include antibiotics used to treat bacterial infections such as gonorrhoea and chlamydia, as well as antifungal agents that help treat systemic fungal infections.
- Targeted treatments: These include topical or surgical treatments for warts caused by HPV infections. In the case of pinworm infections, antiparasitic medications are used to kill the parasites.
Source: Cleveland Clinic, 2022
Are there any home remedies that may help?
The effectiveness of these home remedies is not scientifically proven. However, in many cases, they may provide relief.
- Sitz baths in warm water can soothe itching and irritation in the anal area.
- Applying aloe vera gel can calm the skin and relieve itching.
- Coconut oil may help moisturise the skin and reduce irritation.
- Applying cold compresses can ease itching and reduce swelling.
Source: DeineApotheke, 2022
Summary
Anal itching, also known as pruritus ani, is a common and often uncomfortable symptom that may involve intense itching, burning, soreness, and redness of the skin around the anus, as well as a persistent feeling of moisture in the anal area. Causes include haemorrhoids, anal fissures, diabetes, sexually transmitted infections such as HPV, chlamydia, and gonorrhoea, as well as yeast infections and pinworms. Proper hygiene and regular medical check-ups are essential for relieving symptoms and ruling out serious health conditions.
