Pruritus Ani

What is pruritus ani?

Itching around the anal area, called pruritus ani, is a common condition. An irresistible urge to scratch results. It may be most noticeable and bothersome at night or after bowel movements.

What causes this to happen?

Several factors may be at fault. A common cause is excessive cleaning of the anal area. Moisture around the anus, from excessive sweating or from moist, sticky stools, is another possible cause. In some people, a loose and/or irritating stool may be caused by a high intake of liquids.

In addition, drinking certain beverages, including some alcoholic beverages - especially beer - milk, citrus fruit juices and drinks containing caffeine, such as coffee, tea and cola, may be aggravating for some people. Similarly, some foods that may be a problem include chocolate, fruits, tomatoes, nuts and popcorn. Other rare causes of pruritus ani may include pinworms, psoriasis, eczema, dermatitis, hemorrhoids, anal fissures, anal infections and allergies.

Does pruritus ani result from lack of cleanliness?

Cleanliness is almost never a factor. However, the natural tendency once a person develops this itching is to wash the area vigorously and frequently with soap and a washcloth. This almost always makes the problem worse by damaging the skin and washing away protective natural oils.

What can be done to make this itching go away?

A careful examination by a colon and rectal surgeon or other physician may identify a definite cause for the itching. Your physician can recommend treatment to eliminate the specific problem. Treatment of pruritus ani may include these four points.

1. Avoid further trauma to the affected area:
   • Do not use soap of any kind on the anal area.
   • Do not scrub the anal area with anything - even toilet paper.
   • For hygiene, use wet toilet paper, baby wipes or a wet washcloth to blot the area clean. Never rub.
   • Try not to scratch the itchy area. Scratching produces more damage, which in turn makes the itching worse.
2. Avoid moisture in the anal area:
   • Apply either a few wisps of cotton, a 4 x 4 gauze or some cornstarch powder to keep the area dry.
   • Avoid all medicated, perfumed and deodorant powders.
3. Use only medications prescribed by your physician and use them only as directed. Apply prescription medications sparingly to the skin around the anal area and avoid rubbing.
4. Avoid excess fluids and the foods previously mentioned. In most instances, a maximum of six glasses of fluid daily is reasonable. There is not usually any health benefit to drinking more fluid than this in the course of a day.

How long does this treatment usually take?

Most people experience some relief from itching within a week. Complete cure usually comes within four to six weeks. A follow up appointment with your colon and rectal surgeon may be recommended to prevent recurrence of pruritus ani.

© American Society of Colon and Rectal Surgeons