Pruritus ani

What are the aims of this leaflet?

This leaflet has been written to help explain more about pruritus ani in adults. It will tell you what it is, what causes it, what can be done about it, and where you can find more information.

What is pruritus ani?

The term ‘pruritus’’ (itching) ani (anus)’ means itching and/or burning around the opening of the anus (back passage). Pruritus ani refers to the symptom of itching around the anus and there are many possible causes.

Pruritus ani is common, affecting up to 1 in 20 people, and occurs more often in men than women. People of any age can be affected, but it is more common in those aged 40-60 years. People affected by pruritus ani are usually otherwise well.

What causes pruritus ani?

Pruritus ani has many potential causes, so it is advisable to seek help from your doctor if you experience itching around the anus.

Common causes

  • In up to 90% of cases the symptoms arise because stools (poo) stay in contact with the skin around the anus and cause irritation. Minor leaks of stools, passing wind and not cleaning the area after opening your bowels properly, can lead to pruritus ani. Constipation, diarrhoea, haemorrhoids (piles) and skin tags can make leakage of stools more likely and make the skin around the anus harder to keep clean, thereby making the irritation worse. Intensive and over-frequent cleaning of the skin around the anus can also cause irritation making pruritus ani worse.

Less common causes:

  • Skin conditions around the anus, such as  psoriasis, eczema, thrush (a Candida yeast infection) and fungal infections.
  • Threadworms are a common cause of pruritus ani in children, but rarely in adults. The itching is usually worse at night.
  • Allergy. Pruritus ani may be due to an allergy to something in contact with the skin, for instance to fragrance in toilet paper, or to local anaesthetics or preservatives in creams used for piles, condoms, and lubricants.
  • Skin irritation. The skin around the anus is sensitive and can easily be irritated by moist wipes, soaps, perfumes, antiseptics (for example, Dettol). These may make the skin sore, itchy and contribute to pruritus ani.
  • Sweating. The skin around the anus is often moist with sweat. If lengthy periods pass without ventilation to the area, for instance if you sit down for a long time or wear tight underwear, the skin may become more irritated and itchier.

Is pruritus ani hereditary?

No.

What are the symptoms of pruritus ani?

Itching is the main symptom, often occurring after the bowels have opened. Itching can be worse in the evening and at night which can interfere with sleep. Sometimes the skin becomes sore and can crack or ‘fissure’ (small tear in the lining of the anus) after scratching, making it uncomfortable to open your bowels.

What does pruritus ani look like?

The skin around the anus may look inflamed, thickened, and show scratch marks. Small fissures may occur, and these may feel painful and bleed.

How is pruritus ani diagnosed?

It is usually possible to make a diagnosis by listening your history and examining the affected skin. After examination,  the doctor may suggest extra tests, depending on what they suspect the cause may be.

Can pruritus ani be cured?

As there are so many different causes, there is no one treatment that can cure all cases. It is important to have a correct diagnosis to ensure the right treatment can be implemented to relieve the itching. The symptoms can be managed but the condition may recur (come back).

How can pruritus ani be treated?

It is a good idea for all patients, whatever the cause of the pruritus ani, to adopt the self-care measures described below. These self-care measures are simple but very important. Whatever the cause or treatment, it may take many weeks or months until you notice an improvement.

Treatment the doctor may prescribe

There is a variety of creams your doctor my suggest such as:

  • A soothing cream containing zinc oxide.
  • Regular application of a moisturising (emollient) ointment especially after bowel movements.
  • A short course of a steroid ointment or cream to be applied to the area every day to reduce the itching. This can then be used as and when needed should pruritus ani return.
  • A short course of antihistamine may be prescribed by your doctor to relieve itching especially at night.
  • Some haemorrhoid creams may also be used to help reduce the itching.

If your doctor suspects you have a rare cause of pruritus ani, they may suggest other cream or tablet treatments.

Self-care (What can I do?)

  • It is important to have regular bowel movements where your stools (poo) are soft but not runny. You must avoid constipation or diarrhoea.
    • In general, ensure that you drink plenty of water and that your diet contains fiber-rich foods, such as fruit, vegetables, and others. This will help having regular bowel movements.
    • Avoid straining to pass stools.
    • If you are constipated try adding more fibre to your diet, see https://www.nhs.uk/conditions/constipation/
    • If your stools are too soft/runny and prone to leaking, you may benefit from reducing the amount of fibre and fruit in your diet.
    • If you are constipated or have a change in bowel habit despite the measures above, see your GP for advice.
  • After you pass stools, clean the anus gently with lukewarm water, and pat dry with a soft towel
    • Ideally clean the anus using the shower jet, or a bidet.
    • Avoid rubbing the area.
    • Avoid leaving any soap or toilet tissue in contact with the skin.
  • Avoid irritating or scratching the anus, especially at night
    • Avoid using moist wipes, deodorants, disinfectants, talcum powder or any other perfumed products - these are too harsh for the delicate skin around the anus.
    • Keep your fingernails short and, if you scratch at night, consider wearing cotton gloves.
    • Wear loose cotton underwear, avoid man-made fabrics, tights and tight trousers.
    • Consider sleeping without underwear.
    • Avoid situations where the skin around the anus may get sweaty, such as sitting for prolonged periods of time, exercising, or cycling.
    • If you suffer with leakage of stools or mucus from the anus, for example during exercise, consider a small plug of cotton wool.
  • If you feel certain foods make your symptoms worse, avoid them. Some patients find that coffee, cola drinks, chocolate, citrus fruits, tomatoes, nuts, beer and dairy products make them worse. You may want to keep a diary of what you eat and of your symptoms over a 2-week period to see if avoiding some of the foods above makes a difference.

Where can I get more information?

Web links to detailed leaflets:

https://dermnetnz.org/topics/itchy-anus

www.fascrs.org

www.acpgbi.org.uk/patients/conditions/9/pruritus_ani_itchy_bottom

http://cks.nice.org.uk/pruritus-ani

Jargon Buster: https://www.skinhealthinfo.org.uk/support-resources/jargon-buster/

Please note that the BAD provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET

PRODUCED | AUGUST 2004
UPDATED | MAY 2010, MAY 2013, JUNE 2016, NOVEMBER 2022
NEXT REVIEW DATE | NOVEMBER 2025

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