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What Can I Do About an Embarrassing Itch?

by Dr. Sharon Orrange on June 21, 2016 at 3:33 pm

Itchy butt, pruritus ani, itching around the anus . . . whatever you want to call it, it’s more common than you might think. Many folks try to deal with it on their own without coming to the doctor because, well, it’s embarrassing. So let me walk you through it step by step.

What is pruritus ani? It’s the medical term for itching around the anorectum (this includes outside and inside). Itching around the anus or higher up in the rectal area may bother you the most at night and can really affect quality of life.

How common is it? In one survey of 100 randomly selected individuals (aged 21 to 65), 20 percent had ongoing symptoms. The majority of those folks hadn’t talked to a doctor about it either, so you are not alone.

Why do we get itching around the anal area? Dietary factors and fecal soilage account for the majority of patients with anal pruritus but one fourth of patients have no identifiable cause. Several things can be quickly ruled out with a quick look by you or your primary care doctor: tumors, anal fissures, abscesses or hemorrhoids.

Now “fecal soilage” doesn’t sound good—what does it mean? This does not mean that you aren’t cleaning well enough. In fact some of you clean too well with witch hazel and other astringents which dry the area out, making the itching worse. Stool that is loose or sticky is more likely to cause fecal soilage than formed or bulky stools, and this will worsen the itching.

What foods make itching around the anus worse? The “Cs” of coffee, cola, chocolate, citrus, and calcium (dairy) are potential dietary contributors to itchy butt. Tomatoes and tea also may make itching worse.

Is it just a skin problem? This is where seeing your doctor can help. Skin conditions like psoriasis can also be the cause along with other types of dermatitis. Skin irritation can be worsened by scratching or by the use of additional skin products to relieve the itching, like witch hazel.

What works to ease the itch? Start by avoiding food and beverages known to make the itching worse, and if you are having loose bowel movements or diarrhea try cutting out lactose. If everything else is normal, start with keeping the area dry and clean, but without excessive wiping or use of astringent cleaners (again, like witch hazel).

Here is a stepwise plan you may try before visiting your doctor:

  • After a bowel movement, a bath or using a pre-moistened pad or tissue can be used for wiping.
  • Following bathing, the area around the anus should be dried using a soft towel with a dabbing/patting motion, or with a hair dryer set on cool. Wiping too aggressively is NOT helpful
  • Over the counter options to start with: Calmoseptine is an over the counter ointment that works really well for itchy butt—start with this. Balneol lotion or lotion packets are also a favorite of colorectal surgeons for use after a bowel movement. Zinc oxide (Desitin or Balmex) can be used also as a barrier cream.
  • You can also try talcum powder to help keep the area dry.

Ok, those didn’t work. Now what? See your doctor. An over-the-counter 1% steroid/hydrocortisone cream can be used twice daily to relieve the itching and help healing, but you don’t want to use that for very long.

If the itching is bad at night, take a 25 mg Benadryl (diphenhydramine) to help while you wait for other remedies to kick in.

Last, if the above listed interventions don’t help, your doctor may give you Protopic 0.1% ointment (topical tacrolimus) which has been shown to help.

Allergy (patch) testing is also recommended if it doesn’t get better

Dr. O

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