What Is Pruritus Ani?
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Pruritus Ani - Causes, Symptoms, Diagnosis, and Treatment

Published on Mar 23, 2023   -  6 min read


Pruritus ani refers to an intense itching sensation around the anus. Read the article to know more about pruritus ani or anal itching.


Pruritus ani is a common medical condition that affects both men and women. Pruritus ani is most common in adults, affecting 1 to 5 % of the general population. Men are four times more likely to be affected than women. The condition is most prevalent in people between 40 and 60 years. There are numerous causes of pruritus ani, and an appropriate diagnosis is required to treat the underlying cause. Medical management of pruritus ani frequently relieves symptoms and improves patients' quality of life.

What Is Pruritus Ani?

Pruritus ani, which means itchy anus, is an uncomfortable sensation of the skin around the anus that causes the desire to scratch. Pruritus ani, also known as anal itch, is a symptom, not a disease, and it can have a variety of causes. Pruritus ani can be classified as either primary or secondary. The classic syndrome has no identifiable cause (referred to as "idiopathic"), whereas the secondary form has an identifiable, but often specifically treatable, cause. Itching may result from minor skin stimulation. The subsequent scratching may cause skin injury, resulting in a larger area of irritated skin. In addition, scratching repeatedly increases the need to scratch, exacerbating the problem.

What Causes Pruritus Ani?

This pruritus or itching symptom is common in many anorectal conditions. Possible causative agents include hemorrhoids, excessive skin tags, fecal soiling or incontinence, anal fissures (painful clefts or grooves), anal fistula (abnormal passageways between the bowel and an organ or skin surface), and anal warts. It is sometimes unclear what causes a long history of primary pruritus ani. It is thought that the itching is caused by an irritating secretion from the anal canal. With repeated trauma or scratching for extended periods, the local nerve fibers in the skin may become chronically active. Itching can also be caused by nerve pathway disorders or a central nervous system stimulus such as medications. In addition, itching can occasionally be psychogenic. The itchy sensation indicates either of the following factors has irritated the skin in the affected area:

  • Stool Left on the Skin Around the Anus - If the anal area is not properly cleaned after a bowel movement, some amount of stool may be left on the skin, causing itching. In addition, watery stools may occasionally leak out of the anal opening, causing itching. This can happen in otherwise healthy people whose diets include a lot of liquids.

  • A Diet That Irritates the Anal Skin - A variety of foods and beverages can irritate the anus, like spices and spicy foods, tea, coffee (both caffeinated and decaffeinated), milk, alcoholic beverages (especially beer and wine), citrus fruits, vitamin C tablets, chocolate, and tomatoes. It usually takes 24 to 36 hours after eating or drinking something that can irritate the anus before anal itching begins. That is the duration for food to pass through the digestive tract.

  • Antibiotic Treatment - Some powerful antibiotics that work against a wide range of bacterial species can cause anal itch by disrupting the normal ecology of the intestines. Tetracyclines and Erythromycin are two examples of broad-spectrum antibiotics (both sold under several brand names).

  • Local Irritation or Skin Allergy in the Anal Area - Chemicals and medications applied to the anal area can lead to local irritation or allergic reactions in sensitive people. Some of the most common culprits are dyes and perfumes used in feminine hygiene sprays and other deodorants for the region around the anus or genitals, toilet paper, medicated skin cleansers and soaps, particularly perfumed soaps, and medicated talcum powders. In addition, over-the-counter (OTC) medications (suppositories, creams, and ointments) intended to treat anal problems can also cause anal itching.

  • Intense Cleaning After a Bowel Movement - While the anal area needs to be cleaned after every bowel movement, it must be done gently. Rubbing and scrubbing aggressively, especially with soaps or other skin cleansers, can cause skin irritation and cause an anal itch.

Infectious diseases can also cause pruritus ani. Bacterial skin infections, fungal infections (although one common fungus, Candida albicans, appears to be normal flora of the perianal skin), parasitic infections with pinworms or scabies, and viral infections with anal warts are all examples.

  • A variety of skin conditions can cause secondary pruritus ani. Psoriasis, atopic dermatitis, seborrheic dermatitis, contact dermatitis, lichen simplex, lichen planus, and lichen sclerosis are all potential causes of pruritus ani. Pruritus ani can also be caused by local cancers such as Bowen's disease or extramammary Paget's disease.

  • Pruritus ani can be caused by medical conditions that affect the entire body. Diabetes, leukemia and lymphoma, liver diseases (obstructive jaundice), kidney failure, iron deficiency anemia, and hyperthyroidism are a few examples.

While there are numerous potential causes, it is important to note that the itching has no identifiable cause in many cases.

What Are the Clinical Features of Pruritus Ani?

Pruritus ani symptoms may include:

  • Itchiness.

  • Irritation.

  • Burning.

  • Soreness.

  • Scratches (excoriations).

  • Skin that is thick or leathery on or around the anus (perianal area).

How Is Pruritus Ani Diagnosed?

The healthcare provider will conduct a physical exam to rule out any underlying causes of the itchy anus, such as dermatological conditions or illnesses. They will examine the perianal area and note changes in skin color, texture, rashes, or lesions.

Investigations may be required to determine the root cause.

  • Bacteriology skin swab.

  • Mycology skin scraping.

  • Sticky tape test for pinworm ova.

  • Patch testing to diagnose allergic contact dermatitis.

  • A skin biopsy is performed to diagnose inflammatory disorders or skin cancer.

How Is Pruritus Ani Treated?

  • The treatment of anal itching is determined by the cause of the problem. Self-care measures may include using an anti-itch cream or treating an infection or fecal incontinence.

  • If the symptoms worsen at night, an antihistamine may be prescribed. This medication is taken orally. It can provide temporary relief until an anti-itch cream takes effect.

  • Most people find relief from anal itching with proper care. However, if the itching persists, medical attention is needed.

How to Prevent Pruritus Ani?

The mainstay of anal itching prevention is a careful washing routine that keeps the area clean, cool, and dry while avoiding irritating the skin. The following self-care measures can alleviate symptoms:

  • Gently Cleansing: The area around the anus must be cleaned when it is soiled or after each bowel movement. This could include a quick shower, a bidet, a sitz bath, or the use of a squeeze bottle. Toilet tissue that is moist can be useful. Scrubbing and rough clothes should be avoided. Pat dry with a cloth or use a hair dryer on the fan setting to dry the area. Using the heat setting could aggravate this sensitive area even more.

  • Do Not Scratch: Scratching only provides temporary relief from itchy skin. It aggravates the skin even more. Applying a damp, room-temperature compress to the area or taking a lukewarm oatmeal bath may provide relief. To avoid scratching while sleeping, the nails must be short, and cotton gloves can be worn before bed.

  • Wear Non-Binding White Cotton Underwear: This keeps the area dry. Pantyhose and other tight-fitting garments should be avoided because they can trap moisture.

  • Irritants Should Be Avoided: Genital deodorants, personal cleansing wipes, scented toilet paper, bubble baths, and harsh or perfumed soaps must be avoided. Cleaning with gentle soap, water, and no other products is usually the best option.

  • Alterations in the Diet: Tea, coffee, alcohol, citrus fruits, dairy products, pepper, spicy foods, tomato sauce, and tomatoes should be limited or avoided until the symptoms improve. Avoiding excess use of laxatives.

  • Apply Ointments, Creams, or Gels as Needed. Apply a thin layer of zinc oxide ointment (Desitin, Balmex) or petroleum jelly to the affected skin to keep it moist (Vaseline). Apply hydrocortisone 1 % cream twice to three times daily for a week or two to relieve inflammation and itching.

  • Increase Intake of Vegetables, Whole Grains, and Noncitrus Fruits. This will aid in the maintenance of regular bowel movements. Beans, nuts, and seeds are also high in fiber. Fiber supplements like psyllium (Metamucil) and methylcellulose (Citrucel) may be beneficial.


Anal itching is a bothersome condition. It is irritating and embarrassing and may become so unbearable in some situations. It can occur due to various causes. An itchy anus can be relieved with proper hygiene, medications, and gentle care. If the symptoms do not improve even after self-care measures, a doctor must be contacted immediately.

Frequently Asked Questions


How to Treat Pruritus Ani?

Pruritis ani or anal itching can be treated by using creams, ointments, methylene blue injection (anal tattooing), antibiotics, and antifungal medications, avoiding harsh soaps, deodorants, and scents, eating fiber-rich foods, using dye-free, unscented toilet paper, avoiding certain foods and drinks, and wearing cotton underwear. One must refrain from rubbing, scratching, and obsessive cleaning, as all these can interfere with healing. Intense itching will resolve after 5-10 minutes if not rubbed or scratched.


Which Medicine Is Considered the Best for Pruritus Ani?

Over-the-counter (OTC) hydrocortisone creams, in combination with an anesthetic pain reliever, can be topically applied to the affected area twice or thrice a day to get relief from the symptoms. Any steroid cream should be used only briefly, as prolonged usage can worsen the condition. Studies show that capsaicin topical cream is a good alternative to corticosteroids in long-term (chronic) anal itching cases. Soothing ointments like zinc oxide or bismuth subgallate can also be used.


Is Pruritus Ani Caused by Worms?

Anal itching or pruritis ani can be caused due to various reasons a few of which are infections, ongoing diarrhea, dermatitis (skin inflammation), and hemorrhoids. Pruritis ani can also be caused as a result of infestation with Enterobius vermicularis, or pinworms, particularly in children. These worms arise from the anal canal, especially at night and in the morning, thereby worsening pruritis at those times. However, these worms are rarely the cause of anal itching in adults. If these pinworms are identified in children, they can be treated with Albendazole or Mebendazole.


Can Pruritis Cause Pain?

The term pruritis refers to itching. It creates a sensation or feeling on the skin to scratch. There can be a tendency to itch in the perianal area. This itching can sometimes be mistaken to be painful by the individual. However, other reasons for perianal pain should be eliminated. The itching can worsen at night or following a bowel movement. Intense itching will resolve after 5-10 minutes if not rubbed or scratched.


Is Coconut Oil Beneficial for Pruritus Ani?

Coconut oil is a natural moisturizer that helps soothe the skin, and it has certain antibacterial properties that act against infections that cause anal itching. Warm coconut oil can be rubbed on the affected area twice daily to relieve itching and burning sensations. One must ensure that they wash the area later with clean water. Other natural remedies include apple cider vinegar, fiber-rich foods, ghee, yogurt, garlic, oatmeal baths, Epsom salt, and aloe vera.


Can Pruritus Ani Be Cured?

Pruritis ani can be treated by facilitating the skin's healing by reducing inflammation. One must refrain from rubbing, scratching, and obsessive cleaning, as all these can interfere with healing. Intense itching will resolve after 5-10 minutes if not rubbed or scratched. Over-the-counter (OTC) hydrocortisone creams, in combination with an anesthetic pain reliever, can aid in healing. Natural remedies include apple cider vinegar, fiber-rich foods, ghee, yogurt, garlic, oatmeal baths, Epsom salts, and aloe vera.


How Can Pruritus Be Treated Naturally?

The term pruritis refers to itching. It can be treated naturally in the following ways:
- Applying menthol oil since it has a cooling effect and can offer relief from pain and itching.
- Applying a cold pack, ice pack, or wet cloth to the affected site for about five to ten minutes.
- Using colloidal oatmeal available in creams and lotions or adding the finely ground powder directly to the water while bathing can also be beneficial.
- Wet wrap therapy.
- Applying apple cider vinegar.
- Avoiding irritants like wearing fabrics made of wool and synthetic materials.


What Foods and Beverages Can Cause Pruritus Ani?

Foods and beverages that can cause pruritus ani include milk products, nuts, cheese, chocolate, tea, coffee, carbonated beverages, and acidic or spicy foods. Less commonly, anal malignant (cancerous) conditions can result in itching. Rarely poor cleanliness can also be the primary cause. It is advisable to continue all these drinks and foods at a time. Removing these items one by one from the diet slowly every few days can help one identify which food or drink is causing pruritus ani.


What Are the Different Stages of Pruritus Ani?

Based on the skin condition, pruritus ani was classified by Gordon into three conditions as follows:
Stage 0: There is a normal appearance of skin in this stage.
Stage 1: The skin appears red and inflamed.
Stage 2: In this stage, there is the presence of white lichenified skin.
Stage 3: In this stage, there is lichenified skin, along with coarse ridges of skin, and ulcerations often occur secondary to scratching.


Is Pruritus Ani a Long-Lasting Condition?

The prognosis for people with pruritus ani is good, with appropriate treatment and proper personal hygiene. The symptoms usually resolve within one to three weeks. However, severe cases may take a longer time to heal. One must refrain from rubbing, scratching, and obsessive cleaning as all these can interfere with healing. Intense itching will resolve after 5-10 minutes if not rubbed or scratched.


Does Pruritus Have the Ability to Spread?

Pruritus can cause an itching sensation and be painful. It could be confined to one area (localized) of the body or spread throughout various areas. Pruritus can be caused by contact with an allergen, pregnancy, dry skin, or the body’s reaction to certain medicines. A contagious itch is a condition in which seeing other people itch can induce an itching sensation in those with chronic itch symptoms and healthy individuals.


Does Pruritus Pose a Threat to Life?

The term pruritis refers to itching. Usually, itchy skin is not a serious condition, but it can cause discomfort. Sometimes, itchy skin could be due to an underlying serious medical condition. Most itchy skin conditions can be treated at home using moisturizers, lotions, and over-the-counter medications. Severe itching or itching that lasts for more than six weeks can be a cause for concern. Persistent itching and scratching can result in skin injury, infection, and scarring.


Why Do Symptoms of Pruritus Worsen at Night?

At night, there is an increased release of cytokines from the body, which are immune system proteins that cause inflammation. This can either result in itching or worsen itching. Also, the production of corticosteroids by the body, which keeps the inflammation under control, decreases around this time. Various health conditions like psoriasis, hives, dermatitis, and bugs like lice, scabies, pinworms, and bedbugs can aggravate the itching sensation at night.


Is Pruritus an Indicator of Liver Failure?

Pruritus, or itch, can be a common complication of cholestatic liver diseases. It is also common in autoimmune liver diseases like primary sclerosing cholangitis, primary biliary cirrhosis, and obstructive biliary disease. Pruritus can also occur with cancer of the head of the pancreas, drug-induced liver disease, and hepatitis. With the progression of fatty liver disease, toxins can accumulate in the blood and cause pruritus (itching).


Does Drinking Water Help Get Rid of Pruritus?

Drinking plenty of water benefits the body in various ways, including relieving pruritus. It prevents the formation of dry skin and keeps the body hydrated. Also, drinking plenty of water eliminates toxins from the body that can irritate the skin. However, caffeine and alcohol can dehydrate the skin and worsen itching.

Last reviewed at:
23 Mar 2023  -  6 min read




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