Causes of anal itching
- Genital warts (vulva or penis), caused by papillomavirus, thrive in warm, moist conditions such as the skin near the anus and can be very itchy.
- Genital herpes (caused by herpesvirus) can also infect the anus, and causes itching just before the sores appear and also during the healing stage.
How you can help yourself
- Wash the anal area after you have had your bowels open, but not more than three times in a day, using an unperfumed soap and water. Some doctors recommend using aqueous cream (available from pharmacies) as a cleanser. Apply the cream, massage it gently over the area and then rinse off. If you are somewhere where you cannot wash, clean the area with wet tissues (but not with pre-moistened wipes containing perfume, alcohol or other irritants). If you use shower gel to wash your body, make sure you rinse it off very thoroughly so that none remains between the buttocks.
- Dab gently with a soft towel to dry – do not rub. If drying is difficult, use a hairdryer on cool setting.
- Do not put any disinfectant on the skin or in the bath water – this can irritate the skin. Do not use bubble bath – the perfume can irritate. Instead, put a handful of kitchen salt in your bath.
- Keep a cotton-wool ball, dusted with powder, against the anus, inside your underpants or knickers. Use baby powder (not perfumed talcum powder) to dust it. Change it each time you wash.
- Wear loose cotton underwear. Avoid tights and elastic ‘shapewear’ underwear, because they encourage sweating and moistness in the anal area. Avoid anything that keeps the buttocks close together.
- Do not use biological (enzyme) washing powders for your underwear, or perfumed fabric softeners. Instead, use a detergent labelled ‘for sensitive skin’.
- Do not scratch. If you scratch, you damage the skin more and then you itch more. If you feel you really must scratch, try pinching the skin near the anus between your thumb and forefinger through your clothing; this is less damaging than actual scratching. People often scratch at night and do not realize they are doing so. If you think you might be scratching at night, talk to your doctor about taking an antihistamine, keep your fingernails short, wear cotton gloves at night for a while and ask your doctor to check for threadworms.
- Do not use any greasy creams (such as Vaseline) on the area. Greasy creams keep the skin soggy and make the problem worse. Zinc oxide cream (from pharmacies) can be soothing if the skin has been damaged by scratching.
- Be very cautious about anaesthetic creams or ointments. Sometimes they can help by relieving the itch/scratch cycle, but use them only for a short period (about a week).
- Similarly, be very cautious about steroid creams. In the UK, it is possible to buy weak steroid cream (containing hydrocortisone 1% or less) from pharmacies. In the short-term, the steroid reduces inflammation and therefore relieves itching but, in the long-term, it can make the skin thinner and worsen the problem. Resist the temptation to keep on using a steroid cream. Use it for just 1 week, then throw the tube away.
- Try witch hazel – an old-fashioned remedy available from pharmacies. Dab it on twice a day, but stop immediately if it seems to be making the problem worse instead of better.
- Dr James Le Fanu has a column in the Daily Telegraph that acts as a forum for readers’ solutions to health problems. Readers have reported that the inside of a banana skin can relieve itchy skin, including anal itching.
- Feel round the anus for lumps. This may not be easy, because the skin round the anus is normally puckered. A lump might be a wart, a pile or a skin tag alongside an anal fissure.
- Avoid foods that cause excessive flatulence.
How your doctor can help
If you are anxious about being examined by your doctor, look at the section on seeing your doctor about an anal problem. Your doctor can check to see whether you have any conditions such as piles (haemorrhoids), fissure, warts, psoriasis, eczema, fungal infections or other infections that need treatment.
- If you scratch at night, an antihistamine taken before you go to bed can help. Antihistamines relieve itching and some also tend to make you drowsy.
- Discuss with your doctor whether you might have threadworms (pinworms). They look like small threads of slow-moving white cotton. These can be eliminated with mebendazole or piperazine. The treatment has to be repeated after 14 days, because the eggs can persist for this length of time in the environment (NHS MeRec Bulletin 2008;18:11–13). The other members of your household will also need to be treated, and you should also wash your hands and scrub your nails before eating and after each visit to the lavatory, and wash the anal area in the morning to get rid of any eggs deposited during the night.
- An ointment containing a chemical found in chilli peppers (capsaicin) is an effective treatment for very troublesome anal itching (Gut 2003;52:1233–5), but the researchers used a special very dilute ointment (0.006%) that is not generally available.
- If nothing helps, your doctor might consider referring you to a specialist for injection of a chemical called methylene blue into the anal area. So far, research has involved only a small number of patients, but the itching improved in most patients and disappeared completely in half (Colorectal Disease 2009;11:282–7). More research is awaited to find out how long the relief will last.