Definition

Anal itching, or pruritus ani, is a bothersome and sometimes intense itching of the skin around the anus (rectal opening). Pruritus ani is a common problem that affects up to 5% of the population. It affects men and women and may occur at any age.

Causes

There are many causes of pruritus ani but most fall into three categories: moisture, diet, and skin irritants:

Moisture
Prolonged exposure to moisture from vaginal discharge, perspiration, loose stools or mucus discharge from other rectal problems may lead to pruritus ani.

Diet
Certain foods can produce enzymes that are irritating to the skin when stool is passed. Common food are those containing caffeine (coffee, tea, colas, and chocolate), spicy foods, dairy products, beer, citrus fruits, tomatoes, and nuts.

Skin Irritants
Dyed or scented toilet paper, soaps, and laundry detergent may cause irritation. Stool left on the skin from leakage or incomplete hygiene may also cause the irritation.

Symptoms

The most common complaint is an irresistible urge to scratch. Some people will experience a burning sensation or note occasional bleeding when wiping after a bowel movement.

Diagnosis & Treatment

Pruritus ani is diagnosed by an examination of the skin around the anal area. The appearance of the skin will vary, depending on the severity and the length of time the condition has been present. It may start with redness of the skin and can progress to thickening of the skin. It may also lead to cracks and open sores which may result in a burning sensation and small amounts of blood on toilet tissue.

Treatment focuses on removing the instigating agents and skin protection with creams or ointments.  Occasionally, a biopsy (removing a small piece of skin for microscopic examination) may be necessary.

Visit the American Society of Colon & Rectal Surgeons website for more information