Skin conditions, digestive issues, and chronic diseases are all potential culprits for this common yet embarrassing problem. 

By Amanda MacMillan
July 27, 2018

So you’re really itchy—in one of the most private and difficult to talk about places on your body. And while it may feel mortifying to even type the words “anal itching” into your search engine, it’s actually a common problem. The “it” we’re referring to is pruritis ani, the technical term for irritation around the anus that causes the desire to scratch.

If you’re suffering from an itchy butt, the first thing to know is that it’s most likely a symptom of another issue—not a disease or condition in itself. And because itching can lead to scratching, tiny cuts, pain, and swelling, it’s important to get to the bottom (no pun intended) of the problem. Here are some of the common causes of itchy butt, and how you can find relief.

RELATED: 12 Reasons Your Skin Is Itchy—and When to Talk to a Doctor

Hygiene issues

In many cases, itching in the perianal region (around the anus) has to do with how a person is wiping after a bowel movement. Not wiping well enough can leave behind fecal matter and moisture, says Brian Kim, MD, co-director of the Center for the Study of Itch at Washington University School of Medicine. This is more commonly the case in young children or in older adults with mobility issues, as opposed to healthy adults.

On the other hand, too much wiping—or the wrong kind of wiping—can also lead to irritation and itching. Parswa Ansari, MD, assistant professor of surgery at the Donald and Barbara School of Medicine at Hofstra/Northwell, refers to this common problem as “overzealous hygiene.”

In a 2016 paper in the journal Clinics in Colon and Rectal Surgery, Dr. Ansari explains: “The use of soap [in the perianal region], particularly scented ones, should be avoided,” he writes. “Warm water alone can be used, and the area should not be scrubbed vigorously during bathing or after toileting.”

Pre-moistened wipes and pads also aren’t recommended, Dr. Ansari writes, since they can contain chemicals—like alcohol, witch hazel, and other astringents—that can further irritate already sensitive skin. (This can cause people to wipe even more aggressively, he notes, creating a vicious and constantly itchy cycle.) If dry toilet paper isn’t cutting it, he recommends using unscented toilet paper moistened with warm water.

RELATED: 12 Reasons You Have Scaly Skin—and How to Get Rid of It

Skin conditions

Chronic conditions like psoriasis and eczema can cause inflammation and itching anywhere on the body, including the perianal region.

Psoriasis—which causes itchy red patches and silvery, flaky scales to form on the skin—is responsible for about 5% to 8% of anal itching cases referred to colon and rectal surgeons, according to Dr. Ansari. And while psoriasis can’t be cured, a dermatologist can help keep it under control by prescribing a brief course of topical steroids and longer-term doses of other topical medications. Ultraviolet light therapy may also be helpful.

According to a 2014 review in the International Journal of Clinical Practice, doctors are “frequently confronted” with patients suffering from anal eczema, “and the need for efficient and safe therapies is high.” Eczema (also called atopic dermatitis) can be treated with steroids and other anti-itch ointments or creams.

Another skin condition that can cause anal irritation—especially in women—is called lichen sclerosus. This condition causes white, wrinkled skin changes in the labia and in the perianal region, and it usually responds to a 6- to 8-week dose of topical steroids. These lesions have been associated with skin cancer, so they should be biopsied if they don’t respond to treatment.

Your clothing

Anal itching is sometimes associated with tight clothing or materials that don’t breathe well, says Dr. Kim. “We know that sweat can cause irritation anywhere on the body with prolonged exposure, and in this area especially it can cause a lot of itching or even a yeast infection,” he says.

Eczema-like rashes can also be triggered by allergies, says Dr. Kim—including to certain clothing materials, the dyes used in their production, or the laundry detergent they were washed in. “If itching starts suddenly out of the blue, one of the first things you should ask is whether you could be using or wearing something that’s causing irritation in that area,” he says.

Sweat and friction from clothing can also cause hair follicles to get inflamed and infected—a condition called folliculitis that looks like tiny red bumps or pimples. For women, folliculitis is more common in the vaginal area, but it can affect both men and women all over the body, including on (and in) their butts.

RELATED: Sweat Much? Here's Why and What You Can Do About It

Dietary irritants

What you eat can definitely affect how you feel down there, especially during and immediately after pooping. “Maybe you have an unusual diet—like it’s very acidic, or you eat a lot of a certain irritant,” says Dr. Kim. “A lot of people believe that making dietary adjustments can improve itching down there.”

Certain foods can also contribute to diarrhea or anal leakage, which can make it more difficult to wipe thoroughly and can cause irritation and itching in itself. According to Dr. Ansari’s research, foods that have been associated with anal itching include coffee (both caffeinated and decaf), tea, chocolate, citrus fruit and juices, tomatoes and tomato paste, cola, alcoholic beverages, and dairy products.

Pinworms

These tiny white parasites were in the news recently, when actress Kristen Bell revealed that both she and her daughter were infected with pinworms after an infestation at her daughter’s preschool. “It was very itchy,” Bell said on an episode of The Joel McHale Show with Joel McHale.

Pinworms are the most common type of intestinal worm infection in the United States, but the infection mostly occurs in babies and young children. (It can, however, spread to their caregivers and other adults, as Bell’s story illustrates.) People get infected by swallowing pinworm eggs, which can live for two weeks on human skin, clothing, bedding, or food.

The parasites are visible in an infected person’s poop, and doctors sometimes use a “tape test”—in which a piece of tape is placed on the skin around a baby’s anus and then examined under a microscope—to identify tiny pinworm eggs. Luckily, pinworms can be wiped out with two doses of oral medication (available over-the-counter or by prescription), given two weeks apart to prevent reinfection.

RELATED: Why Kristen Bell's 'Anal Worms' Story Isn't as Dangerous—or Uncommon–as It Sounds

Hemorrhoids or anal fissures

If your chronic itch gets worse—or turns painful—when you strain to go Number 2, it could be caused by swollen veins in the anus (hemorrhoids) or tiny tears in the surrounding skin tissue (anal fissures). Both of these can also cause small spots of blood on your toilet paper, although you should see your doctor if you notice significant blood in your stool.

“Hemorrhoids are actually very common, and a lot of people don’t even know they have them,” says Dr. Kim. “They just have itching down there and they don’t know why.” Anal fissures are common as well, especially in infants, older adults, and women soon after childbirth.

Eating more fiber, staying hydrated, and focusing on other ways to relieve constipation and soften your stool—so you don’t have to push so hard when it’s time to go—can improve both of these conditions. Hemorrhoids can also be treated with an over-the-counter hydrocortisone cream.

Infections

The term yeast infection may make you think of the vagina, but this type of fungal infection can also occur in the perianal region—especially in people who are elderly, obese, have compromised immune systems, or are taking antibiotics.

According to a 2013 paper in Gastroenterology Clinics of North America, yeast infections play a role in 10% to 15% of cases of anal itching. They usually can be treated with anti-fungal powder or lotion, although oral anti-fungal drugs may be needed for severe cases.

Anal itching can also be a symptom of sexually transmitted infections, including herpes and anal warts caused by the human papilloma virus (HPV). Symptoms usually occur around the anus (instead of the vaginal area) when a person has received anal sex. Anti-viral medication can help keep herpes under control, while treating anal warts may require topical creams, cryotherapy, or even surgery.

RELATED: 4 Places You Can Get an STI—Besides Your Vagina

Scabies

Scabies is a common skin condition caused by a tiny bug called the human itch mite. It’s very contagious, requires a prescription medication to treat, and can result in an itchy rash and sores all over the body—including around the anus and genitals.

On the other hand, if you only have itching in the perianal area, it’s probably not scabies. “It usually affects the groin, the armpits, the belly button, the rest of the body,” says Dr. Kim. “If you’re really looking for a specific cause of isolated anal itching, it’s most likely something else.”

Chronic diseases

Certain long-term health conditions can contribute to anal itching and inflammation in a variety of ways. For example, conditions like diabetes and autoimmune diseases can leave people more vulnerable to bacterial or fungal infections. And digestive disorders like Crohn’s disease can cause diarrhea and stool leakage, which can irritate the skin around the anus.

Some diseases, like iron-deficiency anemia, kidney or liver disease, and certain types of cancer, can also cause generalized itching throughout the body, according to a 2008 study in the American Journal of Clinical Dermatology. Treating the underlying condition is the best way to stop these types of symptoms, but doctors sometimes recommend oral or topical medications specifically to relieve itching, as well.

RELATED: 9 Autoimmune Diseases Every Woman Needs to Know About

Nerve damage

“We have some suspicion that some of this type of itching is neurologic,” says Dr. Kim. “As patients get older, a lot of them have lower back injuries and many people probably have minor damage to the nerves coming out of their spinal cords.”

These problems can cause twinges of pain or a nagging itch in the area around the buttocks and anus, Dr. Kim adds. Treatment for this type of nerve damage varies, he says, but may include physical therapy, surgery, or behavior modification.

Anal cancer

Having an itchy butt isn’t usually a reason to jump to scary conclusions. But rarely, it can be a sign of cancer. Up to half of patients with Paget’s disease—a type of cancer that attacks the surface layer of skin and typically affects the breast, vulva, or perianal area—report itching as one of their major symptoms.

Bowen’s disease, a very early form of skin cancer also called carcinoma in situ, can affect the perianal area and cause significant itching. “While these diseases remain rare,” Dr. Ansari wrote in his 2016 paper, doctors should know how to recognize them “so that anal biopsies are performed when appropriate, and treatment is not delayed.”

RELATED: How Risky Is Anal Sex? A Gynecologist Explains

Where to start

Because the causes of anal itching are so broad and wide-ranging, it can be hard to know where to start if you do have a problem. Talking to your primary care doctor is always a good option, says Dr. Kim; you could also check with a dermatologist if you think your problem is more skin-related, or a gastroenterologist if it seems more digestive in nature.

Whatever you do, don’t suffer in silence. “This type of itching can be so debilitating, I’ve had patients who were thinking about quitting their jobs,” says Dr. Kim. “And any type of scratching can be embarrassing, but scratching in that area is even more socially unacceptable.”

A chronic itch can be extremely frustrating, especially if you don’t know what the root cause is. Fortunately, says Dr. Kim, many factors that contribute to anal itching can be identified and treated, so patients can get back to living their lives without distraction or irritation.