What Is Anal Itching? What Is Itchy Bottom? What Causes Anal Itching?

Anal itching, also known as itchy bottom, pruritus ani or anusitis, is irritation and sometimes inflammation of the anus - located at the exit of the rectum. Itching severity varies and is usually exacerbated by such factors as type of clothing worn, whether the patient is seated or upright, moisture levels, pressure and general rubbing of the anal area. Anal itching can become so severe that some people find it intolerable, describing the sensation as one of incredible burning and soreness.

Anal itching is not a disease in itself, but rather a sign or symptom. In the majority of cases, there is an underlying cause or condition which causes the anal itching. However, sometimes the underlying cause is never found.

Regardless of the cause, virtually every type of anal itching sign or symptom can be successfully treated.

Anal itching is much more common than people realize, probably because it is not exactly something most people will reveal to others, apart from the their doctors. According to the National Health Service (NHS), UK, about 1 in every 20 British people experience "itchy bottom". It is four times more prevalent in males than in females. Although anybody can develop anal itching, people aged 40 years and more are more likely to get it, compared to younger individuals.

According to Medilexicon's medical dictionary,  

pruritus ani is "itching of varying intensity at the anus; may be paroxysmal or constant, associated with seborrheic candidiasis or moniliasis, with irritated and enlarged hemorrhoidal veins, or may occur independently of any cutaneous lesions in association with systemic disease."

What are the signs and symptoms of anal itching?

A symptom is something the patient feels or reports, while a sign is something that other people, including the doctor detects. A headache may be an example of a symptom, while a rash may be an example of a sign.

Most humans and other animals sometimes scratch their bottoms. For a person with pruritus ani (anal itching) the urge to scratch around the anus is very strong and persistent. Although the urge may occur at any time of day or night, it is more common after going to the toilet; especially if stools are liquidy. Some patients say the itching becomes more intense just prior to falling asleep in bed at night.

The symptoms of anal itching are self explanatory - "itching of the anus and the anal area". The patient generally experiences:

• Burning
• Intense itching
• Soreness
• Pain (sometimes)

Symptoms may be short-term or persistent. Some individuals may experience irritation that is so intense that the desire to scratch must be satisfied there and then - this can be embarrassing.

What can set off anal itching or exacerbate it?

• Anxiety
• Heat
• Mental stress
• Moisture
• Soiling (defecating or pooing in one's clothing)
• Some clothing or bedding materials, such as wool
• Having nowhere private to go into nearby

What are the causes of anal itching?

Anal itching is usually a sign or symptom of a harmless physical problem with no long-term health consequences. Unfortunately, it can also be an indication of something more serious, such as:

• Skin type - if the skin around the anal area is too dry there is a significantly greater risk of developing persistent and sometimes severe anal itching.


• Moisture levels - if moisture levels around the anal area are high, the chances of having anal itching are raised. High moisture levels can be the result of several different factors, including over-sweating, allergies, diarrhea, very wet and sticky stools, inappropriate clothing, fecal incontinence, and not having access to toilet paper or any means of cleaning oneself.


• Abrasive rubbing - cleaning your bottom with toilet paper can aggravate anal itching if the sensitive skin area is rubbed too hard, for too long, or too often.


• Over-washing the anal area - if harsh soaps affect the skin, especially if not rinsed off properly, the chances of itching in the anal area may increase.


• Some chemicals - some substances found in some soaps, douches, laundry detergents and body sprays may irritate the skin and cause anal itching.


• Type of toilet paper - the texture and substances added to toilet paper may irritate and inflame the skin in the anal area, resulting in itching.


• Some foods - some people may develop anal itching after consuming certain types of hot sauces or spices. The irritation may occur when the food is anywhere in the digestive system, even when stools are exiting through the anus.
  
  If a stool is not smooth and does not come out with the minimum of friction, irritation may occur and then subsequent itching - some people find that their anus becomes irritated after passing stools which originated from eating tomatoes, nuts, popcorn, chocolate, and even drinking alcoholic beverages. If some foods make people have diarrhea, their risk of developing anal itching is greater (because of the diarrhea).


• Some medicines - some medications, such as antibiotics can cause diarrhea, which can cause anal itching.


• Laxative abuse - if laxatives are used inappropriately and the patient has diarrhea or very liquidy stools, the probability of anal itching occurring becomes much greater.


• Hemorrhoids - when the veins around the anus or in the rectum are swollen or inflamed the patient has hemorrhoids. Hemorrhoids can occur both inside and above the inside of the anus. They can also appear externally, under the skin of the anus. People with hemorrhoids commonly suffer from anal itching.


• STDs (sexually transmitted diseases) - also known as STIs (sexually transmitted infections) cause anal as well as genital itching.


• Parasites- some parasites may cause anal itching. Parasites are more commonly a cause of anal itching in tropical countries, or tropical regions of countries.


• Skin conditions - such as eczema, seborrhea, and psoriasis, which may include itching in many parts of the body's surface, often have characteristic focal areas of irritation. People with these skin conditions commonly experience anal itching.


• Some yeast infections - this generally affects women. Yeast infections which affect the genital area, may spread to the anus, causing intense irritation.


• Forced bowel movement - if the stool is dry and large and the individual heaves and still pushes it through, there is a risk of an anal abrasion (small tear in the anus). A deeper tear is called an anal fissure, which may also cause itching.


• Tumors - a tumor in the anal region may cause anal itching. The tumor may be cancerous (malignant) or non-cancerous (benign). This is rare.

How is anal itching diagnosed?

In order for doctors to diagnose the cause of your symptoms, they will need to know your medical history. They might ask what soaps, creams or powders you use on your anus or if your symptoms worsen after the consumption of certain food types.

Your GP may also ask about when the itching is at its worst, and how long it lasts. They might also want to know if anyone else in your family has had or is suffering from anal itching. The doctors may be able to come up with a diagnosis just from these questions alone; however, if the cause is not clear you may be referred to a proctologist (doctor specializing in rectal and anal problems) or dermatologist (skin expert).

Diagnosis might be made just from a rectal exam. This will involve a GP checking the anal area for any skin that is inflamed, cracked or bleeding. An internal exam may then be required; the doctor inserts his/her finger into the patient's anus. Doing this can help determine what is causing the anal itching as well as eliminating more serious conditions, such as colorectal cancer. Sometimes a more detailed exam of the digestive system, such as a colonoscopy or a proctoscopy may be required.

What are the treatment options for anal itching?

Most of the time itchy bottom is easy to treat and responds well to treatment. However, this does not stop it from recurring in the future. The type of treatment chosen is dependent on the cause of the anal itching. The various methods of treatment may include:

• Anal cleanliness/dryness - When suffering from anal itching, keeping your anus clean and dry is very important. Each time you pass a stool and before going to bed it is advised that the skin around the anus is carefully cleaned using water and then dried thoroughly.
  
  When drying, be gentle, avoid vigorous rubbing as this could further irritate the area. Another option is using a hair dryer on low heat or patting with a dry pad.


• Be careful when washing with soap - When washing the skin around the anus avoid perfumed soap, try using one which is mild and unscented, and be sure to rinse away all the soap with water.


• When travelling - The above options may not be possible when on the move or away from home. In this case try using damp toilet tissues to clean yourself.


• If the area keeps getting moist due to sweat - Putting a cotton tissue in your underwear will absorb the sweat/moisture and reduce itching.


• Avoiding consumption of certain foods - There are a number of food types that can make the anal itching worse. If you notice the urge to itch getting worse after eating a particular kind of food, you should try to cut down on it. Below is a list of foods that are known to make anal itching worse:
  
  
  • Chocolate
  • Citrus fruits
  • Coffee
  • Dairy Products
  • Nuts
  • Spicy food
  • Tomatoes
  • Unnecessary amounts of liquids


• Things you can do yourself - There are some other ways you can keep control of your anal itching symptoms. These are as follows:
  
  
  • Use colorless plain toilet paper
  • Make sure you have a shower every day
  • Wear underwear that is made of cotton and not too tight.
  • Be sure to wear clean underwear every day.
  • Trim your fingernails regularly; scratching the anal area with long fingernails can damage the skin. Ideally scratching the area should be avoided altogether, as it can make the itching worse.


• Prescription Medication - Doctors can prescribe medication to help relieve the symptoms.


• Creams - Doctors can also prescribe creams or ointments.


• Corticosteroids - Patients with anal itching where the anal area is tender and inflamed may be prescribed a short course of corticosteroids (less than 7 days). It is applied onto the skin around the anus and will relieve the itching impulse and inflammation. It is known on occasion to make the itching worse, if this is the case it you should stop taking it and contact your doctor.


• Antihistamines - This is to be taken at night and can alleviate your itching and help you sleep.


• Treating the underlying cause - If the anal itching is the result of an underlying cause, the doctor will nead to treat that first. In most cases, if that underlying cause is effectively treated, the anal itching will resolve itself.

What are the complications of anal itching?

Scratching the anus too often can cause damage to the skin and may tear it. This can lead to the following complications:

• Lichenification - the skin around the anal area becomes thick and leathery.
• Ulceration - the skin becomes sore and breaks.
• Excoriation - the top layer of the skin wears away.
• Infection- this complication can be easily treated if the patient has prompt treatment.

Even though these complications are unpleasant, most of them can be treated effectively if you see your doctor as soon as symptoms appear.