There are certain body parts where an incessant itch can be extremely uncomfortable and inconvenient. Your butt is undoubtedly number one on that list.
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Indeed, intense anal itching can be infuriatingly irritating (and embarrassing). But other than feeling like you have annoying ants in your pants, should you be concerned about a persistent prickliness in your posterior parts?
Called pruritus ani, an insistent itchy sensation in the skin around the anus is quite a common condition. In addition to itchiness, you might also experience other symptoms including, per the Cleveland Clinic:
- Scratches (excoriations)
- Thick or leathery skin on or around your anus (perianal area)
While pruritus ani is prevalent, there are many possible causes (some more serious than others).
Here, gastroenterologist Elena A. Ivanina, DO, MPH, shares the main reasons for your rump itch, plus tips on how to ease the itch.
When your butthole is hounded by an irritating itch, your first reflex is likely to scratch it. But try to resist the uncontrollable urge. Scratching your anal region can result in further irritation or cause skin damage or an infection, according to the Cleveland Clinic.
1. You Have Hemorrhoids
You probably already know that painful hemorrhoids can hassle your hind end. But they can be itchy, too.
"Hemorrhoids are the veins that everyone has on the inside of our rectum (internal) or outside of the anus (external)," Dr. Ivanina says. But if they get engorged with blood due to higher pressure, they can become symptomatic with bleeding, pain and itching, she explains.
If you have large external hemorrhoids, you might find it hard to wipe thoroughly after a bowel movement, according to the Cleveland Clinic. Problem is, if stool lingers in the folds of skin around your anal area, it can cause irritation.
What's more, internal hemorrhoids may lead to a leaky anus, which can create the same unsanitary issue, per the Cleveland Clinic.
Fix it: “To diagnose, hemorrhoids your physician needs to perform a rectal exam,” Dr. Ivanina says. Treatments range from stool softeners, sitz baths and creams to outpatient procedures and even surgery for more severe cases, she says.
2. You Have an Anal Fissure
An anal fissure — a tear in the skin of the anal canal — is also connected with an annoying anal itch.
Anal tears are often attributed to trauma to the area, which may result from constipation, straining during a poop session, extended bouts of diarrhea, anal sex or anal stretching, according to the Cleveland Clinic.
On top of itching, anal fissures can also be extremely painful, especially during and after passing a bowel movement, Dr. Ivanina says.
Additional symptoms of anal fissures include, per the Cleveland Clinic:
- Blood on the outside surface of the stool
- Blood on toilet tissue or wipes
- A visible crack or tear in the anus or anal canal
- Burning that may be painful
- Discomfort when urinating, frequent urination or inability to urinate
- Foul-smelling discharge
Fix it: “To diagnose an anal fissure, your physician needs to perform a rectal exam and then treat according to severity, starting with stool softening, creams and procedures [such as Botox injections or surgery] if necessary,” Dr. Ivanina says.
3. You Have Pinworms
Pinworms — small, thin, white roundworms about the size of a staple — can live in the human colon and may produce that prickly feeling in your perianal area, Dr. Ivanina says. (Ew).
When an infected person sleeps, these parasites (called Enterobius vermicularis) leave the gut through the anus and deposit their eggs on the surrounding skin, which aggravates the area and initiates the itch, Dr. Ivanina says.
Not to alarm you, but pinworm infections are prevalent. Approximately 1 billion people (mostly children) are affected by these parasites, according to the Cleveland Clinic. They're also highly contagious — you can catch them if you touch the sheets, underwear or towels of someone with pinworms, or by inhaling the pinworm's egg, per the Cleveland Clinic. Another way they spread: if someone itches the area, then handles something that someone else then touches or picks up, according to the New York State Department of Health.
Despite how common this infection is, Dr. Ivanina says pinworms are tricky to diagnosis because they are not found in a typical parasite stool test.
Fix it: While these parasites don’t cause any serious medical problems, the best way to clear them from your colon is by seeking medical attention.
To properly diagnose pinworms, "you must either look for the worms in the perianal region two to three hours after going to sleep or touch the perianal skin with transparent tape to collect pinworm eggs around the anus first thing in the morning to be examined under a microscope,” Dr. Ivanina says.
Once diagnosed, treatments include anti-parasitic medications such as mebendazole, pyrantel pamoate or albendazole, Dr. Ivanina says.
4. You Have an Anal Yeast Infection
When you think of yeast infection, you likely associate it with a different body part — the vagina — but anuses are also susceptible to these issues, too.
"A yeast infection can occur anywhere on your body, including the anus," Dr. Ivanina says. "The most common cause is from a yeast called candida, which creates an extremely itchy rash around the anus."
An overgrowth of candida can occur whenever your body's natural balance of yeast and bacteria become interrupted, according to the Cleveland Clinic.
"This overgrowth can be triggered by [the use of] medications like antibiotics, steroids or from medical conditions such as diabetes," Dr. Ivanina says.
Other signs of an anal yeast infection to look out, per the Cleveland Clinic, are:
- A burning sensation
- Irritated skin
- Anal pain and soreness
- Bleeding or other discharge
Fix it: If you have any of the above symptoms, see your doctor. According to Dr. Ivanina, an anal yeast infection is diagnosed by physical examination and is treated with antifungal creams. Good anal hygiene — including keeping the area clean and dry — can also reduce your risk of a yeast infection, she adds.
5. You Have a Skin Condition Like Psoriasis
Not even your anus is exempt from skin issues like psoriasis. That's because your anal region is covered with skin, which means it's fair game for the same dermatological disorders that develop elsewhere on your body.
"Although psoriasis most commonly affects the knees, elbows, trunk and scalp, it is an itchy autoimmune rash that also affects the perianal region as well," Dr. Ivanina says.
In addition to itching, common symptoms of psoriasis include, per the Mayo Clinic:
- A patchy rash that varies widely in how it looks from person to person, ranging from spots of dandruff-like scaling to major eruptions over much of the body
- Rashes that vary in color. (They tend to be shades of purple with gray scale on brown or Black skin and pink or red with silver scale on white skin.)
- Small scaling spots
- Dry, cracked skin that may bleed
- Burning or soreness
- Cyclic rashes that flare for a few weeks or months and then subside
Fix it: “This diagnosis requires a thorough examination by a physician and is treated with creams and, in the most severe setting, immunomodulatory medications to calm an overactive immune system,” Dr. Ivanina says.
6. You’re Eating Certain Trigger Foods
Hate to break it to you, but some of your favorite foods — including your cherished cup of morning joe — have been associated with anal itching.
Yep, foods with a lot of caffeine — like coffee, tea, chocolate, energy drinks and some sodas — can relax the internal anal sphincter muscle, Dr. Ivanina says. "[Caffeine] is thought to be a major contributing factor, as it may lower the anal resting pressure and contribute to leakage of stool that causes irritation and itching," she adds.
Other foods that can induce anal itching include citrus fruits, tomatoes, spicy foods, beer and dairy products, Dr. Ivanina says.
Fix it: According to Dr. Ivanina, an elimination diet may help you identify or figure out which food is producing your pruritus ani predicament. Here's how to do an elimination diet: Cut out one food every few days and take notice of your nether bits. If your symptoms subside after removing a certain food, you know it's the reason for your itchy rear end.
7. You’re Using Irritating Products
While most people don't ponder their perianal area as much as their facial region, the skin down there is just as sensitive and susceptible to irritation from certain types of products.
Things such as scented soaps, powders, lotions, creams and ointments can all activate an allergic reaction and result in an itchy rump, according to the Cleveland Clinic. Even toilet paper — if it's too tough — can trigger a itch.
If you clean your bottom with baby wipes, you might run into a similar problem. That's because many wipes contain chemicals that can dry out the delicate skin of your derrière, per the Cleveland Clinic. And alcohol-free wipes aren't any better; they may still include substances that can be harsh on your hind end.
Fix it: To prevent pruritus ani, pick products — including toilet paper and soaps — that are made without dyes or scents, which can contain allergens or chemical irritants, according to the Cleveland Clinic.
Instead of baby wipes, stick to a splash of water, which should suffice to keep your butt fresh, per the Cleveland Clinic.
8. You Have Chronic Diarrhea
A chronic case of the runs can result in an itchy, irritated rear.
That's right. You have a higher probability of pruritus ani if you have perpetually loose poops, according to the Cleveland Clinic. So, what's the correlation?
"Diarrhea can often lead to suboptimal perianal hygiene," Dr. Ivanina says. That's because if you're pooping persistently, stool remnants are more likely to stick around your anus and aggravate the skin there, she says.
What's more, itching and irritation are also possible side effects of sitting on the toilet too long, Dr. Ivanina adds.
Fix it: “Diarrhea can develop as a result several causes,” Dr. Ivanina says. “Therefore, chronic diarrhea always requires a thorough evaluation by a gastroenterologist with endoscopy, colonoscopy, lab tests, stool tests and breath tests,” she says.
And to ensure your anal region stays sanitary and stool-free, consider buying a bidet. “One of the best tools available for perianal hygiene is a bidet attachment to keep the anal area clean,” Dr. Ivanina says. Avoid harsh wiping and soap products, which as we already know, can cause more irritation.
9. You Have a Sexually Transmitted Infection
Sexually transmitted infections (STIs) can also initiate itchiness in the anal region.
"Common culprits include chlamydia, gonorrhea, syphilis, human papilloma virus (HPV), genital warts and herpes simplex virus," Dr. Ivanina says.
In addition to anal itching, STIs with anorectal involvement can also involve pain, tenesmus (a frequent feeling that you need to pass poop even though your bowels are empty), urgency, drainage, bleeding, ulcerations, inflammatory lesions and proctitis (inflammation of the rectal lining), Dr. Ivanina says.
Fix it: Many STIs require treatment with prescription medication, so it’s important to consult with your doctor immediately if you believe an STI is setting off that scratchy sensation down below.
What’s more, “human immunodeficiency virus (HIV) transmission is increased in the setting of active STIs, therefore it is very important to test and treat as early as possible,” Dr. Ivanina adds.
10. You’re Taking Certain Medications
The source of your scratchy backside could be in your medicine cabinet.
Certain medications — such as topical steroids, laxatives, colchicine, quinidine, peppermint oil and some antibiotics — can lead to an itchy anus, Dr. Ivanina says.
"Medications can cause pruritis ani in many ways," Dr. Ivanina says. For example, antibiotics can disturb the local microbiome, which can lead to anal itching, she explains.
Fix it: If you suspect your medication is messing with your bottommost body part, tell your doctor. They may be able to prescribe you a different drug or dosage.
11. You Have an Another Underlying Health Condition
Some underlying medical conditions can cause itchiness.
Health problems like diabetes, liver disease, leukemia, lymphoma, renal failure, iron-deficiency anemia and thyroid disease can cause general itching, Dr. Ivanina says. "Sometimes, [the condition] may affect the anus, specifically."
Fix it: See your doctor who can properly assess and diagnose any underlying medical issues that may be instigating anal itching.
12. You’re Dealing with Anxiety or Stress
Believe it or not, your itchy butt could be related to your psychological wellbeing.
Dr. Ivanina says that anxiety, stress and depression may impact your bottom, too. "These conditions may contribute to anal itching through the gut-brain axis," she explains.
The gut-brain connection — also known as the enteric nervous system — consists of more than 100 million nerve cells that cover your GI tract, from your esophagus to your rectum. These nerve cells play a prominent role in mood, according to Johns Hopkins Medicine.
That means that your actual brain and your butt can communicate. And if you're under psychological distress, it's possible that this can increase sensitivity to the perianal area, Dr. Ivanina says.
Fix it: Rule out any physical causes of anal itching first. See your doctor for a thorough evaluation, Dr. Ivanina says. If anxiety, depression or stress turn out to be the root cause of your anal discomfort, consider seeking therapy to help manage your feelings and thereby improve your itchy symptoms.
When Should You See a Doctor About an Itchy Butt?
"If transient anal itching develops and resolves after a few days, there is no need to get further evaluation," Dr. Ivanina says.
However, when the itching is persistent and is associated with other symptoms such as bleeding, diarrhea or pain, see your physician right away, she says.
- Cleveland Clinic: “Anal Itching (Pruritus Ani)”
- Johns Hopkins Medicine: “The Brain-Gut Connection”
- Cleveland Clinic: “Itchy Bottom? Don’t Blame Hemorrhoids”
- Mayo Clinic: “Psoriasis”
- Cleveland Clinic:” Anal Yeast Infection”
- Cleveland Clinic: “Anal Fissures”
- Cleveland Clinic: “Pinworms”
- New York State Department of Health: "Pinworm Infection"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.