What is pruritus ani?

Pruritus ani is the medical term for severe itching around the anus. It is a common condition that causes an overwhelming urge to scratch, often worsening at night or after a bowel movement. It is more frequently seen in men than in women or children.

Causes of pruritus ani

There are several potential causes of pruritus ani, including:

Anal conditions

• Haemorrhoids (piles) and anal fissures can cause tiny amounts of leakage, leading to skin irritation and itching

• External anal skin tags can make hygiene difficult, contributing to irritation

Hygiene and moisture-related factors

• Sweating around the anal area is a common trigger

• Residual stool or excess moisture left after bowel movements can cause skin irritation

Underlying skin conditions

• Anal intraepithelial neoplasia (AIN) and other dermatological conditions may contribute to itching

• Fungal infections of the anal skin can cause persistent itching and discomfort

Dietary triggers

Certain foods and drinks may irritate the anal skin after a bowel movement, including:

• Tea, coffee, and carbonated drinks

• Milk and dairy products

• Tomatoes, citrus fruits, and spices

• Alcohol (especially beer and wine)

• Chocolate and cheese

Irritants from soaps and hygiene products

• Perfumed soaps, wipes, and lotions can trigger local irritation

Parasitic infections

• Threadworms, a common cause of anal itching in children, can spread to other family members if not treated

How is pruritus ani investigated?

A detailed clinical history and a thorough examination of the anal skin, anus, and rectum are required to determine the underlying cause.

Diagnostic tests may include:

• Proctoscopy or rigid sigmoidoscopy – Used to inspect the lower bowel and identify any contributing conditions

• Skin biopsy – May be required to diagnose underlying skin conditions such as AIN or fungal infections

Treatment for pruritus ani

Addressing underlying causes

• If haemorrhoids, anal fissures, or skin tags are present, treatment is recommended to relieve symptoms.
• AIN and other skin conditions may require surgery or close monitoring.

Antifungal treatments

• Fungal infections usually respond well to antifungal creams.
• Overuse of creams containing steroids can damage the skin and worsen symptoms, so it is essential to follow medical advice.

Treatment for threadworms

• Family-wide treatment is often necessary to prevent reinfection.

Lifestyle and hygiene measures

• Thorough but gentle cleaning of the anal area after bowel movements is recommended.
• Avoiding dietary triggers may help reduce irritation.
• Avoiding perfumed soaps and wipes can prevent further skin sensitivity.

For more information on managing pruritus ani, refer to the pruritus ani advice sheet.

Why choose the Midlands Bowel Clinic?

• Specialist colorectal consultants experienced in diagnosing and treating pruritus ani and related conditions

• Comprehensive investigations, including proctoscopy, sigmoidoscopy, and skin biopsy if required

• Personalised treatment plans, including lifestyle modifications, dietary advice, and medical treatments

Contact us

If you are experiencing persistent anal itching, irritation, or discomfort, contact us today to discuss diagnosis and treatment options.