Anal Dermatitis / Pruritus Ani

Anal Dermatitis (Pruritus Ani) refers to itching around the anus, regardless of the cause. In some cases, the reason for the itching might be obvious, such as dermatitis or a history of skin disorders elsewhere on the body. Your doctor will help you determine the underlying cause by asking lifestyle questions and conducting tests. Itching, burning and soreness are frequently experienced together. Much of the time, patients attribute their symptoms to hemorrhoids, but often the creams, wipes and other such treatments cause irritation of the skin, worsening the itching.   Itching around the anus may also worsen from scratching or rough cleansing and wiping, leading to abrasions and injury to the delicate area.

Potential Causes

Some of the most common causes of pruritis ani include moisture, skin irritation and scratches or abrasions. Hemorrhoids and fissures may also directly lead to itching. Simple factors such as moisture condensing in the area (from perspiration, staying in damp clothes or bathing suits, or not completely drying after washing) can lead to itching and exacerbate already sensitized skin.

Although it might seem like an obvious conclusion, anal dermatitis is very rarely about a lack of hygiene. In fact, the opposite might be true: A lot of people wash too vigorously once the itching starts, sometimes rubbing hard with a washcloth or using strong soaps or cleaners. This in turn can worsen the condition by irritating the skin and causing it to crack and split.

In some people, pruritis ani can indicate a reaction to certain foods and drinks. For example, foods like cheese (and dairy products, in general), tomatoes, coffee/tea, chocolate and carbonated beverages could lead to anal dermatitis. This can happen even if the person doesn’t seem to have a true allergy to the food itself. It is more related to the chemicals and pH of the food and how this affects the stool. Occasionally, a medication can be the source of anal irritation. An in-depth talk with your doctor is sometimes the only way to determine the root of your anal problems.

If the cause of itching around the anus can’t be determined easily, your doctor might recommend a consult with a dermatologist to rule out underlying skin issues that could be causing the itching. Anorectal disorders such as inflammatory bowel disease or a bacterial infection could also be behind the itching, and these also might need to be investigated if the original plan of treatment doesn’t seem to provide relief.

Dealing with Anal Dermatitis

During your consultation, your doctor will conduct a review of the symptoms, asking you questions to determine when the itching started, what has changed in your lifestyle or health over the previous few weeks, and whether you are experiencing other issues (i.e., hemorrhoids, skin rashes, diarrhea). Once your doctor has determined the cause of the problem, he or she can counsel you on the best way to deal with it.

Often, treatment of anal problems consists of several steps:

  • Identifying hemorrhoids, fissures, or infections and initiating the appropriate treatments.
  • Keeping the area dry. Take a shower or wash the area carefully after exercise or if you are perspiring. Then pat dry and make sure you air dry completely. Topical astringents like witch hazel should be used cautiously. Cornstarch powder may be useful as well.
  • Cleaning gently. Avoid harsh soaps and wipes. Clean gently with quality soft toilet paper taking care to blot more than rub across the anus. Occasionally, gentle hypoallergenic baby wipes may be helpful, but should be stopped if the itching persists. Avoid cleansing with sponges, louffas or washcloths, altogether. Soaking in warm water or showering works well. And use only mild soaps such as Balneol, Dove Sensitive skin or Ivory, if soap is needed.
  • Use topical medications as directed. Stop all hemorrhoidal creams, suppositories and wipes. If your doctor prescribes a cream for topical application, apply as directed. Many times, barrier creams like those containing zinc oxide are helpful.

If you have diarrhea or frequent soft stools, your doctor may recommend fluid restriction or antidiarrheals to diminish local irritation from excessive bowel movements and cleansing.

Many times, patients have relief in a few days, but some cases may take longer. Your doctor might recommend additional tests like a colonoscopy, skin biopsy or lab work to figure out if there’s something else behind your anal problems.

The Saleeby & Wessels Proctology Approach

At Saleeby & Wessels, we want you to have confidence to come to us with even the most stressful colon and rectal health problems, including anal dermatitis. We understand that you might feel embarrassed, but this is a very common condition and fewer than 10% of cases are chronic and persistent. So let us help you find a solution to your problem. We will treat your symptoms and help you be proactive about your colon and rectal health going forward.

Our board-certified colon and rectal surgeons are experts at healing conditions such as Pruritus Ani. We are skilled and experienced surgeons having completed advanced rectal and colon surgical training, as well as general surgical training, and passed the examinations of the American Board of Surgery and the American Board of Colon and Rectal Surgery.

We provide you with the care and understanding you need and are committed to putting our patients first – every step of the way.