Rectal Itching: Why Your Bottom Itches and What Helps

Why the anus itches

The skin around the anus is thin, moist and sensitive. Small amounts of stool or mucus contain enzymes and bacteria that irritate it. Sweat and friction add to the problem. Itching leads to scratching and vigorous wiping, which damage the skin further and make it itch more: the itch-scratch cycle. Breaking this cycle is the key to treatment.

In about half of cases there is no single underlying disease, called idiopathic pruritus ani, and hygiene and skin care are enough. In the rest, a specific cause can be found and treated.

Common causes

Moisture and hygiene

• not cleaning thoroughly after a bowel movement, or leakage of small amounts of stool
• over-cleaning: scrubbing, harsh soaps, wet wipes containing fragrance or preservatives, and repeated wiping
• sweating, tight synthetic underwear and sitting for long periods
• loose stools or diarrhea

Anal and rectal conditions

• Hemorrhoids: swollen veins that can leak mucus and make cleaning harder. Itching often comes with bright red bleeding.
• Anal fissure: a small tear causing sharp pain with bowel movements, and itching as it heals.
• Skin tags that trap moisture.
• Anal fistula: a tunnel from the anal canal to the skin that leaks pus or mucus.
• Rectal prolapse and weak sphincter muscles causing leakage.

Infections

• Pinworms: the most common cause in children. Itching is worst at night when female worms lay eggs around the anus. Other family members are often affected.
• Yeast (Candida): especially in people with diabetes, after antibiotics, or with sweating and obesity. The skin is red, moist and may have small satellite spots.
• Bacterial infections such as streptococcal perianal infection in children, with bright red skin.
• Sexually transmitted infections: herpes, genital warts, gonorrhea and syphilis.
• Scabies.

Skin conditions

• Contact dermatitis: reactions to fragrances, dyes, wet wipes, creams (including some hemorrhoid creams with local anesthetics) and laundry products.
• Psoriasis, including inverse psoriasis, which looks red and shiny in skin folds.
• Eczema and seborrheic dermatitis.
• Lichen sclerosus: white, thin, fragile skin, more common in women.
• Lichen simplex chronicus: thickened skin from long-term scratching.

Diet

Some foods and drinks can loosen stools or irritate the skin after passing through: coffee (including decaf), tea, cola, beer, wine, chocolate, citrus fruits, tomatoes, spicy foods, dairy and nuts.

Less common but important

• Anal cancer and precancerous changes (anal intraepithelial neoplasia): a persistent itch with a lump, ulcer or bleeding. Risk is higher with HPV infection, HIV and receptive anal sex.
• Paget disease and Bowen disease of the perianal skin, rarely.
• Systemic causes of itching: diabetes, liver disease, kidney disease and thyroid disease.

How the cause is found

A doctor will ask how long the itch has lasted, when it is worse, about bowel habits, bleeding, diet, cleaning habits, products used, other skin problems and symptoms in family members. They will look at the skin and do a gentle rectal examination, sometimes with a short scope (anoscopy) to check for hemorrhoids, fissures and growths.

Tests may include:

• the tape test for pinworms: sticky tape pressed against the anus first thing in the morning, before washing
• skin swabs for yeast or bacteria
• patch testing for contact allergy
• a skin biopsy if the skin looks abnormal or does not respond to treatment
• blood glucose to check for diabetes

How to stop rectal itching

Skin care

• Clean gently after each bowel movement with plain water: a bidet, a shower head, or damp unscented toilet paper. Avoid soap on the area.
• Pat dry with soft toilet paper or a towel, or use a hairdryer on a cool setting. Do not rub.
• Avoid wet wipes, scented products, bubble baths and powders.
• Apply a barrier cream such as zinc oxide or petroleum jelly after cleaning to protect the skin.
• A small piece of cotton placed against the anus can absorb moisture during the day.
• Wear loose cotton underwear and change it daily, or more often if sweating.

Stop scratching

• keep nails short
• wear cotton gloves at night if you scratch during sleep
• a cool compress can calm an itch attack

Bowel habits and diet

• aim for soft, formed stools with fiber supplements such as psyllium, which reduce leakage
• try cutting out common trigger foods for 2 weeks, then reintroduce them one at a time
• treat diarrhea or constipation

Medicines

• 1% hydrocortisone cream, applied thinly once or twice a day for up to 1 to 2 weeks, can calm inflammation. Do not use steroid creams long-term, because they thin the skin.
• Antifungal creams for yeast.
• Pinworm treatment: mebendazole, pyrantel pamoate (over the counter in the US) or albendazole. The whole household is usually treated, with a second dose after 2 weeks.
• Prescription treatments for persistent cases, such as topical capsaicin or tacrolimus, under specialist care.
• Treating hemorrhoids, fissures or skin diseases directly.

Most people improve within 2 to 4 weeks once the itch-scratch cycle is broken.

Frequently asked questions

What causes rectal itching?

The most common cause is irritation from moisture, traces of stool, over-wiping, harsh soaps and scratching. Hemorrhoids, anal fissures, pinworms, yeast, skin conditions such as psoriasis and eczema, and certain foods like coffee, spicy foods and citrus are also frequent causes.

Why is my bottom itchy at night?

Warmth in bed and fewer distractions make any itch feel worse at night. Pinworms are a classic cause of night-time anal itching, especially in children, because the worms lay eggs around the anus at night. The tape test can confirm pinworms.

How do I stop rectal itching fast?

Rinse with plain water, pat dry gently, apply a zinc oxide barrier cream and avoid scratching. A thin layer of 1% hydrocortisone cream for a few days can calm inflammation. Wear loose cotton underwear. See a doctor if it does not settle within 3 to 4 weeks.

Can hemorrhoids cause itching?

Yes. Hemorrhoids can leak mucus and make it harder to clean the area, which irritates the skin and causes itching. They often also cause bright red bleeding after bowel movements. Treating the hemorrhoids and keeping the area clean and dry usually relieves the itch.

Can rectal itching be a sign of cancer?

Rarely. Anal cancer can cause itching, but usually with other signs such as a lump, a non-healing sore, bleeding or pain. A persistent itch that does not respond to treatment, or any of these signs, should be examined by a doctor.