Pruritus ani (itchy anus) can be caused by a number of factors, including hemorrhoids. Hemorrhoids occur when the veins in the anus and lower rectum become enlarged. Hemorrhoids can be internal or external and can cause symptoms such as itching and bleeding.

Read on to learn why hemorrhoids cause itching and what to do about it.

Why Do Hemorrhoids Itch?

Itching usually occurs with external hemorrhoids or internal hemorrhoids that have prolapsed (come down out of the anus). The itch can be triggered by several factors.

Inflammation

Hemorrhoids can cause an inflammatory reaction. Swelling can occur with inflammation, which contributes to symptoms like itching.

Treatment aimed at suppressing inflammation can help to ease itching and other symptoms like irritation, pain, and bleeding.

Rubbing

External hemorrhoids are susceptible to contact with things like:

• Toilet paper
• Washcloths
• Clothing
• Skin-to-skin rubbing
• Other irritants

External hemorrhoids can also develop blood clots. These clots usually resolve on their own but may leave behind a skin tag (excess skin), which can itch or become irritated.

These skin tags can also make it difficult to practice proper hygiene because they can trap particles of feces.

Rubbing of hemorrhoids or skin tags through rough wiping, cleaning, or scratching can hinder healing and make symptoms worse. It's hard not to scratch an itch, but even intense itching generally subsides on its own after five to 10 minutes.

Passing Feces

Constipation can cause straining that worsens hemorrhoids, while diarrhea can irritate the skin around the anus.

Hemorrhoids can also cause fecal leakage, which may irritate the skin in the anal area.

Natural Production of Mucus

Mucus discharge from the anus can be a symptom of hemorrhoids. As with stool, this mucus can leak out accidentally (particularly when passing gas) and cause irritation and itching.

How to Stop Hemorrhoids From Itching

In addition to measures to treat hemorrhoids directly, there are ways you can manage the itch.

Maintain Good Hygiene

Keeping the perianal area (the area around the anus) clean is important, but there can be too much of a good thing. After a bowel movement, gently clean the area with a wet cloth or an unscented baby wipe instead of dry toilet paper. Be careful not to rub or clean aggressively.

Keeping the area dry is important too. After cleansing, pat dry.

Avoid Scented Soaps

Scented and/or dyed soap, wipes, toilet paper, or other products can irritate the sensitive skin around the anus and cause itching, especially if overused or part of a rough cleansing routine.

Hydrocortisone Cream

Medication such as hydrocortisone can help shrink hemorrhoids, making it easier to keep the area clean. Hydrocortisone can also help relieve inflammation and itching.

Topical steroids such as hydrocortisone should be used in low potencies (such as 1% to 2.5% hydrocortisone), and for short periods as they can cause side effects such as epidermal thinning. Check with your healthcare provider before using topical steroids.

Sitz Bath

A sitz bath (a warm water bath for the buttocks and hips) can be taken using a small plastic tub that fits over the toilet or in a regular bathtub filled with a few inches of water.

Regular sitz baths can help relieve itching and irritation. Try 20-minute sessions after each bowel movement two or three times during the day. Make sure to gently but thoroughly dry off afterward.

Aloe Vera Gel

Aloe vera gel or cream can be helpful for some causes of anal itching, such as psoriasis or anal fissures.

Hemorrhoid Suppositories

Many hemorrhoid medications are available in suppository form. These are inserted into the anus in the form of regular suppositories or with gauze inserts ("anal tampons").

Use a Bidet

A bidet is a separate fixture or toilet attachment used to rinse the perianal and genital areas.

It can be used to cleanse after a bowel movement or rinse soap residue. A handheld detachable showerhead or a plastic squeeze bottle filled with water can also serve this purpose.

Numbing Creams

A cream or ointment that contains lidocaine can be applied to numb the area.

Topical Protective Creams and Ointments

Topical ointments can help relieve anal itch and protect the skin from irritation. They may include ingredients such as:

• Witch hazel
• Zinc oxide
• Petrolatum
• Xylocaine

Other Causes of Anal Itching

In addition to hemorrhoids, anal itching can have many different causes. In fact, many times no cause can be identified at all.

Some healthcare professionals use the ITCH acronym to identify the source, which stands for:

• Infections
• Topical irritants
• Cutaneous (skin) conditions/cancer
• Hypersensitivity
  

Anal Fissures

An anal fissure is a tear in the lining of the anus, often caused by a hard bowel movement. It may cause symptoms such as pain or itching.

Fungal Infection

Anal itching can be caused by a fungal infection such as a yeast infection.

Itch from mild fungal infections may be helped by measures such as good hygiene practices and wearing loose, breathable clothing.

Prescription antifungal medications may also help. Over-the-counter antifungal creams are not approved by the Food and Drug Administration (FDA) for rectal usage.

Virus

Anal warts are caused by the human papilloma virus (HPV), a common sexually transmitted infection (STI). The warts start as small growths around the anal/genital area, and can grow larger.

Anal warts can cause symptoms such as:

• Itching
• Bleeding
• Mucus discharge
• Feeling like there is a lump in the anal area

Genital herpes (another STI) can affect the anal region as well as the genitals. It is caused by the herpes simplex virus. Blisters, lesions, and/or scabs may develop, and the skin may itch, burn, or become irritated.

Proctitis

Proctitis is inflammation of the rectal lining.

It may occur with:

• Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease
• Certain infections, including some STIs, and food poisoning
• Radiation therapy
• Injury to the anus or rectum
• Side effects of some medications
• Lack of blood flow to the rectum

Psoriasis

Psoriasis is a chronic inflammatory skin disease that causes symptoms such as itching. It can occur in the genital and perianal areas.

Pests

Pinworms (small parasites that can live in the colon and rectum) are more common in children than adults. Many people have no symptoms, but for some the itching can be intense and interfere with sleep.

Scabies is a skin condition caused by tiny mites that burrow into the outer layers of the skin. It can also cause itching.

Poor Hygiene

To little or too much cleaning can cause itching in the perianal area.

Keep the area clean, particularly after bowel movements, but go easy. Vigorous hygiene can remove the protective mucus layer around the anus and cause or worsen itching.

Sensitivities

In addition to contact sensitivities, such as from scented soaps, food sensitivities can also cause anal itching. Some of the common culprits are the "Cs":

• Cola
• Coffee
• Chocolate
• Citrus
• Calcium (dairy products)
  

Sweat Buildup

Prolonged exposure to moisture around the anus can cause anal itching. Exposure may come from:

• Sweat
• Vaginal discharge
• Loose stools or mucus discharge

Moisture can be trapped by tight clothing, fabrics that don't breathe (such as nylon underwear), or skin folds.

You can help keep the perianal area dry by:

• Wearing breathable clothing
• Putting gauze pads or another absorbent pad in the area to soak up moisture
• Applying cornstarch powder or Zeasorb (a super absorbent powder)

Cancer

While a less common cause of anal itching, cancers should be ruled out as a cause of symptoms.

Summary

Many things can cause an itchy perianal area, including hemorrhoids, hygiene problems, infections, and sensitivities. Rubbing, fecal leakage, and poor hygiene can make the itching worse.

Gently keeping the area clean and dry can help soothe itch and irritation. Topical medications and ointments may also help when used under the advice of a healthcare professional.

A Word From Verywell

Anal itching can be uncomfortable and painful, especially if accompanied by hemorrhoids. If you are experiencing anal itching, talk to your healthcare provider to get a proper diagnosis and see what treatment options are best suited for you.