What Causes Itching in the Anal Area?

Conditions like hemorrhoids and pinworms can cause uncomfortable anal itching. But there are some surprising culprits that also can lead to an itchy bottom.

Though embarrassing and uncomfortable, an itchy bottom is a common condition. You might worry that you have a health condition like hemorrhoids or pinworms, but there are many different causes of anal itching.

“Very often, itching is from neither hemorrhoids nor pinworms,” says Robert Nunoo, MD, a colorectal surgeon with WakeMed in Raleigh, N.C. “It could even be dietary.”

From spicy foods to alcohol, a number of foods can irritate the anus. Figuring out what exactly is causing the irritation can be tricky because it takes about 24 to 36 hours after eating or drinking an irritant for the itching to begin, according to Harvard Health.

“Skin infections and fungal infections like jock itch can spread down there,” says Dr. Nunoo.

Personal habits, like washing too much or not enough, can also cause anal itching. Aggressive scrubbing may irritate the skin and trigger an itch. On the other hand, not cleaning the area properly and leaving stool behind on the skin can trigger one, too, notes Harvard Health.

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Do I Have Hemorrhoids?

Hemorrhoids are swollen veins in your anus and rectum. About 75 percent of adults have hemorrhoids from time to time, according to Mayo Clinic.

“We all are born with blood vessels found in the anal canal,” says Dr. Nunoo. “There are things that lead to the vessels getting bigger, and very commonly this is pressure.” Under pressure, the veins can stretch and swell. For instance, “if you’re constipated and pushing real hard, that can lead to hemorrhoids,” he says. “Pregnancy increases pressure down in the pelvis. People who lift weights put a lot of pressure on the pelvis, too.”

Besides anal itching, hemorrhoid symptoms include pain, discomfort and bleeding. Sometimes the swelling, or protrusions, can be felt, says Dr. Nunoo. To diagnose hemorrhoids, your doctor may perform a digital examination and a visual inspection.

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Do I Have Worms?

Pinworms are staple-sized parasites that can live in your colon and rectum. They can enter your body if you accidentally swallow their eggs. While sleeping, pinworms leave your body through your anus and lay eggs on your skin. This can cause anal itching, difficulty sleeping and abdominal pain.

Pinworm infections are the most common worm infection in the United States, according to the Centers for Disease Control and Prevention. School-age children and preschoolers have the highest rates of infection. “If you’re worried about worms, you should go to the doctor,” says Dr. Nunoo.

To help your doctor diagnose the worms, you might need to do a tape test. As soon as you wake up, you’ll press the adhesive side of transparent tape around your anus. Pinworm eggs stick to the tape and can be brought to your doctor.

Once a diagnosis is made, anti-parasite medications like mebendazole or albendazole may be prescribed to get rid of the worms.

What Can I Do About Anal Itching?

“If the itching is something that’s happening on a daily basis or you’re scratching in the middle of the night, it’s time to see a doctor,” Dr. Nunoo advises.

Before heading to the doctor, if possible, jot down any foods or other factors that you suspect could be the culprit of the itching. “I recommend doing a food diary to see if you can find any correlation,” he says. “Coming in with a food diary will make it a lot easier for your doctor to help you.”

Dr. Nunoo has specific advice about hemorrhoids: “The best thing you can do for your colon health to prevent hemorrhoids is consume fiber,” he says. “Eat a lot of fruits and vegetables. For those who already have hemorrhoids, I encourage taking a fiber supplement like Benefiber or Metamucil — any over-the-counter fiber supplement.”

“Not everything that is painful or itchy around the bottom is hemorrhoids,” reminds Dr. Nunoo. “Many things can cause symptoms, like fissures and fistulas. If you're bleeding, you should get a colonoscopy to ensure that it’s not colon or rectal cancer.”