What to Do About Itchy Anus

Q. I have suffered from pruritus ani (itchy anus) for years. I saw different specialists who were good at diagnosing the problem but incapable of telling me what caused it or how to cure it.

Many of the treatments they prescribed (pills or creams) worked temporarily, but they didn’t really eliminate the embarrassing itch. Can you offer any remedies that might work?

How Can You Relieve Itchy Anus?

A. Itchy bottom can be caused by several factors. In fact, scientists have found nearly a hundred different causes for this condition (Annals of the Royal College of Surgeons of England, Sep. 2008). A treatment will work only if it is appropriate for the specific problem that has triggered the itch. That is why it is important to get a medical examination if the problem persists for long. Sometimes the primary problem is psoriasis. Hemorrhoids and fissures are common causes.

Some people report that diet has an impact. Coffee apparently relaxes the sphincter that keeps fecal matter where it belongs. The result may be soiling that is not visible but results in irritation. We have also heard from people who react badly to wheat, citrus fruit or chocolate. Others fault peanuts, spices, grapes or tomatoes. Although scientists haven’t studies the role of diet for controlling itchy anus, most doctors recommend paying attention.

Occasionally, fungal infections are behind pruritus ani. People with diabetes may develop yeast infections that cause itchy anus. A doctor could prescribe an antifungal medication in such cases.

Medicines That Cause Pruritus Ani

Sometimes, the medication itself is the problem. Readers report that the heartburn drugs esomeprazole and lansoprazole can cause trouble. Peppermint oil (used for irritable bowel syndrome) or colchicine (for gout) may also be irritating.

Contact Dermatitis

Moist toilet wipes that contain preservatives can cause an itchy contact dermatitis. Creams, soaps and toilet paper dye are other common culprits. Plain water or witch hazel may be better choices for hygiene.

Would a Bidet Solve the Problem of Itchy Anus?

Q. I have been diagnosed with pruritus ani, itching around the anal area. This condition causes itching so intense that it can keep me up at night.

My doctor ruled out hemorrhoids and other causes. I was told to stay away from cortisone creams, as they could make the condition worse. Is there any natural remedy that can help this intense itching?

A. You may want to start with a bidet. Gentle cleaning of the posterior with a stream of warm water may be less irritating and better than using toilet paper.

Most people associate bidets with the French, but the Japanese have perfected toilet technology. Not only do their toilets wash the bottom, but some dry it with warm air. The price can range from a few hundred dollars for a seat installed on your existing toilet to thousands of dollars for a stand-alone luxury unit.

Readers who have traveled abroad appreciate bidet-like features in a toilet:

“After suffering with hemorrhoids or itching most of my life, I found the solution on a trip to Thailand in the form of the bathroom bidet sprayers they use there. This device is the ultimate in logical simplicity; it allows you to clean without rubbing or soaps that irritate the skin and perpetuate the itching.”

We have heard from another reader who says using a bidet can be helpful:

“I have found long-term relief from itching by installing a bidet toilet seat. I never need to use toilet paper and there is no residue that can cause itch. The air dryer that comes with the seat is quite nice.”

Another option is to clean with witch hazel-dampened toilet paper. Witch hazel is a natural astringent and eases irritation.