Pruritus ani poses many challenges

I often see patients with a complaint of anal irritation and itching. Anal itching is very bothersome and is usually the reason the person decides to seek medical help. Generally, the patient has already tried many of the over-the-counter anal creams, ointments, and suppositories and they often get no relief from the anal itching. The official medical wording for the diagnosis of anal itching is “pruritus ani.” This medical diagnosis is very properly named, because “pruritus ani” is the Latin term for “itchy anus.” The medical term “perianal” describes the location as being “around the anal opening.”

Anal itching may be off and on, or may be present every day. In severe cases, there is an intense anal itching all day long and the itching may be severe enough to even keep a person awake at night. Without proper treatment, the perianal tissues may become inflamed and irritated to the point of causing slight rectal bleeding with bowel movements, and blood spotting may also be seen on the toilet tissue after wiping. Of course, all rectal bleeding must be evaluated by your health care provider to be certain the true source of the bleeding is identified.

Certainly, it is appropriate to gently cleanse the anal area when bathing, but not to excess. With anal itching, patients often believe this is caused from the anal area not being clean enough.

Therefore, patients with anal itching and irritation frequently and aggressively wash their anal area when they shower or take a bath. They may also wash this area after each bowel movement. Here is what people with anal itching really need to know. Excess cleansing of the perianal area is the cause of the anal itching and irritation!

Here is what happens with overzealous and excess perianal cleansing. When the perianal skin initially becomes irritated and inflamed, the body naturally lays down epithelial (skin) cells to heal the perianal area as part of the body’s normal healing process. If the itching persists, it is logical to believe that the anal area must not be clean enough.

So, we then come along with our bar of soap, wash cloth, and frequently scrub this area vigorously. Well, guess what! We just washed off all the cells trying to heal this area, and the inflammation, irritation, and itching only gets worse! Further, because of the strong anti-bacterial properties of most bars of soap, a perianal yeast infection will often develop, and this adds significantly to the itching.

The following is a very effective way to get rid of the anal itching and irritation. First, one must stop all soap and excess cleansing of the anal area. When irritated, the anal area should only be cleaned with water and generally no more than once a day. There should be no scrubbing of the anal area. Following a shower, the area should be gently patted dry. In addition to stopping all soap to this area, I prescribe a 10-day course of the prescription cream Lotrisone, with only a small amount to be applied to the anal area twice a day. Lotrisone will decrease inflammation and it also is anti-yeast.

A high fiber diet with daily fiber supplements will prevent diarrhea and/or constipation, both of which can irritate the anal canal. If you have persistent anal irritation, be sure to see your health care provider to properly diagnose the cause.

It will most likely be from the most common cause of anal itching – excess perianal cleansing!

Editor’s note: Dr. Jim Surrell, author of “SOS (Stop Only Sugar) Diet,” has his practice at the Digestive Health Clinic at Marquette General Health System. Requests for health topics for this column are encouraged. Contact Dr. Surrell by email at