Category Archives: Pruritis Ani

Here’s Why Your Anus May Be Itching at Night | Minnesota

If you’ve ever experienced an itchy bum in the middle of the night, it’s quite an unpleasant sensation. Scratching the area may provide temporary relief, but the harshness of your nails ends up causing further irritation and damage to the already sensitive anal region.

Known as pruritis ani, this condition literally translates to “itchy anus” and occurs on an intense, cyclical basis where an unpleasant burning sensation around the anus produces the urge to scratch. This feeling typically intensifies at night or after a bowel movement, when even minimal stimulation of the anal skin can cause extreme itching.

So what causes anal itching? The exact reason for pruritis ani is unclear, but it is often linked to anorectal diseases, lifestyle habits and skin conditions. Below are a few of the more common reasons your bum may be keeping you up at night:


Anal itching is both a symptom and complication of hemorrhoids that can escalate into pruritis ani. When a patient experiences hemorrhoid flare-ups, blood vessels in the walls of their anus and lower rectum swell and bulge, often causing inflammation and bleeding. This irritation around the anus causes sporadic itching, and continuous scratching of the area can further harm the sensitive tissues and worsen symptoms.

More specifically, itching can occur when overstraining during bowel movements pushes an internal hemorrhoid outside the anus, otherwise known as a prolapsed internal hemorrhoid. Internal mucus then comes into contact with the anal tissues and prolongs the itching.


Pinworms are tiny parasites that infect the colon and rectum via ingestion of their eggs through contamination. Once the eggs hatch in your intestines, the pinworms wiggle out from the anus (especially at night) and lay eggs on the surrounding anal skin. The primary symptom is intense anal itching that causes restless sleep. However, treating pinworms is usually a simple and straightforward process of oral medication and topical creams.

Skin Conditions

Chronic skin disorders around the anal region, such as eczema and idiopathic dermatitis, can cause itching and dry, flaky skin for no apparent reason. Allergic dermatitis, however, results from the skin coming into contact with an allergen via creams, lotions, soap, powders, etc. and having a negative reaction. At times, excessive cleaning using one of the aforementioned products ends up worsening one’s anal itching. While chronic skin conditions are untreatable, allergen-based conditions can be managed by avoiding the triggering products.

Hygiene Habits

Both excessive cleaning and lack of cleaning of the anal region can irritate the skin. Over-wiping after bowel movements, especially with rough toilet paper or soap/topical products, can lead to dryness and itching.
For more information on pruritis ani and its causes and treatment methods, check out our earlier blog post here.


The Unfortunate Condition of Anal Itching | Minnesota

When you watch hospital dramas on TV you get this impression of the medical world being this dramatic place where love and life are in constant peril. This is not the case in reality. If they made a TV show about the mundane things most people go to the doctor for no one would want to watch it. In fact, it’s part of the joke in shows like House where Dr. House is punished by clinic duty.

That being said, let’s talk about pruritus ani, a rare and exotic disease caused by a river parasite in the Himalayas. OK, so that’s a lie. It’s just a fancy term for anal itching. If that’s not obvious enough, anal itching is when the skin around your anus (perianal skin) becomes intensely itchy. And now you have to go to work constantly repressing the urge to scratch your bum. If you’re reading this, you may be one of the 1-5% of the population that anal itching effects, and you’re four times as likely to be a man.

There are two types of anal itching. Primary, where there is no definitive cause, and secondary, where anal itching is the symptom of an underlying medical issue. Some of the myriad of potential causes include:

– Hemorrhoids
– Skin tags
– Poor hygiene (residual fecal matter)
– Sweat
– Diabetes
– Incontinence
– Anal fistulas
– Anal fissures
– Anal warts
– Repetitive scratching/trauma/irritation
– Medication (e.g.antibiotics)
– Skin conditions like psoriasis
– Infection
– Psychosomatic; your own mind tricking you into thinking you have anal itching (i.e. anxiety, schizophrenia, etc)
– Diet

Here are some ways to manage the symptoms. Just keep in mind that, if anal itching is a symptom of an underlying disease, merely treating the symptoms may not actually fix the cause of anal itching.
– Cleaning the anus by using a wet unscented wipe or toilet paper or washcloth.

– Avoid scrubbing.

– Avoid medicated powders, lotion, soaps, and sprays.

– Do not wear clothing that is too tight, too often.

– DO NOT ITCH. Just don’t. Wear mitten to sleep.

– Do Sitz Bath with warm water

– May take Benedry for a few nights

Most of the time, as long as you follow these steps itching should go away on it’s own, unless of course, you have an underlying condition that is causing the itching such as hemorrhoids or a fistula.

If the anal itching is associated with any type of rash, lump, discharge, bleeding, or fever, call your doctor.

Learn about Pruritis Ani | Minneapolis & St Paul

What is pruritis ani?
Pruritis ani is a Latin term meaning “itchy anus” and it is an unpleasant, intense, cyclic itching or burning sensation of the skin around the anus (rectal opening) that produces the urge to scratch. Minimal stimulation or irritation of the skin in the anal area may cause itching. The subsequent scratching may cause damage to the skin which leads to more itching and scratching, which is a vicious cycle.

Pruritis ani is classified as either primary or secondary. The primary form is idiopathic, which may not have an identifiable cause, while the secondary form has an identifiable cause. It affects up to 5% of the population in Minnesota.

The symptom of itching is common to many anorectal diseases, such as internal and external hemorrhoids, anal tags, anal fissures and fistulae, anal warts. But the difference is that itching in pruritis ani is more intense and cyclic, having an irresistible urge to scratch, and it happens more often at night or after a bowel movement.

What causes pruritis ani?

The exact mechanism of developing pruritis ani is not clear. There are many risk factors that contribute the disease.

  • Excessive Cleanliness
  • Prolonged exposure to moisture
  • Dietary factors
  • Skin Irritants
  • Infectious processes
  • Anal skin diseases.
  • How is pruritis ani diagnosed?
    The diagnosis of pruritis ani is clinically diagnosed by history, physical examination, and anoscopy. There is no test for it. In the initial office visit, your doctor may inspect the anus visually to look for skin changes or growth in the anus, followed by a digital rectal examination with a gloved, lubricated finger and then anoscopy to look for abnormalities in the lower rectum and anal canal. If indicated, your doctor may also perform a biopsy (a small piece of skin removed for microscopic examination).
    Anoscopy is a rectal exam with a very short (3 to 4 inch) rigid metal tube to examine the lower rectum and anal canal. It is very useful when your doctor suspects hemorrhoids, anal fissures and other anorectal diseases.

    How is pruritis ani treated?
    The goal of therapy is to reduce or eliminate the itching symptom and cure the disease by restoring clean, dry, and intact skin.

  • Avoid injury to the skin. This is one of the most important, but often most difficult, part treatment of pruritis ani. This means no scratching with hands or dry toilet paper, which is often very difficult to achieve, due to the intense desire to scratch. The patients should cut their nails and wear a pair of mittens at night so they are not able to scratch.
  • Thicken stool and create a formed bowel movement to minimize leakage. Most people can benefit from taking a fiber supplement. If stools still remain loose, additional medications, such as Imodium and Lomotil, may be helpful.
  • Make dietary changes. Avoiding overuse of several common foods and beverages may improve symptoms. These foods and include coffee, colas, tea, chocolate, tomatoes and beer.
  • Improve bowel hygiene or modify cleaning habits. It is important to clean the anus gently. Cleaning with plain water rinses is quite helpful. Anything containing deodorants, alcohol and witch hazel agents should be avoided. You may use diluted white vinegar.
  • Make sure the skin is dry. You may use a hair dryer on a low setting and place a wisp of rolled cotton between the buttocks and against the anus to absorb moisture.
  • Try skin barriers or short course of steroid cream in the initial stage of treatment.
  • Treat the underlying diseases such as hemorrhoids, anal tags, anal fissures, and anal warts.
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