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Pruritus ani
Diffuse all round is not the same as a spot you can point to — and cleaning more thoroughly almost always makes it worse, not better.
Also known as: pruritus ani · anal itching · itchy bottom at night · anal eczema · burning at the anus · sore back passage
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Itching at the back passage is common, awkward to talk about and therefore often self-treated for years. It is almost always worst in the evening and at night, because warmth, quiet and the absence of distraction come together. One distinction decides most of it: does it itch all round and diffusely, or is there a spot you can point to? Diffuse and wandering fits irritated skin, moisture, traces of stool — and in children threadworms. A single, one-sided or raised spot that stays for weeks is something else and needs looking at. The second point is a loop almost everyone falls into: it itches, you clean more thoroughly, the skin barrier thins, it itches more. Wet wipes, disinfectants and soap are not the solution but usually part of the problem — they are among the commonest causes of contact allergy in exactly this area. Knowing the pattern gets you a long way with very little: clean less rather than more, keep it dry, a protective layer rather than an active ingredient. And if nothing turns within two to three weeks, the next step is to look, not to try another product.
If it also itches between the fingers, at the wrists or at the belt line, and above all at night, a mite is likelier than threadworms — the treatment is quite different.
No wet wipes, no disinfectant, no soap on the area. Water only, then dab dry instead of rubbing. If a product was the trigger, it turns within that time.
A plain zinc paste or a greasy ointment thinly applied in the evening keeps moisture and irritants off the skin and lets the barrier settle.
Cotton underwear, nothing tight, air dry or use a cool hairdryer. A soft tissue laid in loosely keeps it dry overnight.
Neither hard nor liquid. Both leave traces or require straining, and both keep the skin irritated.
A steroid on a fungus looks better first and then gets markedly worse — the edges blur and it becomes harder to recognise afterwards. The swab costs nothing and saves months.
Before washing and before opening the bowels. And if treated, the whole household at once with the repeat dose after two weeks — otherwise it comes back.
A spot that stays despite everything, is one-sided or becomes raised needs looking at — by a dermatologist or a proctologist. This is not about drama, but about a look settling what creams leave open.
In women with night-time itching and pale, thin skin it is at the top — it typically involves front and back at once.
Wet wipes, disinfectants and ointments are the commonest triggers here — and if it gets worse under treatment, the product is the suspect.
A swab or skin scraping settles in one appointment what creams leave open for months. Two kinds come into question — a yeast in the moist fold and a dermatophyte carried in from the foot or groin. They are treated differently.
Sit for ten minutes in hand-warm plain water, once or twice a day, then dab dry gently.
After a bowel movement clean with lukewarm water instead of rubbing, apply cool compresses, do not sit longer than three minutes on the toilet.
One to two tablespoons of ground linseed or a tablespoon of psyllium husks with at least 250 ml of water, once a day.
If the itch follows the time of day — strong in the evening, gone by day — and a child lives in the house, the adhesive-strip test is worth doing before any cream.
Cortisone ointment takes the itch away for days — beyond two weeks it thins the sensitive skin and makes things worse, and that circle is what holds many people. What works is less rather than more: no wet wipes, no soap, no perfumed care; after a bowel movement clean with plain water and pat dry, then a zinc paste as a barrier. In children, threadworms are considered.
About one to five in a hundred adults are affected, men more often. In about one in four no cause is found. The itch is strongest at night, because there is less distraction and the skin is warmer. Cortisone ointment is used for at most two weeks, because the skin there is thin. After dropping wet wipes and soap it improves in many within two to four weeks. In children, threadworms are considered — the sticky tape test in the morning shows them.
The single most important question. Diffuse and wandering suggests irritated skin or worms; a spot you can point to and that stays suggests something of its own.
The signature of a fungus: it grows asymmetrically rather than all round, has a slightly raised, more active edge, lasts for months and does not respond to disinfection. Anyone thinking only of irritation misses it for exactly that reason.
True of almost every cause, so it separates nothing — warmth, quiet and lack of distraction amplify any itch.
Wet wipes, disinfectants, ointments, soap, intimate sprays. Contact allergies arise here especially easily — and the remedy becomes the cause.
Pale, parchment-like skin with small splits, often at the front too: that is the picture of lichen sclerosus, missed for years in women on average.
If not everything comes away after opening the bowels, the remainder irritates the skin. The cause is often haemorrhoids or too soft a stool — not poor hygiene.
Night-time itching, restless sleep, fidgeting. In an adult with a single persistent spot the picture no longer fits.
A raised blood sugar favours fungal overgrowth and itching and is often first found through the skin.
An empty store causes itching all over — worth checking if it does not itch only here.
Both over- and underactivity dry the skin and change the bowel habit at the same time.
Bile backing up typically itches all over and worst at night — relevant here only if it is not confined to this one place.
Almost always normal with threadworms. A normal value does not argue against them — the tape test is what checks it.
Soluble fibres like psyllium and oats bind water and make the stool supple. Wheat bran and a lot of raw vegetables, by contrast, increase bloating and pain in a sensitive gut — this distinction explains most of the failures.
Fibre without water makes the stool harder instead of softer. The two belong together, and the effect only sets in after some days.
Draws water into the bowel and therefore works with a sluggish stool. The belly shows the upper limit: if the stool gets too loose, the dose at once was too high.
Yoghurt, kefir, sauerkraut and the like bring living cultures with them. Many tolerate them well; with a strongly bloated belly they can also do the opposite in the first weeks.
Soft, formed stool reduces wiping and irritation — that is exactly where the benefit lies. 5–10 g a day with plenty of water, worked up over 1–2 weeks.
Zinc ointment from outside lays a film over the irritated skin. Zinc swallowed does nothing here as long as there is no deficiency.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Cortisone ointment helps briefly and thins the skin over weeks — then it itches more than before. That is the circle most people get stuck in here: two weeks at most, then a break.
Sugar in the urine and in the skin feeds yeasts — lasting itch at the anus or in the genital area with no other reason is among the classic first pointers to sugar that is too high.
The itch is almost always stronger at night — the skin is warmer, better supplied with blood, and nothing distracts. That holds for any itch and is no sign of a particular cause.
Coffee, citrus, hot spices, beer and chocolate are often named. Two weeks without and then testing one at a time shows whether it applies — local moisture usually matters more than the diet.
Hard stool irritates mechanically, very soft stool keeps the skin damp. 25–30 g fibre with enough fluid finds the middle.
Lukewarm water instead of soap and moist paper — both are more often triggers than cause.
Zinc-containing or calendula ointments protect the skin while it heals.
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