What is Anal Itching?
Anal itching (known medically as pruritus ani) is irritation of the skin at the opening of the anal canal through which stool exits the body that leads to itching. The skin surrounding the opening is known as the anus. The itching is accompanied by the desire to scratch. Although itching may be a reaction to chemicals in the stool, it often implies that there is inflammation of the anal area. The intensity of anal itching and the amount of inflammation increases with the direct trauma of scratching and the presence of moisture. At its most intense, anal itching causes intolerable discomfort that often is described as burning and soreness.

What are the types of pruritus ani?
There are two main types of pruritus ani – primary and secondary.

Primary (idiopathic) pruritus ani – this condition has no identifiable underlying cause. This is the most common type of pruritus ani.
Secondary pruritus ani – this condition may be due to many different underlying causes. They may include infections, contact dermatitis or other dermatological conditions, systemic diseases, and other factors.
Pathophysiology of Anal Itching
The pathophysiology of pruritus ani has not been elucidated yet. It has been hypothesized that when sensory nerves in the perianal area are stimulated, skin irritation and subsequent pruritis is induced; consequently, the skin is excessively scratched, which causes skin injury. Fecal contamination due to abnormal transient internal sphincter relaxation has also been reported to result in a subsequent perianal itching problem. Feces contain endopeptidases of bacterial origin, in addition to potential allergens and bacteria. These enzymes are capable of causing both itching and inflammation.

Causes and risk factors of anal itching
Causes of pruritus ani can be either primary, meaning that there is no sign of another condition, or secondary, which means that there is an identifiable underlying cause.

Possible underlying causes include:

Hygiene: Washing too much or too little can cause irritation.
Cosmetics: Soaps and other products can irritate the skin.
Skin conditions: Dermatitis and psoriasis can cause itching.
Anal or rectal disorders: Examples include conditions such as piles, anal fistulas, and anal fissures.
Infections: Sexually transmitted infections (STIs), especially those that involve parasites, can lead to itching. Some types of bacteria, fungi (yeast), or parasites can cause itching. Staphylococcus aureus or Streptococcus pyogenes (types of bacteria), Candida albicans (a yeast), pinworms (mainly in children), and Sarcoptes scabiei (scabies mites) are some organisms that result in itching and irritation.
Systemic conditions: Some conditions that affect the whole body can cause itching, including anemia, diabetes, inflammatory bowel disease (IBD), jaundice, leukemia, lymphoma, and thyroid disease.
Incontinence: This condition can make it hard to control moisture and bacteria.
Foods: Dietary irritants include chili peppers.
Drugs: Pruritis can be a side effect of chemotherapy, colchicine (Colcrys), neomycin (Mycitracin), and corticosteroids.
What are the signs and symptoms of an itchy anus?
In addition to anal itching, you may also experience:

Burning
Soreness
Visible redness
Swelling
Ulcers
A rash


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