Itching in the anal area: causes and remedies

Skin irritation in the anal area is not unusual, but it is still considered a highly sensitive and taboo subject. Many affected people suffer itching, burning or irritation of the skin for prolonged periods of time. But there are effective treatments available to combat these symptoms.

When the skin is red and itchy, most people do not have a problem finding a remedy and, if necessary, consulting a doctor. It's a different story when symptoms appear in the anal area. Then, because they feel ashamed, many sufferers accept strong discomfort without taking steps to relieve it.

But it is advisable to consult a dermatologist or proctologist (a specialist in anorectal diseases), because anal irritation (pruritus ani) usually occurs as a result of another condition. It is important to address this to prevent the acute symptoms from developing into a chronic disease.

Anal eczema caused by chemical or mechanical irritation

In many cases, anal eczema is caused by chemical or mechanical stimulation. On the one hand, such irritations can be triggered by incorrect or exaggerated hygiene. The sensitive skin in the anal area is easily penetrable by foreign substances and reacts sensitively to washing agents like surfactants in shower lotions, as well as to care products with skin-irritating additives such as parabens or fragrances. In some cases, already reactions to moist, coloured or rough toilet tissues may cause anal eczema, as can anal intercourse and rubbing underwear.

Intense sweating and poor anal hygiene (also common in those with a lot of hair) can also contribute to skin irritation. Stool itself also contains several aggressive substances, including protein-splitting enzymes, which actively attack the skin. Thus, frequent diarrhoea, e.g. due to chronic inflammatory bowel diseases such as ulcerative colitis or Crohn's disease, and faecal incontinence often cause severe irritation.

Allergies and atopy can lead to anal eczema.

Anal eczema frequently arises in the context of immunological reactions, particularly due to:

Contact allergies, e.g. to perfumes and preservatives, latex or nickel (diagnosis by epicutaneous test).
Allergenic, incompatible or irritating foods
Neurodermatitis

More causes: Haemorrhoids, fistulae or infection?

In addition to anal eczema, other influences also cause intense itching in the anal area. This is particularly true for enlarged haemorrhoids, affecting about half of those over 30 years of age. Itching is also a symptom of anal fissures (tears in the anal canal) or anal fistulas (abnormal, inflamed ducts connecting the last part of the intestine to the outer anal area). Similarly, lichen sclerosus, an inflammatory skin disease in the genital area, may manifest itself around the anus.

Lastly, psoriasis frequently strikes the anogenital area in addition to many other areas of the body. Here, the lesions are not marked by the usual dry scaling, but instead exhibit itchy, burning and/or weeping skin changes.

Infections - as the cause or consequence of anal skin irritation - are not infrequently involved. Bacteria and fungi in particular find it easier to grow on affected skin in a moist and warm environment. If in doubt, also think of intestinal parasites like tapeworms and pinworms, that lay their eggs near the anal area. A swab taken by a doctor and a stool test will help clarify the situation.

Help and care

In addition to treating the underlying disease, care measures can relieve or eliminate the symptoms:

Gentle, lipid-replenishing ointments with caring ingredients can help at first. One preparation with thymus peptides (Thymuskin Sclero discret cream) was shown by a dermatologist to have skin-soothing and itch-relieving properties. The skin irritations subsided and at the same time the skin tolerated the cream very well.
Sitting baths with tanning properties (e.g. with the addition of oak bark tea) relieve inflammation. Ointments with zinc also combat inflammatory reactions in acute cases.
Use only mild, pH-neutral products to shower and wash, and only rinse the anal region with clean water.
After going to the toilet and in case of (even minimal) stool leakage, clean the anal area (if possible without rubbing with dry toilet paper) also with water and gently pat dry.
Reduce sitting activities or take more frequent breaks.
Choose cotton undergarments that are not pinching, as they are breathable and absorb moisture better.