What is pruritus ani (itchy bottom)?  

Pruritis ani is the medical term for an itchy bottom or irritation of the skin around the anus (“pruritis” refers to itching sensations of the skin). 

There are two main types of anal itching: 

• Primary anal itching (idiopathic): has no underlying cause, and is the most common type. 
• Secondary anal itching: pruritis is due to an underlying cause such as an infection, dermatological problems, systemic diseases, etc. 

What causes an itchy bottom?  

Some possible causes of anal itching include: 

• Hygiene; over-cleaning and under-cleaning the anus can both lead to itching. 
• Skin irritants, such as soaps 
• Excessive rubbing of the area with rough toilet paper or wet wipes 
• Skin conditions; dermatitis, psoriasis, etc. 
• Anorectal conditions; piles, anal fissures, anal fistulas, etc. 
• Infections, including STDs 
• Parasites; hookworm and threadworms, which lay eggs in the anal folds 
• Systemic diseases; inflammatory bowel disease (IBD), diabetes, jaundice, etc. 
• Excess sweating or humidity that can be exasperated with tight underwear made from synthetic material. 
• Some foods or beverages with dietary irritants, such as spicy or acidic foods 
• Bowel movement problems; diarrhoea or constipation
• Psychological problems; stress or anxiety  

Is an itchy bottom serious?  

Very often, an itchy bottom isn’t a sign of something serious and will be cured with home remedies. In very rare cases, it can be a sign of something more sinister, such as anal or bowel cancer.  

Why is my bottom itchy at night?  

If an itchy bottom becomes more noticeable at night, it is likely to be caused by threadworms, which are particularly prevalent in children. The female threadworms will leave the anus at night to lay eggs on the skin. It is thought this happens at night because there is a still and warm environment.  

Can an itchy bottom be prevented?  

Some tips to prevent anal pruritus or stop it from getting worse are: 

• Resist the urge to scratch. If you are prone to scratching in your sleep, wearing cotton gloves at night and keeping your nails trimmed can help 
• Keep the perianal area clean and dry. In people with anal itching, it is recommended to wash with water (without soap) after defecation and pat dry, since wiping can further irritate the area. 
• Do not use soap, bath oils, or other chemical products when cleaning the anal area 
• Eat foods with high fibre content, to avoid diarrhoea and constipation 
• Avoid spicy or acidic foods and drinks with caffeine 
• Avoid wearing tight underwear 

When should you see a doctor for an itchy bottom?   

An itchy bottom is a common symptom that can be caused by a number of conditions. Despite this, patients are often reluctant to see a doctor about it as they are embarrassed. 

 You should see a doctor if: 

• the itching doesn’t ease within a few days 
• comes back frequently 
• you are experiencing itching elsewhere on your body 
• struggling to sleep due to itching 

What is the treatment for an itchy bottom? 

The treatment of anal itching usually focuses on maintaining a good hygiene routine. If there is a secondary cause, the treatment will vary. 

In general, the basic treatments for anal itching include: 

• Topical medication: various creams and ointments exist to help relieve itching and irritation. It is not recommended to use more than one type at once or to use any cream or ointment for longer than a week. 
• Oral medication: may be prescribed if there is an infection.