An itchy butthole is not an ideal situation for anyone at any time of day, but it’s also a pretty universal experience. If you’ve found yourself wondering, Why does my butthole itch? you’re not alone.
The irritation—technically known as pruritus ani, per the U.S. National Library of Medicine (NLM)—can occur inside the anus or the perianal area, which is essentially the skin surrounding the anal opening.
If you are experiencing anal itching, it’s pertinent that you don’t scratch yourself silly. While there’s nothing wrong with scratching an acute itch, such as a bug bite, constant or “chronic” scratching can feed into what pros call the “itch-scratch” cycle.
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This causes more skin inflammation and thus worse itch, says Brian Kim, MD, the co-director of the Center for the Study of Itch at Washington University School of Medicine. If you *must* scratch, be as gentle as possible and try to keep it to a minimum, he says.
Meet the experts: Samantha Nazareth, MD, is a gastroenterologist who practices in New York City. Brian Kim, MD, is the co-director of the Center for the Study of Itch at Washington University School of Medicine. Soma Mandal, MD, is an internist at Summit Medical Group in Berkeley Heights, New Jersey.
The itchiness can happen due to a range of issues—and the key to eliminating anal itching is figuring out the underlying cause. (Keep calm, it’s usually not a big deal.) Read on to get to the bottom of your, err, bottom issues—and to find relief from anal itching both in the short and long run.
1. You’re wiping all wrong.
WH advisor Samantha Nazareth, MD, a gastroenterologist who practices in New York City, always asks her patients about their bathroom hygiene habits. Are you an aggressive wiper? Do you not feel clean unless you use wet wipes? “Too many of us are wiping ourselves to death with toilet paper and then using wet wipes afterward,” says Dr. Nazareth. Those practices are bound to cause irritation or even anal fissures (tiny cuts or tears). Your skin is super sensitive down there.
On the flip side, you might not be wiping enough—leftover poop in the anal area, along with extra moisture, is also a recipe for irritation, says Dr. Nazareth.
The Fix
“Ideally, if you’re at home, the best way is going into the tub or using a shower head to clean the area with the force of the water. No soap needed. Then pat dry the area. It’s the best way short of using a bidet,” says Dr. Nazareth. If you’re out and about at a friend’s house, say, and not in a stall, when nature calls, she recommends using a little warm water on the TP and going for the pat-dry afterward.
2. You’re fixated on having “good” hygiene.
Hey, I get it, we all can be a little Monica Geller-y at times. But obsessively cleaning your nether regions until they practically sparkle is not a good idea. In fact, it’s a fairly common culprit of an itchy butt, according to Dr. Kim.
Using things like topical alcohol swabs, wet wipes, scented soaps, and even a natural skin cleanser like witch hazel to keep the perianal area clean or to treat the already-present itchiness can cause irritation and even an allergic contact dermatitis, which is a developed hypersensitivity to an allergen, Dr. Kim explains. “This can further aggravate the itch because now you have two problems,” Dr. Kim says. Uh-oh.
The Fix
Bottom (sorry, had to) line here? Don’t be overly concerned with perfect hygiene—meaning skip the wet wipes, which contain chemicals that can cause allergic reactions, and scented soaps, Dr. Kim says. And when it comes to shower time, she recommends simply using gentle soaps like unscented Dove soap or a Vanicream cleansing bar.
3. You have hemorrhoids.
Hemorrhoids are inflamed, swollen veins around your anus or in your lower rectum, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Typically, external hemorrhoids—ones that form under the skin and around the anus—are the cause for itching.
Constipation (a.k.a. difficulty passing bowel movements) is often the cause of hemorrhoids—you know, from the pushing and extra time spent on the toilet.
The Fix
“I often suggest the Squatty Potty to my hemorrhoids patients,” says Dr. Nazareth, which can help the passage of bowel movements. Another smart tip to avoid flare-ups? Getting enough fiber in your diet to make things flow a little more…smoothly.
4. You might have pinworms.
Okay, this is pretty unlikely, but it’s still possible. Pinworms are small parasites that can live in your colon and rectum, per the NLM. They’re spread by the fecal-oral route (yes, that’s exactly what it sounds like) either directly or indirectly (through contaminated clothing, bedding, food, etc.).
This infection is most common in children, and many people who are infected don’t have symptoms at all. If you have symptoms, they’re most commonly intense anal (or vaginal) itching that can interfere with daily life. But here’s the catch: “You won’t be able to diagnose this at home,” says Dr. Nazareth. “You must get checked by a doctor via a stool sample.”
The Fix
Mild infections can go away on their own, but medication is sometimes needed, per the NLM. Your doctor may recommend an OTC or prescription anti-parasitic medication for everyone in your household to prevent infection and reinfection, Mayo Clinic says.
Yep, these can happen anywhere—not just in your vagina. When a fungus called Candida grows at a quicker rate than usual (typically caused by antibiotics or a weakened immune system), it can cause an infection of the area, according to the CDC. Sitting in sweaty workout clothes (guilty) can create a yeast-friendly environment too, says Dr. Nazareth.
The Fix
Your best defense is to get out of those sweat-soaked clothes and shower post-workout. Already have a yeast infection that brought on anal itching? Dr. Nazareth suggests opting for an anti-fungal ointment or wearing loose clothing at home. “Ideally, don’t wear underwear at all and choose some loose-fitting pants to let things air out in their ‘natural’ state,” she says.
6. You might have scabies.
This is another rare one, but you might as well know what scabies are, right? They’re a parasite—like pinworms—that burrow into the outer layer of your skin and lay eggs there, says Dr. Nazareth. But scabies will itch everywhere, *not* just your butt. Note that the symptoms (intense itchiness and sores) can take as long as four to eight weeks to show up.
The Fix
While scabies can be treated with scabicide creams and lotions for your skin, your home will need to be treated as well.
7. You might have a skin condition.
Have you recently started using a new bath product? An allergic irritation to a fragrance or other product could be the culprit, says Dr. Nazareth. You can also get other itchy skin disorders, like psoriasis (a buildup of skin cells that causes red, itchy patches) or eczema (itchy, inflamed scales on the skin) between the cheeks too.
The Fix
If you suspect you have either of these conditions, it’s best to see your dermatologist to find the best treatment for you (oral medications, steroid creams, or light therapy) and your sensitive skin in that area.
8. You have anal fissures.
Anal fissures occur when there is a split or tear in the rectal opening, says Soma Mandal, MD, an internist at Summit Medical Group in Berkeley Heights, New Jersey. They usually crop up after an episode of constipation, but can also occur after diarrhea.
If you feel pain back there when you’re going number two, or see blood on your TP, you might be dealing with a fissure. “The itching occurs as the fissure heals and alternately reopens,” says Dr. Mandal.
The Fix
The best thing you can do is try to keep the area clean as the fissure heals (which takes a week or two), and make sure you’re getting enough fiber so your BMs are soft (that way, you’ll avoid re-tearing or causing another fissure).
9. You’re taking laxatives or having diarrhea.
Anal itching can be triggered by continuous moisture and subsequent irritation in the anus and rectal area, which you’re susceptible to when you have diarrhea, fecal incontinence, or are just pooping a lot because of laxatives or other meds, and are constantly wiping, says Dr. Mandal.
The Fix
Reducing or cutting out foods and drinks that can cause diarrhea and just not-so-great poops, like coffee, soda, alcohol, citrus foods, chocolate, spicy foods, and tomatoes, may help you find relief. Talk to your doctor or a GI specialist to determine the root cause of the issue and find an appropriate treatment plan.
10. You have skin tags.
Anal skin tags are common (and benign) skin tissue that form in the rectal area, says Dr. Mandal. They feel like small raised bumps and can cause discomfort and itching.
“The skin around the anus is typically looser so the area can expand with bowel movements,” she explains. “If a blood vessel expands near the anus, it can result in a skin tag, as the extra skin bulge lasts even after the blood vessel swelling decreases.”
The Fix
Just like with skin tags on any other part of your body, you shouldn’t attempt to remove them yourself. Talk to your doctor to find out if they can safely remove them for you or refer to you a dermatologist or another specialist who can.
11. You might (but likely don’t) have anal cancer.
Okay, so anal itching does not automatically mean you have anal cancer. But, rarely, anal itching can be a symptom of anal and/or colon cancer—especially if it’s accompanied by bleeding, says Dr. Nazareth. In the case of anal bleeding, you should see your doctor. While it’s likely something benign, like hemorrhoids, Dr. Nazareth says it’s still wise to get the all-clear from your doc, especially if you’re BIPOC, which means you’re at a greater risk of developing colon cancer, notes Dr. Mandal.
The Fix
Most cases are treated with a combination of radiation and chemotherapy, according to the American Cancer Society.
12. You’re eating the wrong foods.
What goes in…must come out. So, it shouldn’t be too shocking to learn that your diet might be to blame for your bum’s itchiness. Again, the typical culinary culprits are acidic and irritating foods like coffee, citrus, spicy foods, and alcohol—essentially the same list of foods that might cause acid reflux.
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Unfortunately, it’s not really clear how or why eating these acidic and irritating foods causes anal itching. “But we know that acidic substances can be damaging to the skin barrier, which triggers itch,” Dr. Kim explains. “Essentially, when you scratch or irritate the barrier, it can falsely set off an ‘alarm,’ which causes unnecessary inflammation.”
The Fix
A simple solution? Switch up your diet and—hopefully!— watch the itch disappear. (And if the itchiness prevails, consulting a doc is always a safe bet.)
13. You might have an STI.
If your butt is begging to be scratched, it might mean you have a sexually transmitted infection such as herpes or anal warts caused by the human papillomavirus (HPV). Given that the symptoms are on your butt, they were likely contracted through anal sex. In the case of HPV, the warts—which have a cauliflower-like appearance and are darker than normal skin tone—are to blame for the itch, Dr. Kim says. “They stick out and get irritated in the close space. The inflammation then causes the itch.”
The Fix
Feel something bumpy down there? Then you should definitely visit your doc—for a few reasons. First, your doc will help with treatment likely by prescribing meds to apply to the warts several times a week until complete, according to the NLM.
Second, HPV isn’t something you want to ignore. While most high-risk HPV infections go away within one to two years and do not cause cancer, per the NLM, some can be long-term and, if not treated correctly, may cause cancer.
14. You might have nerve damage.
Many experts also speculate that anal itching might be neurological, especially in the case of patients with back issues. “If you have a history of low back injury or pain along with numbness or weakness due to injuries in the lower back, it’s possible that other nerves, such as those that supply sensation to the anus, are also damaged,” Dr. Kim explains.
The Fix
Treatment for nerve damage varies and can range from physical therapy to surgery. Be sure to discuss your medical history—including any previous back injuries—with your doctor to figure out what’s going on.
