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Q. I have been diagnosed with pruritus ani, itching around the anal area. This condition causes itching so intense that it can keep me up at night.
My doctor ruled out hemorrhoids and other causes. I was told to stay away from cortisone creams, as they could make the condition worse. Is there any natural remedy that can help this intense itching?
A. You may want to start with a bidet. Gentle cleaning of the posterior with a stream of warm water may be less irritating and better than using toilet paper.
Most people associate bidets with the French, but the Japanese have perfected toilet technology. Not only do their toilets wash the bottom, but some dry it with warm air. The price can range from a few hundred dollars for a seat installed on your existing toilet to thousands of dollars for a stand-alone luxury unit.
Readers who have traveled abroad appreciate bidet-like features in a toilet: “After suffering with hemorrhoids or itching most of my life, I found the solution on a trip to Thailand in the form of the bathroom bidet sprayers they use there. This device is the ultimate in logical simplicity; it allows you to clean without rubbing or soaps that irritate the skin and perpetuate the itching.”
Another option is to clean with witch hazel-dampened toilet paper. Witch hazel is a natural astringent and eases irritation.
Max
Canada
I too have pruritus ani (am in my 30’s) – have had it for several years along with chronic constipation. I’ve tried every cream and natural remedy under the sun. Toilet paper makes it worse as it’s scratchy, even the softest types. I went on vacation and used the bidet that was attached to the toilet and was amazed at the relief I got and the skin around my bum was able to heal. I purchased a travel sized hand bidet from Home Depot for $20 and use it daily at home and work. They also sell bidet attachments for toilets for between $60-$100. For my constipation I try to drink lot’s of water, sprinkle ground chia seeds in my food and sometimes use milk of magnesia to soften the stool, it helps but is inconsistent.
NT
US
I’m about thirty years old. I had a bad case of itching for about four weeks. Everyone’s butt itches from time to time, but this was absolutely absurd. I used hydrocortizone cream for a few days and it got better, so I stopped. Then it came back and was really bad. I woke up at 4 am three nights in a row with a terrible itch that wouldn’t go away. After several trips to the doctor and research online, here’s what I found:
1) I think most people (like me) run into problems from over-wiping/cleaning; however, it’s important to rule out other things: worms, warts, hemorrhoids, etc. If your problem doesn’t get better with OTC medication, go to a doctor.
2) It’s important to do a full treatment on hydrocortizone cream. After my second trip to the doctor, I started on a more rigorous schedule with the cream: two weeks, three times a day. In the end, this appeared to be the thing that helped my condition improve. Zyrtec and Zinc Oxide (diaper-rash cream) could alleviate the itching, but this helped me get better.
3) It’s important to avoid TP as much as possible. I used baby wipes sparingly and my shower faucet as a bidet with a hypoallergenic baby body wash. Washing is still the norm in large parts of the world and for good reason: it works. If you are away from home and need to use the bathroom, go ahead and do it, but wipe as gently as possible. And try to wash as soon as you get home.
IB
Baby wipes are evil. They have harsh soaps which can irritate and they will leave you damp.
Probiotics haven’t helped me.
Apple cider vinegar didn’t help.
Coconut oil made it so bad that I woke up from the itchy feeling.
Witch hazel is great but can make your skin less flexible and prone to cracking.
Cornstarch and talc (gold bond) also make it worse.
The only thing that seems to help are keeping it dry by wearing a folded piece of dry toilet paper between my cheeks and a steroid(cortisone) cream. I thought it was a yeast infection because the antifungal+cortisone cream was making it better but when I switched to an antifungal without cortisone it got worse.
Looking at the bidet solution next…
tom h.
hi. don’t think I’d like to try vicks. would be very hot. I get the itch in my rectum as well as outside it. but I instantly get up (I’m usually in bed when it happens), and go to the shower and place it u
P
Hi SB, which yogurt did you use, and how frequently did you apply it for those two days? Mine also started when on a course of antibiotics which I used for about 40 days earlier this year. I’ve had this itching/discomfort for several months now. Many thanks for your help.
AnnieB
Oh yes, thank you for all the info. Have been fighting this now for several years with no permanent relief. Googled for info, tried several remedies, including a doctor’s remedies, nothing worked. Should have checked here. Will try suggestions one by one and see what works. There is hope!
Dolly
As for the itching I would take probiotics internally and also use yogurt on the affected area. Another thing that could help is Tea Tree Oil on the affected area.
TWB
Oh, yes, the evil bottom itch. I am a guy and suffered from that for years and had tried everything I could think of. Finally asked my dermatologist who recommended trying some Desonide Cream, a prescription. She said to not use it long term but after the first application it worked wonders to stop the itching. And that was several years ago. I still have some Desonide but have no more need for it, just there for an emergency.
Now if I feel a little bottom itchiness I use some Aquaphor cream on a piece of toilet paper and leave it there for the day. I also finish my toilet time with some toilet paper dipped in a small cup of water. This seems to stop any further irritation or itchiness. I am so glad to be beyond this problem.
Paul43
What would be wrong with using a BUG SPRAYER. Set by the toilet. I personally think it would do the perfectly— and they are cheaper than a Bidget.
ebm
I don’t have a bidet and instead keep a tall plastic container in the bathroom for
warm water rinses. You can cover “front and back”. I also use baby wipes and follow
up with wipe rinsed out in water to get the chemicals out. The “white” stuff was the
culprit, carbs, sugary goodies, yeast. Probiotics helped it.
SS
It may be a food allergy. If you eat foods high in vitamin C, especially citrus fruits it can cause itching. Some people take high doses of the vitamin for cold cures and those high amounts could be another way of getting too much vitamin C. Hope this info helps…
Shirley
For many years I suffered from pruritus ani. What a misery. Finally went to a naturopathic doctor and he immediately tested for allergies. I’m allergic to eggs (yolks & whites). Now the only time I’m troubled is when I accidentally eat something containing eggs. What a miraculous relief and relatively easy to live with. None of the numerous doctors I’d been to had ever suggested testing for allergies.
va
I no longer suffer from pruritus ani and have also eliminated several things from my diet i.e. wheat, sugar and soda beverages.
mlh
I have had a condition akin to this immediately relieved with a very small dab of Vicks very carefully applied.
jc
I too suffered from pruritus ani and tried all types of remedies. Since the itching began seemingly for no reason, I finally figured out it must be related to food. After eliminating several things from my diet, I discovered I am allergic to whey, which I was using to make daily protein shakes. I recommend rotating foods (including common culprits such wheat, dairy, corn, soy)out of your diet to see if one of them are the true root of your issue. I have found as I age, I have become intolerant of certain foods which previously did not cause health issues.
MLS
Some people are sensitive to artificial sweeteners and/or consume sugarless products. Cut all that out of your diet and you will get relief.
Fred G.
I have been washing myself for years with a simple “water Wand” which I made myself for probably less than $5 . I started this practice about 30 years ago when I experienced problems form waiting too long to find a Men’s room. I have recommended such a device to a number of people who have all come back to me to thank me for the advice. I haven’t had any problems for many years, and that’s the Bottom Line. (pun intended)
Gabriele
I didn’t have quite the same problem but I started to notice that regular white toilet paper would irritate my vaginal area. I had vacationed in France and had enjoyed using a bidet there, so I started using plain water to wash after, rather than paper.
A friend who was from Java always had a jug of water by her toilet as she said using paper alone didn’t make her feel clean. I had a telephone type shower attachment and the tub was next to the wc, so it was easy for me to use it for cleansing.
I especially prefer it because it allows me to clean the entire area. I know that frequent douching isn’t good for the ph balance so rinsing the area regularly keeps me feeling fresh there also.
Some might need to get a longer hose so it will reach.
DG
Years ago my husband had this problem and the Dr. told him to drink buttermilk. I have no idea how it worked but it did. I don’t suppose it would hurt you. He drank a glass a day.
Karen
1. Has the writer been tested for parasites? Presumed so, but not identified.
2. The writer doesn’t mention whether s/he has tried any of the baby wipe products now marketed to adults.
3. Wonder if it’s something he ate / eats regularly?
DM
You might try TUCKS as they are medicated cooling pad with 50% witch hazel. They are easy to use and not only make you feel clean, but are good for hemorrhoids also.
CG
Have you considered a dietary cause? It might be a food sensitivity. Definitely try the bidet but also consider your diet for potential offenders.
Paul43
I use BENADRYL around my anal area after a shower and it stopped the itching compare to Anti-itching creams etc.
Dorothy
How about trying wipes after using toilet paper? I use several different brands, depending on what’s on sale, including baby wipes. Just don’t toss them into the toilet as this will result in a visit from your plumber!
DS
As the owner of a Toto Washlet seat, I can vouch for the effectiveness of this solution. It’s not cheap, but it works, and it works very well. Further, your doctor should also have told you to lay off the soap when you shower and to avoid moist toilet wipes at all costs.
Suffering from the same thing as you, I learned that my propensity for cleanliness was actually making the situation worse. Your body produces oil that protects the area, so when you remove all that oil with soaps and astringents, you’re actually exacerbating the problem. Good luck!
SB
I suffered terribly with itching “down there” while taking antibiotics for a week. No drugstore cream helped. After reading somewhere about yogurt, I took a teaspoon into the bathroom and used it topically on itching area. IT was no less that a miracle. It was so soothing and the itch was cured within two days.
DH
For this condition my doctor suggested using basic body powder daily in that area to keep it dry. I was very skeptical, but it actually made a big difference in reducing the itching. There are all-natural formulations available. Witch hazel pads are also helpful.
B PT
This could be caused by lichen sclerosis. I had the same symptoms and was finally diagnosed with that after a biopsy.
AF
I had pruritis ani, with the same intense itching. My colo-rectal physician (and literature that he gave me) said to avoid the use of soap. It irritates the skin and exacerbates the problem. Cleaning with water alone (which, after all, is what a bidet does) is sufficient. But here’s the important part— my doctor strongly recommended that after cleaning (which I do with moist toilet paper after every bowel movement) and drying (again with toilet paper), I powder the anal area with common cornstarch. I keep a small shaker of cornstarch in the bathroom drawer. After cleaning myself I shake some onto a square of toilet paper, and apply it. The idea is to keep the anal area clean and DRY. Works like a charm! My pruritis and the itching disappeared immediately upon adopting this method.
Cindy
I suggest trying coconut oil. I have found that this has solved a few different problems in personal areas. It has antifungal and antibacterial properties and is so gentle.
A.F.
Itching of this area can also be caused by a yeast infection; doctors often miss this. Take a probiotic, use an over-the-counter antifungal cream, and eliminate sugar and foods with yeast from your diet for a while and see if that helps.
AnnB
Unless you have or have had pruritus ani, you have no idea how it affects your body and your whole life. Anal itching is absolutely like being tortured. You itch with an uncontrollable desire/need to scratch whether on an airplane, in your office, walking down the street or wherever a person’s life take them.
This is the THIRD time I have written you to suggest that you suggest to your readers that they check in depth on their medications. You have never mentioned it. And doctors haven’t a clue as to what causes it, yet have suggestions for treatment that never help. In some cases, it’s just more medication.
Honestly, would it be a surprise that a medication could cause it? Of course not!
Your suggestion of using a bidet and washing and blow drying sounds oh, so nice, but there would be only momentary relief at best. The itching continues on a squeaky clean or a very dirty anus. It just never stops.
In my case the culprit was Prevacid. Since Prevacid went OTC, anal itching or pruritus ani isn’t listed now in the PDR as a side effect, but it is a definite side effect.
I determined FOR SURE my cause was Prevacid by eliminating my meds one at a time for three days. Within 2 days of eliminating Prevacid the itching had stopped. That was at least 10 years ago. I have never taken it again and I have never had anal itching again.
Please, please, help these people who write to you and at least suggest temporary elimination of meds, one at a time and for a short time and under a doctor’s supervision if you must, to see if it makes a difference. I was desperate and it changed my whole life!
I love your newsletters and always look forward to their arrival in my inbox. Thanks for all that you do for we mortals who need so much help.
Sincerely,
Ann B.
People’s Pharmacy response: This is a very helpful suggestion for determining if a medication might be causing the problem. You are probably aware that it is not often listed as a side effect. Also, like hair loss or cough, doctors may consider it a “minor” side effect, while patients find that it is quite debilitating, as you so clearly express.