Ask The GI

Anal Itching – What’s The Deal?

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Daniel: I’m a 62 yr old male experiencing anal itching and I can’t figure out why. Diet is good with coffee my only real excess. Eliminations are regular, sometimes loose. What might be causing this and what can I do to correct it?

Dr. Chutkan: Daniel, anal itching is a common – and frustrating – problem, and people are often embarrassed to talk about it, so thank you for asking! You mention two things that might be clues to the cause of your anal itching – coffee and loose eliminations. Coffee is one of a number of foods that can cause irritation to the anus that’s manifest as itching. The mechanism might be a slight loosening of the anal sphincter that allows a small amount of stool to leak out and irritate the area. Other foods/beverages that can do this include soda, energy drinks, beer, chocolate, citrus, spicy foods and dairy. If you’re having more than a cup a day you might want to cut your caffeine consumption way down (or stop altogether!) and see if the itching improves.

Loose stools can also create itching from over-wiping. Be sure to avoid using any scented or pre-moistened wipes/products and instead, try using a little vaseline on the toilet paper to clean more effectively with less wiping. If you have access to a bidet, lukewarm water to rinse the area after gentle wiping can be soothing rather than irritating. 

Some other things to think about that may be causing your anal itching:

  • Fungal overgrowth, especially if you’ve recently been on antibiotics or keep damp clothing on after exercise.
  • Anal fissures, which can result from constipation or be associated with more serious conditions like Crohn’s disease.
  • Hemorrhoids, which can result from straining or frequent bowel movements.
  • Stool leakage, or incomplete wiping, resulting in some residual stool in the area.
  • Parasites like pinworm which often cause itching at night when the worms move to the anal area to lay their eggs.
  • Irritation from synthetic fiber underwear.
  • Sexually transmitted diseases (STDs) like genital warts. 

In addition to trying some empiric fixes like cutting back on coffee and putting a little vaseline on the toilet paper, I’d recommend having a gastroenterologist take a look. Fissures, fungal overgrowth, hemorrhoids, anal irritation, and certain STDs can all be diagnosed with a rectal exam, and there are some simple stool tests to diagnose parasites like pinworm. 

The information on this website is for informational or educational purposes only, and is not intended as a substitute for the advice of your healthcare professional or physician. All readers should consult with their healthcare provider before beginning any new medical, dietary, or lifestyle programs. 

Robynne Chutkan, MD

Robynne Chutkan, MD, FASGE, is the founder of Gutbliss Rx. She is an integrative gastroenterologist and the bestselling author of Gutbliss, The Microbiome Solution, and The Bloat Cure. Educated at Yale and Columbia, she’s been on the faculty at Georgetown University Hospital since 1997 and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice incorporating microbiome analysis and nutritional counseling as part of the therapeutic approach to digestive disorders. An avid runner, snowboarder, and yogi, she is passionate about helping her patients live not just longer lives, but dirtier ones!

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