Anal Itching: Causes, Treatments, and When to Seek Help

Anal itching?

Hello, I had hemorrhoid surgery three years ago, and recently I've had a recurrence over the past six months.
Two days ago, an external hemorrhoid protruded (there are three, which seem to have formed small blood clots), and my anus has started to feel very itchy.
After applying a medication called Hiyu Hemorrhoid, it got a bit better, but the itching persists.
I previously had severe mixed hemorrhoids, but it never itched this much; the worst was just extreme pain.
Before summer, I had a hard bowel movement that seemed to cause an anal fissure (at that time, the external hemorrhoids had not yet protruded), and afterward, my anus was a bit painful, which later turned into itching that progressively worsened.
I went to see Dr.
Hu at Shuutian (the surgery was performed by Dr.
Zhao at Tri-Service General Hospital).
The doctor said I have three external hemorrhoids, but they are not severe.
The itching might be due to secretions, and he prescribed a mild steroid ointment, a cooling medication, and Hiyu Hemorrhoid.
After using them, I felt somewhat better, but after my menstrual period, the itching moved closer to the anal area.
I consulted a gynecologist, who diagnosed a fungal infection.
The gynecologist suggested that the previous anal itching might also have been due to a fungal infection.
I applied Meikang and used suppositories, and after taking the medication, it improved.
However, two months later, I experienced anal itching again.
This time, I didn't take medication but used suppositories and topical treatments, and it got better.
This past month, I had my first outbreak of hives, but it improved after taking medication.
However, since two days ago, after the external hemorrhoid appeared, I've been itching again, and the external hemorrhoid is somewhat swollen.
I'm confused about what is causing the itching.
If it is a fungal infection, I worry that a colorectal surgeon might not be able to identify it since hemorrhoids can also cause itching, right? I'm currently using Hiyu Hemorrhoid, but I'm unsure if I should also use Hiyu Liao Tuo (some friends have reported that using this medication helped their external hemorrhoids gradually disappear) or if I should use Meikang.
Can I use both? What should the order be? Which specialty should I consult? I'm feeling frustrated and don't know what to do.
Thank you for your response, doctor.

Ping Ping, 20~29 year old female. Ask Date: 2009/01/04

Dr. Hou Yongji reply Surgery

1.
The diagnosis of anorectal diseases includes not only the medical history but also visual examination, palpation, endoscopy (colonoscopy, anoscopy), and even stool or biopsy tests.
Therefore, please seek treatment from a colorectal surgeon nearby (attached is a list of colorectal specialists).
2.
There are many types of ointments, and it is not possible to understand the ingredients and efficacy of an ointment solely by its brand name.
It is recommended to bring the ointment for consultation during your visit to gain a better understanding.
Thank you, Dr.
Hou Yong-ji.

Reply Date: 2009/01/04

More Info

Anal itching, or pruritus ani, can be a frustrating and uncomfortable condition, especially for individuals with a history of hemorrhoids or other anal issues. Given your background of undergoing hemorrhoid surgery and experiencing recurrent symptoms, it’s essential to understand the potential causes, treatment options, and when to seek further medical help.

Causes of Anal Itching
1. Hemorrhoids: External hemorrhoids can become inflamed and cause itching, especially if they are thrombosed (containing a blood clot). The presence of three external hemorrhoids, as you mentioned, could be contributing to your discomfort.

2. Skin Irritation: Excess moisture, poor hygiene, or the use of irritating soaps and wipes can lead to skin irritation around the anal area, resulting in itching.

3. Fungal Infections: As you experienced, fungal infections, particularly candidiasis, can cause significant itching. This is especially common in warm, moist environments.

4. Anal Fissures: Hard stools can lead to anal fissures, which can cause pain and itching. The cycle of pain and itching can exacerbate the condition.

5. Dietary Factors: Certain foods, such as spicy foods, caffeine, and alcohol, can irritate the anal area and lead to itching.

6. Other Skin Conditions: Conditions like psoriasis or eczema can also affect the anal region and cause itching.

Treatment Options
1. Topical Treatments: You mentioned using various creams, including hydrocortisone (喜癒痔) and antifungal medications (美康). Hydrocortisone can help reduce inflammation and itching, while antifungal treatments can address any underlying fungal infections. It’s generally advisable to follow your doctor’s recommendations regarding which creams to use and when.

2. Hygiene Practices: Maintaining good hygiene is crucial. Gently clean the area with mild soap and water, and avoid using harsh soaps or wipes that may irritate the skin. Pat the area dry instead of rubbing.

3. Dietary Adjustments: Consider adjusting your diet to avoid foods that may exacerbate your symptoms. Increasing fiber intake can help prevent constipation and reduce the risk of hemorrhoids and fissures.

4. Sitz Baths: Soaking in warm water can help soothe irritation and reduce discomfort. This can be particularly beneficial after bowel movements.

5. Avoid Scratching: While it may be tempting, scratching can worsen the irritation and lead to further complications, such as infections.

When to Seek Help
If your symptoms persist despite treatment, or if you notice any of the following, it’s essential to seek medical attention:
- Severe Pain: If the pain becomes unbearable or significantly affects your daily activities.

- Bleeding: Any rectal bleeding should be evaluated by a healthcare professional.

- Changes in Symptoms: If the itching worsens or changes in character, such as becoming more intense or spreading.

- Signs of Infection: If you notice swelling, redness, or discharge, these could indicate an infection requiring medical intervention.

Which Specialist to See
Given your symptoms and history, it would be advisable to consult a colorectal surgeon or a gastroenterologist. These specialists can provide a thorough evaluation of your anal region, assess the hemorrhoids, and determine if there are any other underlying conditions contributing to your symptoms.

Conclusion
Anal itching can be a multifactorial issue, especially in the context of previous hemorrhoid surgery and recurrent symptoms. It’s crucial to follow a comprehensive treatment plan that addresses hygiene, topical treatments, and dietary adjustments. If symptoms persist or worsen, don’t hesitate to seek further medical evaluation to ensure appropriate management and relief.

Similar Q&A

Understanding Anal and Genital Itching: When to Seek Medical Help

Doctor: Hello! I have been experiencing anal itching for quite some time. I have been hesitant to seek medical attention due to embarrassment, but I have researched various methods to alleviate the itching and possible causes online. I have initially ruled out causes such as pinw...

Dr. Wu Fangcan reply Family Medicine
There are many causes of anal itching, including atopic dermatitis, contact dermatitis, scabies, pubic lice, lichen planus, xerosis, psoriasis, and seborrheic dermatitis. Some are associated with systemic diseases such as hyperthyroidism, hypothyroidism, chronic renal failure, ir...

Understanding Anal Itching: Causes, Symptoms, and Treatment Options

I have been experiencing itching around my anal area for some time. I thought that maintaining cleanliness and hygiene would help it improve, but it has been over a month now. The location makes it uncomfortable for me to seek medical attention. The symptoms include itching and s...

Dr. Wu Yuxin reply Dermatology
This issue still requires an in-person consultation for diagnosis. You can visit a dermatologist, and there will definitely be a private examination area in the clinic, so you can feel comfortable seeking care.

Understanding Anal Itching: Causes and Solutions for Relief

Hello, doctor! I've been experiencing persistent itching around my anus, both at night and during the day. I wash the area with soap while showering, but the itching continues. Could this be caused by pinworms or roundworms, or could there be other reasons? I would appreciat...

Dr. Wang Qichao reply Surgery
Hello: If there is a parasitic infection, it is often said that "one barbecue can spread the aroma to many families," which means your family members may also be infected. Please do not attempt to buy antiparasitic medication from the pharmacy on your own! Diagnosing an...

Understanding Anal Itching: Causes, Symptoms, and Treatments

Hello doctor, a few days ago I experienced intense itching in my anus. I applied some talcum powder, which provided relief. However, two days later, I started to feel pain in the anal area, and the next day I had difficulty passing stool. I have previously taken steroids and anti...

Dr. Ke Fangxu reply Surgery
Anal itching is a common issue. It is recommended to take warm sitz baths and apply hemorrhoid ointment. If scratching can be avoided, symptoms usually improve within a week. However, if the symptoms are severe and there is skin inflammation, oral medication may be necessary. If ...