Common Causes of Burning An@l Pain

Burning anal pain can be caused by hemorrhoids, your diet choices, or irritating perfumes and chemicals in toilet paper.

Anal burning and itching can be painful and interfere with work or daily activities. Treatments will depend on the cause but can include medications and lifestyle adjustments.

1. Hemorrhoids (Piles)

Hemorrhoids, sometimes called piles, are a common condition. They can lead to burning anal pain as well as itching, blood in the stool, and hard lumps around the anus when swollen veins place pressure on the anus and lower rectum.1

Approximately 50% of males and females will develop hemorrhoids by the time they are age 50.1 Anyone can get hemorrhoids, but certain risk factors include:1

• Pregnancy
• Straining from heavy lifting
• Sitting on the toilet for long periods
• Family history of hemorrhoids
• Long-term diarrhea or constipation
• Having obesity

2. Stool

Sometimes the cause of burning in and around the anus is caused by stool. After a bowel movement, if the stool isn’t completely removed, it can irritate the skin.3

For some people, liquid stool leaks out of the anus and causes burning and itching. This can happen in healthy people who drink a considerable amount of liquids.3

Using toilet paper to remove stool isn’t always effective. The toilet paper can spread the stool over the anus and surrounding skin. Instead, use toilet paper dampened with water to clean the anal area after a bowel movement.5

3. Diet

A person’s diet can cause anal burning and itching. The foods and drinks that tend to cause these symptoms include:63

• Coffee
• Alcohol
• Tea
• Citrus fruit
• Chocolate
• Tomatoes
• Spicy foods
• Vitamin C tablets

It takes 24 to 36 hours for food to move through the digestive tract. As a result, it will take that long after eating or drinking something for it to cause anal burning or itching.3

4. Anal Fissures

Anal fissures are tears, sores, or cracks in the anus. They happen when the anus is stretched past its capacity, usually because of hard constipated stool, and tears. Once an anal fissure starts, it is prone to re-injury.

The symptoms associated with anal fissures are pain, burning, blood in the stool, and a cut or tear in the anus.

The greatest risk factor for developing an anal fissure is constipation. Hard, dry stool passing through the rectum and anus can stretch the skin too far and cause a tear. Other risk factors include:7

• Low fiber diet
• Vaginal childbirth
• Diarrhea
• Anal trauma
• Inflammation in the anus
• Surgery in the anal area

An anal fissure that allows bacteria to enter the skin could also cause an infection.8 Any signs of swelling, redness, fever, or feeling unwell should be reported to a healthcare provider.

If you have chronic anal fissures, you may need tests to rule out a digestive disease or disorder.4

5. Chemicals and Medications

The anal skin area is sensitive and can easily be injured. Using harsh chemicals and medications in the anal area can cause skin irritation and reactions. These irritants can include:36

• Scented soap and lotion
• Dyes and perfumes in toilet paper
• Feminine hygiene sprays and deodorants
• Medicated talcum powders
• Perianal wipes that contain alcohol or astringents

Before using any over-the-counter (OTC) cream or lotion talk, to a healthcare provider. Some OTC remedies can cause further anal irritation, burning, and itching.

Certain medications, including broad-spectrum antibiotics, also may cause anal itching and burning.3

6. Excessive Cleaning

One common cause of anal burning and itching is excessive anal cleaning. With the new burning and itching symptoms, some people begin to wipe and clean themselves even more, which creates a vicious cycle of skin irritation and excessive wiping.6

This tends to happen to people who feel unclean after a bowel movement and excessively wipe themselves. The vigorous scrubbing and use of medicated wipes irritate the anal area causing skin damage and removing the skin’s natural barriers.

7. Skin Conditions

Psoriasis and eczema are two skin conditions that can cause itching and burning around the anus.10

Psoriasis is a chronic inflammatory disease that causes scaly patches on the skin. According to a 2016 study, 5% to 8% of people who went to their colon and rectal surgeon with rectal itching had psoriasis.6

Eczema is a type of dermatitis that is caused by an allergic response. People with eczema may have dry, scaly skin that itches and burns. It can be caused by various allergens like soaps, lotions, and environmental factors.6

8. Sexually Transmitted Infections

Sexually transmitted infections (STIs) of the anus and rectum can cause symptoms such as painful burning and itching. Other symptoms may include a feeling of needing to pass stool even when bowels are empty, bowel urgency, anal discharge, anal bleeding, or bumpy growths.

STIs can also be asymptomatic (showing no symptoms). STIs that can affect the anus and rectum include:10

• Chlamydia
• Gonorrhea
• Anal herpes
• Human papillomavirus (HPV), or anal warts4
• Syphilis

Anal infections also occur in people diagnosed with human immunodeficiency virus (HIV) infection.

9. Anal Fistulas and Abscesses

An abscess can occur when the glands in the anus become clogged, resulting in a painful bacterial infection. Symptoms can include:11

• Pain, redness, and swelling
• Fever and chills
• Feeling generally unwell

A fistula is a small tunnel that forms between the anal canal and an opening near the anus. Fistulas are often caused by anal abscesses.

Related Symptoms

Anal burning and itching are caused by various conditions and causes. They are often accompanied by other symptoms:6

• Mild discomfort to severe burning and itching
• Pain in the anal area during bowel movements
• Bleeding from the anal area
• Diarrhea or constipation
• Anal seepage

Diagnosis

Anal itching and burning are diagnosed by a healthcare provider based on health history and symptom description. A digital rectal exam (manually feeling the anus and rectum) may be necessary to check for specific causes like hemorrhoids or anal fissures.

Other tests that may be needed include:3

• Stool sample to check for parasite infection
• A swab of the area to test for infections, if an STI is suspected
• Skin scrapings sent for evaluation if a fungal infection is suspected6
• Colonoscopy or other scoping procedure to visualize the tissue

Treatment

Treatment for anal itching and burning should focus on treating the underlying cause. Sometimes when the cause is not found, treating the symptoms becomes the focus.

Common treatments for anal itching and burning include the following:12

• Clean the anal area with warm water and pat dry. Avoid rubbing to prevent skin irritation.
• Use a protective barrier like Vaseline or zinc oxide. This will protect the skin from stool irritation.
• Hydrocortisone cream can alleviate itching but shouldn’t be used for the long term.
• An over-the-counter pain reliever such as ibuprofen or acetaminophen may help with pain.
• Applying ice packs to the area may be soothing.
• Wear loose cotton underwear.

Your healthcare provider will treat any STIs with appropriate medications, such as antibiotics or antivirals.

If diarrhea or constipation is contributing to the irritation and burning, correcting these issues with your bowel movements can offer relief. Treatments may include:

• Increasing fiber in your diet through fruits, vegetables, beans and legumes, and whole grains
• Taking probiotic or fiber supplements
• Medications, such as laxatives for constipation or anti-diarrhea medications

Prevention

While not every case of anal burning and itching can be prevented, several prevention techniques can help decrease the chances of developing these symptoms:6

• Avoid using scented soaps or lotions.
• Use a bidet or squirt bottle to clean the perianal area.
• Avoid scratching.
• Don’t use prepared wipes or witch hazel pads.
• Only clean the anal area with warm water (use moistened toilet paper and pat dry). Avoid rubbing the area to prevent skin irritation.