OK, but Really: Why Is My Anus So Itchy at Night?

While a mild itch is usually no biggie, a persistent itch could be pruritus ani (aka the medical name for anal itching). It might come with other symptoms—like burning, irritation, soreness, or thick, leathery skin on or around your anus—and it can be caused by many different things, from skin conditions to the type of underwear you choose.

Can't figure out why it's happening to you? A gastroenterologist explains here why your anus can get uncontrollably itchy at night, how to relieve it, and when it's time to see a healthcare provider.

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8 reasons your anus may itch at night

Sometimes, your backside can itch for no particular reason, something medical experts call idiopathic pruritis ani¹. This is actually the most common type of anal itching and will typically go away on its own. Still, there are a few other major causes of an itchy bum that can, thankfully, be relieved with at-home options.

Here's a breakdown of the most common culprits:

1. You have a skin condition

Any part of your body where there’s skin—including your anal area—can be affected by skin conditions like psoriasis and eczema. "Although psoriasis most commonly affects the knees, elbows, trunk, and scalp, it is an itchy autoimmune rash that also affects the perianal region as well," Elena Ivanina, DO, MPH, an integrative board-certified gastroenterologist and founder of the Center for Integrative Gut Health, tells Well+Good.

Perianal eczema is a real thing, too, and can cause itchy, inflamed patches of skin around your anal opening and skin between your butt cheeks.

Dr. Ivanina says both skin conditions can flare at night due to changes in skin moisture, body temperature, and exposure to allergens (more on this later). You're also more prone to "subconscious scratching" while you sleep, she adds, which can feed into the ongoing "itch-scratch" cycle². In other words, you scratch to relieve an itch, but it only makes your skin more irritated.

How to treat it

Treating both psoriasis and eczema starts by visiting your healthcare provider. They can prescribe medicated creamed or, in severe cases, "immunomodulatory medications to calm an overactive immune system," Dr. Ivanina says.

2. It's a sexually transmitted infection (STI)

Sexually transmitted infections (STIs) can affect both your genital and anal region, causing itching and burning skin. "Common culprits include chlamydia, gonorrhea, syphilis, human papillomavirus (HPV), genital warts, and herpes simplex virus," Dr. Ivanina says.

Along with itching, Dr. Ivanina says you may experience other symptoms with STIs like:

• Pain
• Tenesmus (a frequent feeling that you need to poop even though your bowels are empty)
• Urgency
• Discharge or bleeding
• Ulcerations or lesions
• Inflammation

How to treat it

If you think you have an STI, get tested by your healthcare provider or at your local health clinic. Getting tested and treated as early as possible with prescription antibiotics will decrease your chance of transmitting the infection or catching human immunodeficiency virus (HIV) as a secondary complication, Dr. Ivanina says.

3. You have pinworms

Not to freak you out, but your itchy butt could be a product of a parasite called pinworms (also known as Enterobius vermicularis)—small, thin, white roundworms (about the size of a staple) that can live in the human colon, Dr. Ivanina says. (Yuck.)

“When an infected person sleeps, female pinworms leave the gut through the anus and deposit their eggs on the surrounding skin,” Dr. Ivanina says. Because pinworms lay their eggs around the anus—especially at night—your anal area might be particularly prickly during this time, she adds.

Pinworms are, unfortunately, pretty common and contagious, but they mostly affect young school-age children. They're most often spread by touching an infected person's belongings, like sheets, underwear, towels, or bathroom surfaces.

How to treat it

Because pinworms are not detected in a typical parasite stool test, you have to diagnose the infection in other ways. Dr. Ivanina says you either have to "look for the worms in the perianal region to three hours after going to sleep or touch the perianal skin with transparent tape to collect pinworm eggs around the anus first thing in the morning."

Thankfully, pinworms don't cause any serious medical issues, and there are medications to get rid of them ASAP, like mebendazole, pyrantel pamoate, or albendazole, Dr. Ivanina says.

4. It's your irritating products

If you have sensitive skin on other parts of your body, your butt region is most likely the same. This means products like scented soaps, powders, lotions, and creams can all cause reactions that lead to an itchy anus. Even rough toilet paper or wipes (which can contain drying chemicals like parabens) can aggravate the sensitive skin on your anal area.

How to treat it

The best way to treat this? Choosing personal hygiene products that are dye- and fragrance-free, including toilet paper. These products are less likely to contain allergens or chemical irritants. And instead of using baby wipes, try splashing a little water on your bottom.

5. It's your underwear/clothing

It's true: Your underwear or PJs could be the source of your scratchy butt—especially if they're snug. "Tight clothing at night can cause anal itching because it traps heat and moisture, leading to a sweaty environment," says Dr. Ivanina. This sweating can cause itchiness and increase your risk of yeast infections (which also cause itching).

How to treat it

To avoid an itchy, sweaty situation, look for breathable, airy fabrics when buying pajamas and underwear—like cotton.

6. You have hemorrhoids

Hemorrhoids are swollen veins that everyone has on the inside of their rectum (internal) or anus (external). But when they become swollen (from straining when you poop or sitting for long periods), they may bleed, hurt, or itch, Dr. Ivanina says. Plus, they can flare when you fall asleep, mostly due to any sleeping position that causes increased pressure, she adds.

How to treat it

It may feel tempting to self-diagnose hemorrhoids and move on, but it's best to get them checked out by your healthcare provider. They'll need to perform a rectal exam and may recommend treatment like stool softeners, sitz baths (a warm water bath), or over-the-counter (OTC) creams, says Dr. Ivanina. Severe cases may need surgery.

7. It's from certain foods

Oddly enough, “anal itching may be worse at night due to eating a trigger food at dinner,” Dr. Ivanina says. Things like citrus fruits, tomatoes, spicy foods, beer, and dairy products can all contribute to an itchy butt, she adds. Another common culprit? Caffeinated food and drinks—like coffee, soda, or chocolate. This is because caffeine is thought to relax your anal muscles, leading to stool leakage and irritation.

How to treat it

Dr. Ivanina recommends trying a brief elimination diet to identify the trigger food. (Although it's probably best to ask your healthcare provider if an elimination diet is right for you.) From there, you can cut one food every few days to see if symptoms improve. If they do, you'll know which to limit or avoid.

8. It's another medical condition

Aside from the above causes, there's a whole host of other health issues that can cause an itchy anus (or itchy skin in general). Dr. Ivanina notes these can include:

• Yeast infections
• Anal fissures (a tear in the lining of the anal canal)
• Chronic diarrhea
• Diabetes
• Liver disease (a group of diseases that develop when your liver stops functioning properly)
• Leukemia (blood cancer)
• Lymphoma (cancer that begins in your lymphatic system)
• Kidney failure (when your kidneys are no longer able to filter and clean blood)
• Iron-deficiency anemia (a deficiency of iron)
• Thyroid disease (a group of diseases that develop when your thyroid gland produces too much or too little hormones)

How to treat it

In some cases, anal itching can be a symptom of a serious medical problem, so it’s best to be safe and see your provider. They can properly examine and diagnose any underlying health conditions that may be causing your anal itch.

How to treat anus itch at night

Anal itching can be uncomfortable (and inconvenient), especially when you’re trying to get a good night’s rest. But it doesn’t have to keep you up tossing and turning. Dr. Ivanina and the Mayo Clinic recommend these tips:

• Resist the urge to scratch. This will just make the area more irritated. Consider wearing cotton gloves at bedtime to prevent scratching in your sleep.
• Apply products that absorb moisture. Zinc oxide ointments like Destin and Balmex or petroleum jelly (Vaseline) can protect the area from moisture.
• Use topical anti-itch creams and ointments. But only temporarily and stop if the itching doesn’t subside or worsens.

How to prevent an itchy anus at night

It's not always possible to prevent an itchy anus at night, especially if it's from a chronic health issue. But there are some things you can do to reduce the risk of rear-end itching. Dr. Ivanina and the Mayo Clinic recommend:

• Treating underlying medical conditions. Once your health issue is under control, symptoms like anal itching might lessen or go away.
• Keeping the bedroom at a cool temperature. This will keep you from getting sweaty. The optimal temperature for sleep is a cool 60 to 67 degrees Fahrenheit.
• Avoiding irritating products. Steer clear of harsh soaps and scented products that may contain allergens or chemical irritants. Instead, opt for dye-free, unscented toilet paper, hypoallergenic skincare products, and fragrance-free detergents to wash your underwear.
• Wearing cotton underwear to bed. They're breathable and absorb moisture.
• Avoiding certain foods and drinks, especially during dinner. Dairy products, carbonated drinks, caffeinated beverages, and acidic or spicy foods may cause anal itching.
• Being gentle. Don’t scrub your anal area with toilet paper or a washcloth, which can be irritating.

When to see a doctor

We all get the occasional itch from time to time, and it's usually no big deal. However, if your anal itching is "persistent, severe, or associated with symptoms that include discharge, bleeding, change in stools, or pain," it's time to see your healthcare provider make sure it's not a serious condition—like Crohn's disease, ulcerative colitis, or cancer, which require treatment.