Some of the many uncomfortable symptoms of hemorrhoids include burning, pain, tearing, bleeding, irritants and more. Today, we’ll focus on itching, and investigate why hemorrhoids itch and how you can soothe them right now.
Who are we? We’re Doctor Butler’s, experts in down-there care of hemorrhoids and related conditions. We make proctologist-developed hemorrhoid ointments and complementary products to help you quickly leave the pain behind. Dr. Robert Cutler medically reviews all of the information here.
This post was originally published on August 30, 2021 and has been updated to include information from the American Society of Colon and Rectal Surgeons.
What are Hemorrhoids?
Hemorrhoids are veins in the rectal region. It’s normal human anatomy to have hemorrhoids, but it’s a problem when they become swollen because a swollen hemorrhoid can quickly become an irritated, itchy hemorrhoid, and that can make daily life a hassle.1
If you have an itchy bottom, it could be due to an irritated internal hemorrhoid, a thrombosed external hemorrhoid, or another anorectal issue. External hemorrhoids are hemorrhoids that form on the anus, typically when a blood vessel breaks open and forms a clot. They are associated with symptoms such as itching, protrusion, and pain.2
Internal hemorrhoids line the wall of the rectum, inside of your anus, and are most associated with bright red blood on dry toilet paper after a bowel movement.3 Internal hemorrhoids can become itchy during bouts of irregular, frequent bm’s which create an acidic environment or from eating too many spicy foods. More about this to come later.
Problem hemorrhoids are reported in up to 90 percent of pregnancies, and in up to 50 percent of the general population4, making them incredibly common. What makes them so common, so itchy and what should you look for in a butt itch cream? Read on to find out.
What Causes Hemorrhoids?
Both internal and external hemorrhoids are due to excess pressure and blood flow to the pelvic region.5 Pregnancy, obesity, constipation6 and heavy lifting are all sources of this excess pressure and are linked with swollen hemorrhoids in people of all age groups.7
What these sources have in common is that they increase the amount of blood flow to the veins lining your rectum and anus. Too much pressure buildup there causes the veins to swell and push out into the anal canal.
Once hemorrhoids are swollen from excess pressure, they can become irritated by passing fecal matter in the case of both internal and external hemorrhoids. External hemorrhoids can be irritated by many things, including rough toilet paper and wiping after a bowel movement.
Why Do Hemorrhoids Itch?
Hemorrhoid itching is caused by the scratch of acidic fecal residue coming in contact with an enlarged hemorrhoid during bowel movements. Acidity irritates the swollen skin, causing itching. Acidic feces residue can come directly from the diet or from overactive bowel habits and is most likely a combination of the two. In addition, there could be other factors.
Overactive bowel habits, or an IBD (from Irritable Bowel or diarrhea for example), can cause food to move too fast through the GI system.8 That creates an acidic bowel movement because bile added to the stool earlier on in the digestive process to break down foods remains active long after it shouldn’t. This causes diarrhea to be acidic, irritating enlarged hemorrhoids and leading to the itching feeling.9
Acidity can also come from food sources. Tomatoes, caffeine, spices, chocolate, and some juices like orange and apple juice are high in it. These foods can directly irritate enlarged hemorrhoids as they make their way to the end of the digestive tract, especially if they get there fast due to an overactive GI tract.10 We even curated a list of high fiber foods to include in your diet to avoid this issue.
Between these two mechanisms, either in isolation or in combination, extra acidity can build up in fecal residue and make hemorrhoids itch.
Furthermore, it should also be noted that it is important to not scratch or dry out the area where your hemorrhoids itch, as this can make excessive itching worse.
Other Reasons That Hemorrhoids Might Itch
Poor Quality Wipes
Wet wipes can sometimes make hemorrhoids itch as well. Poorly made wipes with chemical preservatives and plastic cloth can irritate the lining of the anus or the area towards the outside of the rectum. That irritation can cause itching or pain.11
Pro tip: Itching has the same nerve fibers as pain, and is actually just a low-grade level of pain.
Look for a wipe with no chemicals and a cloth made from bamboo or natural fibers, like our soothing wipes.
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Verified ReviewerCleanliness
If a bowel movement is too loose or too soft, it might be hard to cleanse properly with good hygiene. This is another source of irritation that makes hemorrhoids itch.12 Regular dry toilet paper might not be effective. In this case, you will want to use wet wipes or a bidet, though heed the warnings about wipes in the previous section, as wipes can sometimes make your hemorrhoids itching problem worse.
Thrombosed Hemorrhoids
If your thrombosed hemorrhoids (hemorrhoids that have broken open, like a broken blood blister) have been irritated and broken open, then the itching you are feeling may actually be low-grade pain from the broken skin. Treat this by making lifestyle changes to reduce hemorrhoid flare-ups and itching.
Regardless of the source of itchiness, you should treat the underlying condition causing your hemorrhoids to make sure they don’t continue to be prone to itching! We do have fast relief suggestions below if you’re looking to stop itching right now.
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Verified ReviewerOther Causes of an Itchy Bottom
Here are two other common conditions which cause anal itching:
- Anal tears, aka fissures
- Pruritus ani, a condition affecting the exterior surface of the skin caused by various dermatological conditions (poor hygiene among them), not caused by an underlying anorectal condition like hemorrhoids.
People frequently confuse discomfort from a fissure or Pruritus ani with hemorrhoid discomfort. Many of the relief methods we go into below can help reduce itching due to these two conditions, though treating the underlying condition will be different for each problem. Fissures should heal as long as you keep them clean, avoid re-tearing and any desire to scratch, as long as you treat the underlying cause such as an internal hemorrhoid, etc.
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Verified ReviewerPruritus ani typically clears up with better hygiene, though you should speak to a dermatologist to make sure. Here is more information on the condition from the American Society of Colon and Rectal Surgeons.
3 Ways to Find Relief from Itchy Hemorrhoids
If you need itchy bottom relief right away, here are three remedies that can help:
Numb the Itch
Numbing your nerve endings will reduce the itchiness of your hemorrhoids. Do this by finding a hemorrhoid cream with Lidocaine, which is an analgesic pain reliever. As we learned above, itchiness is actually low grade pain, so a pain relieving cream will help to gently soothe the itch after softly applying and rubbing the application into the area as well.
Our Original Hemorrhoid Cream contains 4.0% Lidocaine, the most potent analgesic ingredient you can get in an OTC hemorrhoid cream to ease some of the itchiness as your irritated hemorrhoids heal.
You can also use treatments containing astringents like Witch Hazel in high concentrations to reduce swelling and itching. Our Hemorrhoid Spray does just that, without any dangerous chemicals or steroids.
Protect Your Sensitive Areas
Because acidic fecal residue irritates enlarged hemorrhoids, using a topical protectant ointment can prevent irritation. The FDA states that a protectant is a drug that provides a physical barrier, forming a protective coating over skin or mucous membranes.
By keeping the area blocked from irritants (like acidic food or fecal residue) contacting your sensitive skin, you’ll be helping it heal. Glycerin is a commonly found protectant, and it’s in our Advanced Hemorrhoid Ointment because of how well it works to protect sensitive skin from further irritation.
Soak in Warm Water
A sitz bath treatment, either taken in a bath tub or in a special sitz bath device that fits over your toilet bowl, can be helpful in soothing sore bottoms. A sitz bath treatment is simply a warm water soak for your bottom. Fill up a bath to your hips and soak for 10 to 20 minutes after every bowel movement if you don’t have a specialized device or basin to soak.
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Verified ReviewerA warm water soak helps with itchiness primarily because it cleans away any irritating residue left over from a bowel movement. Pour epsom salt into the water to add calming ingredients to the treatment. These soaks are incredibly helpful in soothing hemorrhoid symptoms and promote good hygiene.
Final Advice on Treating Itching Hemorrhoids
Because Doctor Butler’s is proctologist-run, we are going to advise you to treat the conditions causing your enlarged hemorrhoids to flare up in the first place. Fortunately, things that you do to help prevent hemorrhoids can also help to stop your hemorrhoids from itching.
If you have a sudden bout of acidic diarrhea, short term over-the-counter medications can be helpful in addition to eating foods that help slow the digestive process like banana, cucumber, white rice, toast and watermelon, combined with staples like grilled chicken or fish can help. These foods will regulate bowel habits, and the more regular you are, the less acidic your bowel movements will be, leading to less irritation.
Also be sure to avoid direct irritants like wet wipes with plastic cloths and chemicals as you attempt to clean away fecal matter and acidic residue. Clean properly with a bidet, a sitz bath or a naturally sourced wipe. Avoid irritating the area with dry toilet paper.
Instant itch relief is important as well, so that you don’t feel tempted to scratch your hemorrhoids. Use a numbing or protecting ointment, like our Advanced Hemorrhoid Cream with Lidocaine, which does both. If you have any questions when your hemorrhoids itch, don’t hesitate to contact us; you’ll be one step closer to Leaving the Pain Behind!
Sources
- Davis BR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Diseases of the Colon and Rectum. 2018;61:284. https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268 ↩︎
- Lawrence A, McLaren ER. External Hemorrhoid. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK500009/ ↩︎
- Fontem RF, Eyvazzadeh D. Internal Hemorrhoid. [Updated 2022 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK537182/ ↩︎
- Staroselsky A, Nava-Ocampo AA, Vohra S, Koren G. Hemorrhoids in pregnancy. Can Fam Physician. 2008 Feb;54(2):189-90. PMID: 18272631; PMCID: PMC2278306. https://www.ncbi.nlm.nih.gov/books/NBK537182/ ↩︎
- Kibret AA, Oumer M, Moges AM. Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One. 2021 Apr 20;16(4):e0249736. doi: 10.1371/journal.pone.0249736. PMID: 33878128; PMCID: PMC8057569. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057569/ ↩︎
- Peery AF, Sandler RS, Galanko JA, Bresalier RS, Figueiredo JC, Ahnen DJ. Risk factors for hemorrhoids on screening colonoscopy. PLoS ONE. (2015) 10:e0139100. 10.1371/journal.pone.0139100. https://pubmed.ncbi.nlm.nih.gov/26406337/ ↩︎
- De Marco S, Tiso D. Lifestyle and Risk Factors in Hemorrhoidal Disease. Front Surg. 2021 Aug 18;8:729166. doi: 10.3389/fsurg.2021.729166. PMID: 34485376; PMCID: PMC8416428. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416428/ ↩︎
- Johannsson HO, Graf W, Pahlman L. Bowel habits in hemorrhoid patients and normal subjects. Am J Gastroenterol. 2005;100:401–6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261279/ ↩︎
- Slattery, S. A., Niaz, O., Aziz, Q., Ford, A. C. & Farmer, A. D. Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea. Aliment. Pharmacol. Ther. 42, 3–11 (2015). https://www.nature.com/articles/nrdp201614/ ↩︎
- Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015 Aug 21;21(31):9245-52. doi: 10.3748/wjg.v21.i31.9245. PMID: 26309351; PMCID: PMC4541377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541377/ ↩︎
- Chang J, Mclemore E, Tejirian T. Anal Health Care Basics. Perm J. 2016 Fall;20(4):15-222. doi: 10.7812/TPP/15-222. Epub 2016 Oct 10. PMID: 27723447; PMCID: PMC5101094. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101094/ ↩︎
- Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. BMJ Clin Evid. 2010 Aug 3;2010:1411. PMID: 21418682; PMCID: PMC3217736. https://my.clevelandclinic.org/health/diseases/15574-anal-itching-pruritus-ani ↩︎
About Robert Cutler, D.O.
Dr. Robert Cutler has performed duties as a specialist in the field of Proctology over 30 years as a practicing physician. Over this time, he has had great success integrating patient care from both an efficiency standpoint and as a practical approach to holistic and preventative medicine.
Dr. Cutler also performs FDA approved Clinical Trials and has had formal research training in Human Subject Assurance Training, OHRP/NIH and Good Clinical Practice for Investigators, Quintiles. Dr. Cutler continues to work on creating more affordable solutions to help people who are affected by ano-rectal problems as well as various chronic or acute skin issues.
