Q: I have developed an annoying and terrible anal itching. My doctor says it's just a rash and to try not to scratch, but it is driving...

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Q: I have developed an annoying and terrible anal itching. My doctor says it’s just a rash and to try not to scratch, but it is driving me to tears because nothing seems to help. Do you have a suggestion what could be causing the itching? I’m scrupulous with my washing, so I know it is not lack of hygiene.

A: Anal itching, otherwise known as pruritus ani in medical terms, is common. For many people, the itching tends to be worse at night. Itching can occur for many reasons. Internal factors can definitely cause symptoms — but so can external factors.

On the more benign side, causes include hemorrhoids, anal fissures and food reactions. Diarrhea — or even a little stool leakage — can also cause itching. Some people will develop itching from yeast infections. Skin problems, like psoriasis and eczema, can also occur in this area.

On the more serious side, cancer or sexually transmitted diseases, such as herpes, can be associated with itching. Although less common, it is still important to rule these out. It can be helpful to have a complete evaluation and talk to your doctor about seeing a gastroenterologist (specializing in digestive disorders) or proctologist (specializing in rectal and anal disorders). It may also be worthwhile to see a dermatologist if your doctor sees a rash.

In the meantime, there are a few simple things to try. One is to avoid excess washing and scratching, which can aggravate the itching. Certain laundry detergents, soaps and scented toilet papers can also cause symptoms.

Avoid soaps, bubble baths and fragrances, which can aggravate the problem. Make sure to dry thoroughly by patting, rather than scrubbing. Wear loose, cotton underwear and avoid pantyhose to help keep the area dry. Some people find that using a zinc oxide ointment — like the ones used for diaper rash — helps.

Foods can also cause itching. Common triggers include tomatoes, citrus, spicy foods, chocolate, caffeine, dairy and alcohol. Medications, vitamins and supplements may also be a culprit.

Anal itching is treatable much of the time, so I think there is hope.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Send questions to apujari@seattletimes.com for possible use in future columns. All information is intended for education and not a substitute for medical advice. Consult your doctor before following any suggestions given here.