What Causes Anal Itching? Is It a Sign of Anal Cancer?

Persistent itching in any part of the body can inevitably raise the question, "Do I have cancer?" But is itching around the anus a sign of cancer?

Anal itching can have many causes. Alongside skin irritation, hemorrhoids, and infections, cancer is a possible cause. However, anal cancer, which can arise from various causes, is generally asymptomatic (causes no symptoms). Moreover, unlike itching, bleeding is often among its first signs.

Nevertheless, consulting a specialist is important to identify the cause of persistent anal itching and obtain the right diagnosis and treatment.

Is Cancer the Cause of Anal Itching?

Cancer very rarely causes anal itching; the first sign of anal cancer is more often mild bleeding. Itching generally results from other conditions, including hemorrhoids, irritation, or infection.

Anal cancer itself is very rare, accounting for only 2.5% of all cancers affecting the stomach and intestines. Still, anyone with concerns should of course consult a specialist promptly. Specialists generally perform a physical examination and tests to identify the cause of itching.

Conditions that can affect the anal area are illustrated below

What Are the Symptoms of Anal Cancer?

Anal cancer does not always cause symptoms. Generally, 2 out of 10 cases are asymptomatic. Its symptoms include:

• Rectal bleeding: This is one of the most common signs of anal cancer. Bleeding is usually clearly visible from the anus or noticed as blood on the stool. Dark or hard stools may indicate bleeding.
• Itching in or around the rectum: Anal itching can have many different causes. Anal cancer is generally asymptomatic, meaning it is usually not associated with anal itching.
• A lump or feeling of fullness in the anus: As anal cancer grows, a lump or feeling of fullness can develop in the anus. This is more common in advanced stages.
• Anal pain: Anal cancer can cause pain in the anal area, but this may resemble pain caused by other conditions.
• Changes in bowel habits and narrower stools: Anal cancer can change bowel habits and cause narrower stools. These symptoms can also resemble those of other bowel problems.
• Anal discharge: Anal cancer can cause anal discharge, but it can resemble discharge caused by other conditions.
• Loss of bowel control: Anal cancer can cause difficulty controlling bowel movements or loss of control. This can also resemble symptoms of other bowel problems.
• Other symptoms, such as pelvic pain and weight loss: As anal cancer progresses, it may also cause pelvic pain and weight loss.

In some cases, specialists may identify swollen lymph nodes in the groin or around the anus during examination.

Tumors developing in the anus may be associated with an inflammatory response to certain infections, such as human papillomavirus (HPV) 16 and 18. People with HPV in the anal area have an anal cancer risk 40 times higher than normal. Men with genital viral infections also have a higher-than-normal risk.

Anal cancer usually does not cause symptoms until the tumor reaches an advanced stage. Its symptoms are difficult to distinguish from hemorrhoids. Consulting a specialist is therefore always the best approach for anyone with itching.

Hemorrhoids or Anal Cancer?

Hemorrhoids are structures formed by enlargement and swelling of veins (hemorrhoidal veins) in the end of the rectum and the anal canal. They may become inflamed and swollen. These palpable structures can cause symptoms ranging from minor discomfort to severe pain. Hemorrhoids can also often be confused with cancer. Unlike anal cancer, however, they are common and are among the main causes of rectal bleeding and itching. General symptoms include:

• Pain
• Bleeding
• Itching
• Burning
• Swelling
• Anal discharge and moisture (with internal hemorrhoids)

Hemorrhoids are divided into internal and external types.

Internal hemorrhoids result from swelling of veins inside the anal canal and are generally painless, though they may cause bleeding and itching. External hemorrhoids result from swelling of veins outside the anal canal and are generally painful. They commonly arise because of constipation, diarrhea, prolonged sitting, or heavy lifting.

Hemorrhoids can generally be treated at home and prevented through lifestyle changes. However, severe symptoms or bleeding may require medical intervention.

External hemorrhoids are among the most common conditions in the community. Medications used to treat them include:

1. Local anesthetics: These can relieve hemorrhoid pain and may contain ingredients such as benzocaine, lidocaine (Anestol), and prilocaine.

2. Corticosteroids: These can reduce inflammation and relieve itching. They may contain ingredients such as hydrocortisone, betamethasone, and fluocinolone.

3. Topical vasoconstrictors: These can reduce hemorrhoid swelling and may contain ingredients such as phenylephrine and epinephrine.

4. Topical analgesics: These can relieve pain and may contain ingredients such as menthol and camphor.

In addition to topical medication, warm sitz baths and lifestyle changes are effective in treating external hemorrhoids, including avoiding constipation through a high-fiber diet, drinking plenty of water, and exercising. However, hemorrhoid treatment should be managed by a family physician, general surgeon, or gastroenterologist.

What Else Causes Anal Itching?

Pinworms, genital warts, eczema, and anal fissures or fistulas can also cause anal itching. What do these conditions mean, and can they be treated?

Pinworm Infection (Enterobiasis)

Pinworm is a parasite that lives in the intestines of exposed people. While a person sleeps, female pinworms try to leave the anus and lay eggs on the surrounding skin. This causes anal itching, particularly at night, although some people have no symptoms.

Pinworm infection can be treated with over-the-counter drugs known as anthelmintics containing albendazole, mebendazole, or pyrantel pamoate. Of course, consulting a specialist first is much more important for an accurate diagnosis and appropriate treatment.

Genital Warts

Genital warts are the most common sexually transmitted infection caused by HPV. Because their symptoms closely resemble those of anal cancer, consulting a specialist is important. Symptoms include:

• Itching
• Bleeding
• Anal discharge
• Swelling or fullness in the anus

Genital warts can be treated with creams prescribed by a specialist. Some cases may require surgery.

Perianal Dermatitis (Eczema)

Perianal dermatitis (eczema) can result from contact with irritants, allergens, or infections. Its main causes include itching and dry skin. Eczema may appear red in people with fair skin, while in darker skin it can be red, purple, or dark brown.

Products such as detergents can cause eczema. Changing detergent or choosing more natural products may therefore be a primary preventive measure. Steroid creams recommended by specialists can also be used.

Anal Fissures or Fistulas (Anal Tears)

Causes of anal fissures (anal tears) or fistulas may include passing hard stool with difficulty or anal surgery. Their main symptom is pain during bowel movements, but pain can also occur at other times. Fistulas may be more painful than fissures. Bleeding and itching are other symptoms, but scratching the itchy area can worsen the condition.

Keeping the area clean is important for healing anorectal conditions such as fissures and fistulas, but soap and excessive rubbing should be avoided. Soap can dry and irritate the skin, while rubbing can cause inflammation and delay healing. Using only lukewarm water or a cleanser specially formulated for sensitive skin is therefore recommended. Keeping the area clean and dry is also important.

A high-fiber diet and plenty of water help prevent constipation by keeping stools soft, reducing irritation during and after bowel movements. Steroid creams can be used in treatment. Compared with fissures, fistulas may sometimes require specific medical procedures to remove them.

Do Not Delay Seeing a Doctor for Anal Itching

Anal itching is a medical problem, not something to feel ashamed or embarrassed about. Anyone with frequent or persistent anal itching should consult a specialist as soon as possible. Specialists can help determine the cause, make a diagnosis, provide appropriate treatment, and improve the patient's well-being.

According to a study, 20% of people with anal itching delay consulting a specialist. They wait 6 months or longer for it to resolve or try remedies based on hearsay. However, itching may be caused by cancer, and delay may allow it to progress, while interventions without specialist advice may worsen matters. Cancer may grow or spread, and the opportunity for early diagnosis and treatment may be missed. Consulting a specialist is therefore always the best choice for persistent anal itching.

A paper published in 2017 stated that chronic anal itching can reduce quality of life and cause sleep disturbances, depression, anxiety, and even suicidal thoughts (Kumar et al., 2017). It also emphasized timely diagnosis and appropriate treatment of the underlying causes.

Similarly, another paper published in 2014 noted that anal itching is common and many people avoid medical help because of embarrassment (Singh & Das, 2014). It emphasized that even when people feel embarrassed about consulting a specialist, the condition should be taken seriously and necessary treatment obtained promptly.

Anal Itching in Summary

Anal itching can have many causes, rarely including cancer. Anal cancer is uncommon. The main causes of itching may be irritation, infections, and hemorrhoids. Because these conditions have very similar symptoms, consulting a specialist is important for accurate diagnosis and treatment.