Hemorrhoids are swollen veins occurring in the anus or lower rectum, often causing intense anal itching (pruritus ani). The discomfort can be significant, leading to a strong temptation to scratch the affected area. However, scratching hemorrhoids is detrimental, as it initiates a cycle of damage and irritation that ultimately worsens the condition.
The Immediate Harm of Scratching
Scratching the perianal skin causes damage to the delicate tissues surrounding the hemorrhoids. This area, already inflamed due to the swollen veins, possesses a fragile moisture barrier. When this protective layer is broken by fingernails or rough rubbing, the skin becomes vulnerable to external irritants.
Disrupting the skin barrier also significantly increases the risk of bacterial infection. The perianal region is consistently exposed to fecal matter, which contains numerous bacteria. Once the skin is compromised, these microbes can enter the tissue, leading to localized infection, increased pain, and sometimes the formation of an abscess.
Scratching also intensifies the existing inflammation and swelling of the hemorrhoids themselves. The mechanical friction causes further irritation, which can lead to increased bleeding. This repetitive damage, known as the itch-scratch-itch cycle, causes local nerves to become hypersensitive, prolonging the overall healing time.
Why Hemorrhoids Cause Itching
The persistent itching sensation is not typically caused by the hemorrhoid tissue itself, but by secondary factors related to the swollen veins. Inflammation is a primary driver, as the body’s immune response triggers the release of substances like histamine in the affected area. This chemical release directly stimulates nerve endings, creating the sensation of an itch.
Internal hemorrhoids that protrude (prolapse) can cause irritation by interfering with the natural closure of the anal canal. This incomplete seal allows small amounts of mucus or residual stool to leak onto the sensitive perianal skin. The presence of this moisture causes maceration, which is the softening and breakdown of the tissue, leading to intense itching.
Sometimes, the itching is made worse by attempts at aggressive cleaning or the use of harsh products. Excessive wiping, especially with dry or scented toilet paper, can cause friction that irritates the skin. Furthermore, chemicals found in certain soaps or wipes can cause contact dermatitis, which is a separate skin irritation that compounds the initial problem.
Safe and Effective Relief Strategies
Instead of scratching, the focus should be on gentle hygiene and reducing the underlying inflammation. After a bowel movement, avoid wiping aggressively with dry toilet paper. Instead, gently clean the area by patting with soft, unscented moist wipes or using a bidet to wash with plain water.
Soaking the affected area in warm water can provide significant soothing relief. A sitz bath, which involves sitting in a few inches of warm water for about 10 to 20 minutes, two to three times a day, helps to relax the anal sphincter and reduce inflammation. Following the soak, the area should be gently patted dry with a soft cloth or allowed to air dry completely.
Over-the-counter topical treatments can provide effective relief. Products containing witch hazel, such as medicated pads, offer a cooling, astringent effect that can calm irritation. Hydrocortisone creams can be used to reduce inflammation and itching, but their use should be limited to short periods, typically no more than seven days, to prevent skin thinning.
Recognizing When Medical Attention is Needed
While most hemorrhoid symptoms respond well to home care within a week, certain signs indicate the need for professional medical evaluation. Persistent or significant rectal bleeding, or any unexplained change in stool color or consistency, should always be investigated. These symptoms can be a sign of conditions more serious than hemorrhoids.
Severe, unrelenting pain that does not improve with conservative treatments may suggest a complication such as a thrombosed hemorrhoid, where a blood clot has formed within the vein. If you develop signs of infection, such as fever, pus drainage, or rapidly increasing redness and swelling, seek immediate medical attention. If symptoms, including itching, persist for more than one week despite consistent home treatment, a doctor can provide a definitive diagnosis. They can then recommend more advanced therapies.