Disclaimer: There may be some inaccuracies about the formulations of other products in this article. These are not intentional. If you find an error please let us know so we can correct it.
Are there different types of anal itching creams?
Indeed there are!
Unfortunately, they’re all marketed as doing the same thing, which makes it super confusing. Hopefully this article simplifies it for you. We’ve tried to cover all commercially available creams, but keep in mind not all creams are available in all countries, and we may have unintentionally missed some creams. Let us know if we’ve missed something, and we’ll add it to our article.
Now, to the interesting part. We can figure out how a cream works by what its active ingredients are. The key categories of ingredients are:
Protectants – waxes/oils/metal oxides etc. These ingredients form a layer on the skin and act as a barrier. This is probably the most important part of any anal itch cream.
Nutrients – vitamins/precursor molecules/other fancy things. Some people claim these molecules speed up the healing process. Some people say this is bogus. We want to stay out of the disagreement, so we’re going to leave it at that.
Soothing Agent – Essential Oils/Botanical Extracts etc. These are ‘sensory’ ingredients that create a sensation (usually hot/cold) and soothe irritation. Often these are added to soothe itching, but some soothing agents also help with burning/stinging and pain. Soothing agents do not cause numbness, and will enable you to continue to feel sensation.
Local Anaesthetics – these ingredients stop the nerves from sending signals, numbing your anus. This can be used to stop pain, itch and mechanical signals. Though it is theoretically possible, local anaesthetics are unlikely to penetrate deeply enough to paralyse your external anal sphincter and cause incontinence.
Steroids – these are anti-inflammatory ingredients that are able to settle down some types of inflammation. These ingredients are particularly effective if you have eczema, psoriasis or dermatitis on your anus.
Vasoconstrictors – these ingredients reduce blood flow to the skin.
Antibiotics – these ingredients either kill or reduce the growth of bugs on your anus.
So we can group anal itching creams as follows:
- Protectant only – Desitin, Anusol and Balmex
- Protectant and Soothing Agent – Itchy Butt, Ma Yin Long, Calmoseptine and Pranicura
- Protectant, Soothing agent and Nutrients – Hemovir
- Protectant and Local Anaesthetic – Cera Ve, Rectinol, Tucks and Hemocane
- Protectant, Local Anaesthetic and Steroid – Doctor Butler’s Advanced and SoovIT Haemorrhoid cream
- Protectant, Local Anaesthetic and Vasoconstrictor – Preparation H
- Protectant, Local Anaesthetic, Steroid and Vasoconstrictor – Doctor Butler’s Max Strength
- Protectant, Local Anaesthetic, Steroid, Vasoconstrictor and Soothing Agent
- Protectant, Antibiotic and Steroid – Itchy Bum (despite the similar name, this is made by a different company and not affiliated with Downthere Healthcare)
- Antibiotic, Soothing Agent and Nutrients – Emuaid
How do I tell which one I should use?
Just use Itchy Butt!
Nono, all jokes aside, for the vast majority of people (>80%) with anal itching, they have what is called ‘primary disease’. That is, there is no underlying medical trigger. For more information about the causes of anal itching, read our article that covers everything you need to know but were afraid to ask here.
For this group of people, proper education (read this page), diet modification, proper toilet and anal hygiene behaviours and the use of a cream with a protectant and soothing agent (i.e. from Group 2 or 3) is all you’ll need. Once you don’t have any further itching, you can choose to continue a protectant cream (Groups 1, 2 or 3) to help prevent recurrence. Alternatively you can stop the cream and start it again if necessary.
So what about groups 4 to 8? Well, given that local anaesthetics can cause a dermatitis over time, we recommend asking a doctor to advise you on whether or not to use a cream from this group.
How do you tell if you’re in the minority of people with an underlying medical trigger? The easy answer is go and see a doctor. They should take a history and perform an examination.
If a skin condition is suspected like psoriasis, seborrheic dermatitis, or eczema, a short course of a steroid may be useful. In this case, you can either use a stand-alone steroid cream twice a day, and a protectant and soothing cream (from Group 2 or 3) as needed, or you can use a cream from group 5, 7, 8 or 9, twice a day. The benefit of using a stand-alone steroid cream and different creams is that you can use a soothing agent as much as you need.
If an infection is suspected, they will either prescribe a topical cream or a course of oral medicine depending on what kind of infection they think you have.
If haemorrhoids are the cause, some people might find that a vasoconstrictor helps, but having said that, the evidence for phenylephrine in haemorrhoids is minimal.
Isn’t Itchy Butt the worst cream because it contains the least ingredients?
This is a fair criticism of our product. We’re trying to be very clear that our product will not CURE your anal itching. The treatment for pruritis ani is to stop further damage occurring to the skin.
Nevertheless, there is a reason we made our cream the way it is. We believe in environmental sustainability, and using ethical ingredients. We also try to minimise the number of unnecessary ingredients. We think that if you want to go about treating your anal itching in the most optimal way, then Itchy Butt, or some other cream from group 2 or 3 is what you should be using.
Among the similar products in Groups 2 and 3, Itchy Butt is the only cream that contains no petrochemicals, no animal products and no artificial preservatives. As for how it compares to the others, this is subjective, and the only way to find out is to try them all!
Don’t all creams require a preservative? Won’t it go off without it?
Actually, only about half the creams listed above contain a dedicated preservative. The others are what is called self-preserving. In the case of Itchy-Butt, the essential oils do give our cream some weak self-preserving properties that helps it to last at least 3 months. Of course, a cream has to last.
What we have tried to avoid is to use a strong artificial preservative. Many of these agents can cause anaphylaxis, contact dermatitis, and upset the balance of good and bad bacteria on the anal skin.