Treatment with antibiotics can bring about a disturbance of the natural balance of intestinal flora, and lead to perianal thrush, a yeast infection affecting the anus.

Aside from diseases relative to the condition, a common view suggests that the initial cause of the itch may have passed, and that the illness is in fact prolonged by what is known as an itch-scratch-itch cycle.

[4][5] It states that scratching the itch encourages the release of inflammatory chemicals, which worsen redness, intensifies itchiness and increases the area covered by dry skin, thereby causing a snowball effect.

Ingestion of pinworm eggs leads to enterobiasis, indicative of severe itching around the anus from migration of gravid females from the bowel.

[8] The goal of treatment is asymptomatic, intact, dry, clean perianal skin with reversal of morphological changes.

[9] A successful treatment option for chronic idiopathic pruritus ani has been documented using a clean, dry and apply (if necessary) method.

[citation needed] For otherwise idiopathic, intractable cases, a double-blind trial with 44 patients found that capsaicin may be an effective treatment.

By applying topical capsaicin mixed with paraffin wax (both available over the counter) with a concentration of 0.006% to the perianal area every 1-2 days, approximately three quarters of patients reported total (or near-total) relief of symptoms.