Pruritus ani is characterized by severe itching of the perianal skin. It may be intermittent, constant, acute, or chronic. In 75% of cases an underlying cause is identified, and correction will often lead to significant improvement in symptoms. Treatment focuses on correcting the underlying cause, education on anorectal hygiene, identification and avoidance of triggers, and symptom management. Early and frequent discussion of expectations can help to protect the physician-patient relationship and guide treatment. This article will serve to outline the etiologies, diagnostic workup, and therapeutic modalities essential to the treatment of pruritus ani.