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Itchy bottom

Introduction

The medical term for itchy bottom is 'pruritus ani'. Itchy bottom is characterised by a very strong urge to scratch the skin around the anus (the opening at the end of the digestive system where solid waste leaves the body).

Itchy bottom is a symptom, rather than a condition. Many cases of itchy bottom have an underlying cause such as:

  • a bacterial infection - such as the streptococcal bacteria that causes streptococcal infections
  • a skin condition such as atopic eczema (where the skin becomes red, dry and flaky)
  • haemorrhoids (piles) - where the blood vessels in and around the anus become swollen

However, not all cases of itchy bottom have an identifiable cause.

How common is itchy bottom?

It is not known how many people experience itchy bottom. However, it is four times more common in men than in women. Itchy bottom can affect any age group, but is most common in people who are 40-60 years of age.

Outlook

Whether the cause of your itchy bottom can be identified or not, the symptoms can normally be effectively treated using self-care measures such as:

  • keeping the bottom dry and clean
  • avoiding certain foods

If the cause of itchy bottom is identified it may require separate treatment - for example, with medication.

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Symptoms

Many of us may occasionally scratch our bottoms. But for people with itchy bottom, the urge to scratch around the anus (the opening at the end of the digestive system where solid waste leaves the body) is very hard to resist.

If you have itchy bottom, the urge to scratch your bottom can occur at any time, but is most common after you have passed stools (especially liquid stools). Many people  find they have an urge to scratch their bottom at night time, just before they fall asleep.

What will make my itchy bottom worse?

An itchy bottom can be made worse by several factors, such as:

  • heat
  • clothing or blankets made of wool
  • moisture
  • soiling yourself
  • stress
  • anxiety

Some people find that the itching sensation is only mild, whereas for others, the urge to scratch is very intense.

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Causes

The cause of itchy bottom is not always known. However, sometimes an itchy bottom is a symptom of another problem or condition, some of which are outlined below.

Infection

An itchy bottom can sometimes be the sign that your body is trying to deal with an infection. The infection may be:

  • bacterial - such as the streptococcal bacteria that causes streptococcal infections, or the staphylococcal bacteria that causes staphylococcal infections  
  • fungal -such as the Candida albicans fungus which causes vaginal thrush (a common infection in women that causes irritation and swelling of the vagina)
  • parasitic - such as threadworms (small worm parasites that infect the intestines) or scabies (tiny mites that burrow into the skin) 
  • viral - such as the herpes simplex virus that causes cold sores 

An itchy bottom can also be a symptom of a sexually transmitted infection (STI). If you have had unprotected sex and think there may be a chance that you have an STI, you should visit your local sexual health or genito-urinary medicine(GUM) clinic. Staff at the clinic can test you for STIs and provide you with further treatment and advice.

See the topic about STIs for more information.

Gastrointestinal conditions

A gastrointestinal condition is one which affects your digestive tract (your mouth, throat, stomach, intestines and anus). Gastrointestinal conditions which may cause an itchy bottom include:

  • haemorrhoids (piles) - where the blood vessels in and around the anus become swollen
  • anal fistula - when a small channel (tract) develops between your anal canal (the last section of the large intestine) and the surface of your skin, near the anus (the opening where waste leaves the body) 
  • anal fissure - a tear or ulcer (open sore) that develops in the lining of the anal canal
  • sphincter incompetence- when the sphincter muscle (the ring of muscle that opens and closes your anus) stops working properly, causing  bowel incontinence (when you to leak stools)
  • chronic (long-term) diarrhoea - passing loose, watery stools
  • chronic constipation- an inability to completely empty your bowels

Dermatological conditions

A dermatological condition is one which affects your skin. Some dermatological conditions can affect any area of skin on the body, including the skin around your anus.

Skin conditions which can cause itchy bottom include:

  • psoriasis- where red, flaky, crusty patches of skin appear because your skin cells reproduce too quickly
  • contact dermatitis- where your skin reacts to certain substances, known as allergens causing your skin to become inflamed (red and swollen) 
  • atopic eczema - where your skin becomes red, dry and flaky

Cancer

In rare cases, an itchy bottom can be a symptom of a gastrointestinal cancer, such as anal cancer or bowel cancer. It is important to remember that the majority of itchy bottom cases are not caused by cancer, but your GP may need to rule out all possibilities.

Anal cancer is rare, with around 850 cases diagnosed in the UK every year. Bowel cancer is the third most common type of cancer, with 38,000 cases occurring in the UK each year. Eight out of 10 cases of bowel cancer occur in people who are 60 years of age or over. If you do have cancer you are likely to have other symptoms as well such as:

  • weight loss
  • changes in your how often you go to the toilet

See the topics about Anal cancer and Bowel cancer for more information about these conditions.

Other conditions

Some conditions which affect your whole body (known as systemic conditions) can sometimes make your bottom feel itchy. Other conditions which can cause an itchy bottom include:

  • diabetes - a chronic (long-term) condition that is caused by too much glucose in the blood
  • renal failure - when your kidneys stop working properly
  • iron deficiency anaemia - when due to a lack of iron your blood cannot carry as much oxygen as usual, leaving you feeling faint and tired
  • an over-active thyroid (hyperthyroidism) where there is too much thyroid hormone (chemical) in the body

Medication

Some types of medicine can cause side effects which make your bottom feel itchy. This is especially true of topical (rub on) medicines, which are applied directly to your skin.

If used for a long period of time, some topical medicines can cause contact dermatitis, a condition which causes your skin to be itchy and red.

Some of the medicines that can cause an itchy bottom include:

  • colchicine - which is often used to treat gout (a type of arthritis that causes swelling in the joints)
  • peppermint oil - which is used to help relieve cramps or spasms in your stomach or intestines
  • long term use of local anaesthetics - medicines which numb a specific part of your body
  • glyceryl trinitrate - a medicine used to treat chest pain
  • long term use of topical corticosteroids - medicines which are applied directly to the skin to help reduce inflammation

If a medicine you are taking is causing your itchy bottom, then your symptoms should ease once you complete your course of medication. Do not stop taking prescribed medicine unless your GP or another qualified healthcare professional who is responsible for your care advises you to.

If you are taking your medicine on a long-term basis, speak to your GP about your itchy bottom - they may be able to prescribe you an alternative medicine.

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Diagnosis

You should visit your GP if you have an itchy bottom. They will look at your medical history, and ask you some questions to find out if there is something which may be causing your symptoms.

For example, your GP may ask:

  • whether you use any creams, powders or soaps around your anus (the opening at the end of the digestive system where solid waste leaves the body) 
  • how often you wash
  • whether you symptoms are worse after eating certain foods
  • about the duration and pattern of your itching, such as when the itch is worst
  • whether other people in your family are also experiencing itching
  • whether you have any other symptoms, such as bleeding or a discharge (a leak of liquid) from your anus

Physical examination

After your GP has asked you about your symptoms, they will need to physically examine your bottom.

You may feel awkward about this, but it is nothing to be embarrassed about. Your GP will be used to carrying out these sorts of examinations.

By carrying out a physical examination, your GP will be able to gain a much better idea about what may be causing your itchy bottom and how it can be treated.

Your GP will first examine the appearance of the skin around your anus, and will look for any skin that is:

  • cracked
  • inflamed (red and swollen)
  • bleeding

Digital rectal examination

After this, your GP may need to examine you internally, by inserting a gloved, lubricated finger (digit) into your anus. This is called a digital rectal examination (DRE).

Again, you should try to relax. This examination should not cause you any pain, but it may feel slightly uncomfortable.

By examining you internally, your GP will be able to look for any factors which may be causing your itchy bottom, and they will be able to rule out any more serious conditions, such as bowel cancer (a very rare cause of itchy bottom).

See the A-Z topic about DRE for more information about this procedure.

Referral

Sometimes your GP may refer you to a specialist for further testing and treatment. The specialist you are referred to will depend on what your GP suspects is causing your symptoms. You may be referred to a:

  • dermatologist (a specialist in treating skin conditions)
  • colorectal surgeon (a surgeon who specialises in conditions which affect your large intestine (colon) and anus
  • colorectal specialist nurse (a nurse who specialises in treating conditions affecting the colon and anus)
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Treatment

Most people with itchy bottom respond well to treatment. Your itchy bottom may come back from time to time, but it should be easy to treat.

Following the self-care measures that are outlined below for around two months should help to prevent your bottom from itching. If after this time your bottom no longer itches, you can relax these measures. However, if you still have an itchy bottom or if your itchy bottom returns, you may need to follow this advice indefinitely (forever).

Keep clean and dry

If you are experiencing itchy bottom, it is important that you keep your bottom as clean and dry as possible.

The best way to do this is to gently clean your anus (the opening at the end of the digestive system where solid waste leaves the body)  and the surrounding skin using water. Youshould do this:

  • after every bowel movement
  • before going to bed

If you want to use soap, use a mild, un-perfumed one which will cause less irritation to your skin. Make sure all the soap is washed away afterwards.

You should then dry your bottom gently - do not rub the area vigorously, as this can irritate the skin. Instead, gently pat the skin dry using a soft towel. If you find it easier, you can use a hair dryer on a low heat setting to dry your bottom.

If you are away from home, use a damp toilet tissue after bowel movements, and gently pat your bottom dry.

If you sweat a lot, or find that your bottom becomes very moist, try placing a cotton tissue in your underwear, so that it absorbs the moisture around the anal area.

Self-care

As well as keeping your bottom clean and dry, there are a number of steps you can take to help keep your itchy bottom symptoms under controll. You should:

  • use soft toilet tissue
  • bath or shower daily
  • wear loose fitting cotton underwear
  • change your underwear daily
  • only put on underwear when your bottom is completely dry
  • avoid wearing tight clothing and wear stockings instead of tights so that you do not get too hot
  • use a light duvet at night so that you do not get too hot
  • avoid using scented soaps, bubble bath, perfumes or powders around your anus
  • keep your fingernails short (to limit the damage you do by scratching)
  • wear cotton gloves when you sleep, so if you itch, you cause less damage to the skin.

Although it may be difficult, try not to scratch your bottom. Scratching the area will usually only make your symptoms worse, and will increase your urge to itch.

Diet

Some foods can make your itchy bottom worse. If you notice that your urge to itch is greater after eating certain foods, try and reduce the amount you eat of them. Some foods which may make your itchy bottom worse include:

  • tomatoes
  • spicy foods
  • citrus fruits, such as oranges
  • nuts
  • chocolate
  • dairy products
  • coffee
  • excessive amounts of liquids such as beer, wine, and milk

Fibre

Your GP may also recommend that you follow a diet that keeps your stools well formed and regular. This means that they will not be loose (runny) but that you will not need to strain when you have a bowel movement. This is because:

  • loose stools may irritate your anus
  • straining to pass firm stools can cause haemorrhoids (piles), where the blood vessels in and around your anus become swollen

This may mean changing the amount of fibre in you diet, as eating more fibre will make your stools softer and eating less fibre will make your stools firmer. Fibre is found in:

  • grains - such as in wholegrain bread
  • pulses - edible seeds that grow in a pod, such as peas, beans and lentils
  • oats - found in some breakfast cereals
  • fruit and vegetables

Medication

Whilst you are waiting for your self-care measures to take effect, your GP may be able to prescribe you medication to help ease your itchy bottom. However, these should not be used for longer than two weeks because topical (rub-on) treatments may start to harm your skin after this time.

Soothing ointments

If the skin around your anus is painful, your GP may prescribe you an ointment or cream which helps to soothe the skin.

You will normally have to apply the ointment:

  • each morning and night
  • after a bowel movement

Topical corticosteroids

If the skin around your anus has become sore and inflamed (red and swollen) as a result of your itching, your GP may prescribe you a mild topical corticosteroid (an ointment containing steroids). This is applied directly to the affected skin and should help to relieve any inflammation and ease your urge to itch.

Although for most people a topical corticosteroid will ease itching, sometimes it can make your itching worse. If you find your itchy bottom is getting worse, you should speak to your GP immediately.

See the topic about Topical corticosteroids for more information.

Antihistamines

If your sleep is being disturbed because of itching at night, an antihistamine may help to sooth your itching, allowing you to sleep more easily. Antihistamines work by counteracting the action of histamine (a chemical released during an allergic reaction). Some antihistamines also have a sedating effect (make you drowsy).

You may either be prescribed:

  • chlorphenamine, or
  • hydroxyzine

These should be taken at night time and should not be used for longer than two weeks because after this time the sedating effect may no longer work.

If you are taking a sedating antihistamine you should take care because:

  • they can affect your ability to drive or operate machinery
  • the sedating effect may be stronger if you drink alcohol

Treating an underlying cause

When making a diagnosis of itchy bottom, your GP will look to see if there is an underlying cause of your symptoms.

If a cause is identified (such as a bacterial infection, or a skin condition - see Itchy bottom - causes your GP will also need to treat that cause in order for your itchy bottom to be properly managed.

For example, a bacterial infection may need to be treated with antibiotics (medication to treat infections that are caused by bacteria). If the underlying cause is not treated, then your itchy bottom may return.

Further treatment

If self-care measures and medications have failed to relieve your symptoms after about a month, your GP may refer you to a:

  • dermatologist - a specialist in treating skin conditions
  • colorectal surgeon - a surgeon who specialises in conditions that affect your large intestine (colon) and anus
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Complications

If you frequently scratch your bottom, you may damage or tear the skin around your anus (the opening at the end of the digestive system where solid waste leaves the body). This can sometimes cause problems such as:

  • thick and leathery skin (lichenification)
  • sore and broken down skin (ulceration)
  • wearing away the top layer of skin (excoriation)
  • infection

The earlier that these complications are diagnosed and treated, the quicker you will recover. See your GP if the skin around your anus changes or feels painful.

Long-term itching

Sometimes, your GP may not always be able to identify the cause of your itchy bottom. If the cause cannot be identified and treated, you may find that your bottom is itchy for long periods of time (chronic).

Chronic, or severe, itchy bottom can make people feel:

  • embarrassed
  • anxious
  • depressed

Because the urge to scratch is often worse at night, you may also find that your sleep is disturbed, leaving you feeling tired during the day.

Speak to your GP if you are feeling unhappy about your itchy bottom, or if you find that it is significantly disturbing your sleep.

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