Got an itchy bottom? Causes and treatment of pruritus ani

I’ve said it before, and I’ll say it again …you really can’t embarrass your doctor. You will have to trust me on this one, but I can guarantee that by the time we have gone through medical school, survived house jobs and completed all our postgraduate training there are very few things that will shock us. I have seen countless patients tell me that they have suffered with an itchy bottom for years (if not decades) and have never come to see anyone for fear of embarrassment. So let me reassure you this is an incredibly common condition, affecting up to 5% of us at any one time, and it is certainly not anything to be embarrassed about.

There are thought to be over 100 potential causes of an itchy bottom, but some are more likely and more common than others. Here is a brief rundown on some likely culprits and what you can do about it.

Skin conditions

Skin conditions such as eczema, dermatitis or psoriasis can affect the anus just as much as any other part of the body. Dermatitis is usually triggered by an irritant factor; this includes excess moisture or sweat around the anus, or sensitivities to beauty products or toilet tissue. If these triggers have been eliminated, simple steroid ointments or creams are usually the next things to try. Other less common skin conditions such as lichen planus or sclerosis also affect this area and can be diagnosed by your doctor.

Infections

Fungal infections are a very common cause for pruritus ani as these bugs thrive in damp, dark areas. Anti-fungal creams are an effective means of treating this. Threadworm is common in children but can also be passed to adults, and causes classical itching down below. Sexually transmitted infections can also affect the anal regions, so it is sensible to get yourself checked out if you have any concerns.

Conditions specific to the anus

Piles or haemorrhoids can often cause itching, as can small anal tears. There are specific creams which deal with both these problems and which can be purchased from the pharmacy or prescribed by your doctor.

General causes of itching

This is a whole area in its own right (mental note for next article) but there are countless conditions which cause generalised itching. Typically these conditions affect the whole body and not just the bottom, but sometimes the itch can be felt more acutely in this area.

Foods

Many people will be aware of the uncomfortable effects felt following a spicy meal the night before. However, there are a few other foods that can result is an itchy bottom. Some fruits, especially citrus fruits, grapes and tomatoes, are known to be triggers for pruritus ani. Beer, milk and caffeine have also been reported to irritate the anus. Excluding these items from your diet for at least a two-week period can be helpful in making the diagnosis.

Medicines and drugs

Obviously there is always a risk that the creams and ointments used to help treat the condition can actually exacerbate it. Sensitivities to topical treatments are not uncommon and worth being alert to. The drug colchicine (which is used for gout) as well as peppermint oil can also cause pruritus ani as a side effect.

Other factors

The bottom becoming overly hot and sweaty can definitely exacerbate an itch. Drying the area fully before getting dressed, and wearing breathable underwear can help minimise these factors. Also stool remaining in contact with the skin can irritate, so good hygiene is important. Stress and anxiety often worsen anal itching, especially at night time. Lastly there is a very well known phenomenon known as the ‘itch-scratch cycle’. Essentially this means that the more you scratch something, the itchier it becomes. Being aware of this and trying to break the cycle is usually very important when dealing with this problem.

Dr Jessica Garner is a GP and health blogger. Visit her blog here.