This is one of those embarrassing problems that no one talks about and many people are surprised to know even exists.
So why don’t people talk about their itchy bottoms?
Imagine the scenario. You’re sitting next to a friend who says: ‘Oh god, my bum itches like crazy!’ You probably would not be laughing or remotely sympathetic. More likely you would think ‘eww’, recoil in horror and assume your mate needs a good wash.
Now imagine another scenario, where a woman who has given birth says: ‘I laughed so loud, I peed myself.’ Thankfully talking about pelvic floor damage after having children is totally acceptable and no one would question that individual’s hygiene.
The difference, of course, reflects society’s acceptance of certain topics and reservation or disgust about others. These change with time, but itchy bottoms certainly have had a bum deal.
Pruritus ani (that’s the Latin) is an unglamorous subject in medicine and has received very little interest, funding or research. This may also explain why most doctors are ill-equipped to treat sufferers or, even worse, make patients feel it’s their own fault.
Let’s go over the facts. One in 20 people will suffer an itchy bottom at some point, it can occur at any age and it’s four times more common in men. There are multiple causes and ways to treat. Most people’s symptoms are transient, but others suffer terribly to the point of being suicidal. The intense itch around the bottom will inevitably lead to scratching, which gives initial relief for a few minutes. But this is where the problem lies. Scratching leads to a stronger itch, which leads to more scratching: a ‘scratch-itch-scratch’ cycle. Asking people to stop scratching without helping them is doomed to failure.
Someone with eczema, psoriasis or another dermatological condition may have the same problem around his or her bottom causing an itch. The trouble is that the skin condition may look different compared to elsewhere on the skin. Bowel infestation such as threadworms causes itching in younger people and is easily treated.
The other causes of an itchy bottom are in the therapeutic realm of a colorectal surgeon, otherwise known as the bum doctor. If the surgeon looks hard enough they will generally find a treatable condition such as piles, skin tags (fleshy pieces of skin around the bottom commonly confused with piles) or a tear in the lining of the back passage known as an anal fissure. Some people’s itch is attributable to looser stools caused by diet, caffeine or irritable bowel syndrome.
Simple advice on how to clean one’s bottom will help the vast majority of people. Unfortunately, this regime needs to be followed each and every time the itch is felt and, yes, that means in the middle of the night. The same regime also needs to be applied after opening one’s bowels. Toilet paper is banned! This is shocking to most Brits, but there are other ways to clean your bottom. Wash with water (easy for those with a bidet) and then dab dry with a towel. A barrier cream such as a paraffin-based cream or any ointment used for nappy rash should be applied after.
If you need to go to the toilet or get an itchy bottom outside the home, there is a way to cleanse your bottom without having to buy a bottle of water. Aqueous cream is widely available and, with cotton wool balls, is used to clean the bottom after going to the toilet and then coat the area to reduce the itch. In the shower, no chemicals or soaps must be used on the itchy area, as these will only make the situation worse.
Many people’s symptoms are helped by the simple hygiene measures described. Others may need any identified causes to be treated and this will help the majority of sufferers. Those in whom an itchy bottom remains should not despair; anal tattooing is your saviour. Yes, really! A chemical called methylene blue is injected under anaesthesia in and around the bottom. The tattoo is not permanent and it really seems to help, but may need to be repeated.
Dr Shahab Siddiqi is a consultant colorectal surgeon with Medstars.co.uk.