What is pruritis ani?
Pruritus ani (itchy bottom) is a common condition which causes itching or irritation of the skin around the anus (back passage).
It has many possible causes, including haemorrhoids (piles) and certain skin conditions. However, the most common cause is a minor discharge from the anus. If small amounts of faeces (bowel movement) or liquid mucous (slime) leaks from the anus, this can irritate the delicate and sensitive skin around the anus. The inevitable scratching that is hard to resist simply aggravates the situation.
If there is an identifiable cause then this will be treated specifically – for example a fissure, fistula or haemorrhoids. Where there is no clear cause then treatment is directed at breaking the vicious circle of contamination, irritation and scratching. The aims are to avoid scratching, keep the area scrupulously clean and to avoid irritants. Some simple guidelines are summarised below:
Most treatment can be done yourself though this takes time and patience. It may take months of gentle care to improve the symptoms.
The following suggestions will help:
- Pay attention to hygiene. Be careful to keep the area as clean as possible, ideally by carefully washing and gently drying the area at least once a day and after each bowel movement. A cool hairdryer could help you do this.
- If you do not have access to a bidet, you may find that sitting on the edge of the bath and using a shower head makes washing easier. If you are at work, take a small plastic bottle of water into the toilet with you to wash after each bowel movement. Some people find cold water more soothing than warm water.
- Don’t use soap as it can sting. It is best to use water on your hand rather than a flannel.
- Use soft toilet paper or damp cotton wool if this is more comfortable. Alternatively, use non-fragranced ‘wet-wipes’ to clean after using the toilet.
- If you have a problem with faeces or mucous leaking from the anus, you could use a small amount of damp cotton wool on your fingertip to gently clean into the anus to make sure there is no residue left behind.
- If your leakage continues after cleaning into the anus, use a small plug of cotton wool in the anus to prevent the faeces or mucous from coming out and irritating the skin.
- Dry the area by gently patting with a soft towel or tissue. Avoid rubbing.
- Try not to scratch the area. If you find that you are scratching in your sleep, wear some cotton mittens in bed. You can get these from your chemist
- Do not use any creams, deodorants, talcum powder, antiseptics or anything else on your anus, apart from the treatment suggested by your specialist.
- Do not put anything in your bath water. In particular, avoid all antiseptics, bath salts, bath oils and bubble bath.
- Wear loose cotton underwear and change this every day. Avoid man-made fabrics coming into contact with the skin around your bottom. Women should wear stockings or open-crotch tights rather than regular tights to reduce sweating.
- You should also avoid tight trousers or jeans and sitting on plastic chairs for long periods of time. Wash your underwear in non-biological washing powder and make sure that all traces of detergent are rinsed out.
Although there is no specific diet to follow, it is important to try and establish a regular bowel habit. Certain foods may aggravate pruritus.
- A diet that is high in fibre makes the faeces softer and more likely to cause leakage. You can try to make your faeces firmer and so less likely to leak by reducing the amount of fibre in your diet. This means avoiding large quantities of bran cereals, muesli, beans, peas, pulses and nuts. Limit the amount of fruit and vegetables, particularly those with skins you eat.
- Avoid lagers and flat beers as these can make the problem worse.
- Avoid coffee, chocolate, tomatoes, nuts, fruit juices high in citric acid and spicy foods as these may make the pruritus worse.
Medicines and creams
A wide variety of medications are available and may be used sparingly under the direction of your doctor. They are of no use by themselves but may be beneficial when combined with the measures outlined above. It is a good general rule to avoid medications in this area if possible.