Itchy bottom

Itchy bottom (pruritus ani) is characterised by a strong urge to scratch the skin around your anus.

The anus is the opening at the lower end of the digestive system, where solid waste leaves your body.

Causes of itchy bottom

As itchy bottom is a symptom rather than a condition itself. Many cases have an underlying cause, for example:

• a bacterial infection – such as those that cause streptococcal infections
• a skin condition – such as atopic eczema, where the skin becomes red, dry and flaky
• haemorrhoids (piles) – swellings that contain enlarged and swollen blood vessels in and around the anus

In children, an itchy bottom is often caused by threadworms.

But not all cases of itchy bottom have an identifiable cause.

Read more about the causes of itchy bottom. 

What makes an itchy bottom worse?

An itchy bottom can be made worse by:

• heat
• woollen clothing or blankets
• moisture
• soiling yourself
• stress or anxiety

What to expect at your GP appointment 

At your appointment, your GP may ask about:

• how often you wash and whether you use creams, powders or soaps around your anus
• the duration and pattern of your itching – such as whether your symptoms are worse at night or after eating certain foods
• other symptoms – such as bleeding or other discharge from your anus

Your GP will usually want to examine the skin around your anus and may ask to carry out a digital rectal examination (DRE) to rule out more serious underlying conditions.

You may feel awkward, but it's nothing to be embarrassed or worried about, as this is one of the most common examinations GPs carry out.

If necessary, you may be referred to a specialist for further investigation and treatment.

Treating itchy bottom

An itchy bottom is usually easy to treat at home. Some ways of easing an itchy bottom include:

• keeping your bottom clean and dry
• avoid using scented soaps
• use soft toilet tissue
• avoid scratching

Your GP can prescribe creams or ointments to help relieve your symptoms while self-care measures are taking effect. Check with your GP or pharmacist about how long you should use them for.

If your itchy bottom is caused by an underlying condition, such as a bacterial infection or piles, it will also need to be treated.

Read more about treating an itchy bottom.

Complications of itchy bottom

Frequently scratching your bottom may damage or tear the delicate skin around your anus. This may lead to problems such as:

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

The earlier these complications are diagnosed and treated, the quicker you'll recover. 

If the cause of your itchy bottom can't be identified and treated, it may last for long periods of time (known as chronic itchy bottom).

The cause of itchy bottom isn't always known. However, it can sometimes be a symptom of another problem or underlying condition.

Infection

An itchy bottom may be a 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 that causes vaginal thrush (itching, irritation and swelling of the vagina and surrounding area)
• 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, which causes cold sores

An itchy bottom can sometimes be a symptom of a sexually transmitted infection (STI).

If you've had unprotected sex and think you could have an STI, visit your local sexual health clinic. They can offer advice and provide testing and treatment.

Gastrointestinal conditions

Gastrointestinal conditions affect your digestive tract (your mouth, throat, stomach, intestines and anus).

Gastrointestinal conditions that may cause an itchy bottom include:

• haemorrhoids (piles) – swellings in and around your anus that contain enlarged and swollen blood vessels
• anal fistula – where 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
• anal fissure – a tear or ulcer (open sore) that develops in the lining of the anal canal
• sphincter incompetence – where the sphincter (the ring of muscle that opens and closes your anus) stops working properly, causing bowel incontinence
• long-term diarrhoea – passing loose, watery stools
• long-term constipation – an inability to completely empty your bowels

Skin conditions

Some skin conditions can affect any area of skin on your body, including the skin around your anus.

Skin conditions that can be associated with an itchy bottom include:

• psoriasis – where red, flaky, crusty patches of skin develop because your skin cells reproduce too quickly
• contact dermatitis – where your skin reacts to certain substances (allergens), causing it to become inflamed
• lichen sclerosus – a long-term skin disorder that causes itchy or sore white spots to develop on the skin around the genitals
• atopic eczema – where your skin becomes dry, red and flaky

Systemic conditions

Systemic conditions affect your whole body and can sometimes make your bottom feel itchy. Systemic conditions include:

• diabetes – a lifelong condition that causes your blood sugar level to become too high
• kidney failure – where your kidneys stop working properly
• iron deficiency anaemia – a decrease in the number of red, oxygen-carrying blood cells, causing tiredness and a lack of energy (lethargy) 
• overactive thyroid (hyperthyroidism) – too much thyroid hormone in your body

Medication

Some types of medication, including those applied directly to your skin (topical), may make your bottom feel itchy.

For example, if you use a cream to treat haemorrhoids, it may irritate the sensitive skin around your anus and make the itching worse.

Some topical medicines may also cause contact dermatitis (red, itchy skin) if used for long periods.

Medicines that may cause an itchy bottom or make your symptoms worse include:

• peppermint oil – which is sometimes used to help relieve stomach cramps
• long-term use of local anaesthetics – medicines that numb a specific part of your body
• glyceryl trinitrate – which is often prescribed as a topical cream to treat anal fissures, and may cause itching 
• long-term use of topical corticosteroids – medicines applied directly to the skin to help reduce inflammation

If a medicine you're taking is causing an itchy bottom, your bottom should itch less after you've completed the course of medication.

Anal and bowel cancer

In rare cases, itchy bottom can be a symptom of a gastrointestinal cancer, such as anal cancer or bowel cancer.

Most cases of itchy bottom aren't caused by cancer, but it's important that your GP rules out all possibilities.

Possible symptoms of anal cancer include:

• rectal bleeding
• pain
• itching
• small lumps that develop around the anus

Possible symptoms of bowel cancer include:

• bleeding from the back passage
• blood in your stools
• a change in your normal bowel habits, such as diarrhoea that lasts longer than 4 to 6 weeks

Treatment for itchy bottom usually involves following simple self-care measures for a few months. If necessary, medication may be prescribed to help ease the symptoms.

If you still have an itchy bottom after 2 months, or if it returns, you may need to follow this self-care advice for longer.

Keeping clean and dry

If you have an itchy bottom, you should keep your bottom as clean and dry as possible.

The best way to do this is to use water to gently clean your anus and the surrounding skin. Clean your bottom in this way after every bowel movement and before going to bed each night.

You can use soap to clean your bottom, but make sure it's mild and unperfumed so it causes less irritation to your skin. Wash all of the soap away afterwards.

After washing, gently dry your bottom. Avoid rubbing the area vigorously, as this may irritate your skin. Instead, gently pat the skin dry using a soft towel. You can also dry your bottom using a hairdryer on a low heat setting.

When you're away from home, you can use damp toilet paper after passing stools, before gently patting your bottom dry.

If you have a tendency to sweat, or if your bottom becomes very moist, putting a cotton tissue in your underwear will help absorb the moisture around your anal area.

Diet

Some foods may make your itchy bottom worse. If the urge to scratch your bottom is greater after eating certain foods, try cutting them out of your diet completely or reducing the amount you eat.

Foods that 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 milk, beer or wine 

Fibre

Your GP may recommend that you follow a diet that keeps your stools regular and well-formed. 

This means your stools won't be loose (runny), but you won't need to strain when you go to the toilet.

Loose stools can irritate your anus. Straining to pass hard stools may cause haemorrhoids (piles) to develop. Piles are swellings that contain enlarged and swollen blood vessels in and around your anus.

Including more fibre in your diet will make your stools softer and easier to pass. Fibre can be found in:

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

Medication

While waiting for the above self-care measures to take effect, your GP may prescribe medication to help ease your itchy bottom.

However, you shouldn't use topical treatments (those applied directly to your skin) for more than 2 weeks, because they may start to harm your skin if used for long periods.

Soothing ointments

Your GP may prescribe an ointment or cream to soothe the skin around your anus. You'll usually have to apply it in the morning and at night, as well as after each bowel movement.

Topical corticosteroids

If the skin around your anus is sore and inflamed due to itching, your GP may prescribe a mild topical corticosteroid (an ointment that contains steroids). Applying this directly to the affected area will help relieve the inflammation and ease the urge to scratch.

In most cases, using a topical corticosteroid will help ease the itch. However, it can sometimes make the itching worse. Speak to your GP immediately if your itchy bottom gets worse after using topical corticosteroids.

Antihistamines

If your sleep is disturbed due to itching at night, using an antihistamine may help.

Antihistamines are medicines that work by counteracting the action of histamine (a chemical released during an allergic reaction). Some antihistamines also have a sedating effect (they make you drowsy).

Your GP may prescribe chlorphenamine or hydroxyzine. These should be taken at night and shouldn't be used for longer than 2 weeks, because after this time the sedating effect may no longer work.

You need to be aware that sedating antihistamines can affect your ability to drive or operate machinery, and the sedating effect may be stronger if you drink alcohol.

Treating an underlying cause of itchy bottom

When diagnosing itchy bottom, your GP will try to determine an underlying cause.

If they identify the cause, such as a bacterial infection or skin condition, it will also need to be treated for your itchy bottom to be properly managed.

For example, a bacterial infection may need to be treated with antibiotics. If the underlying cause is left untreated, your itchy bottom may return.

An itchy bottom in children is often caused by worms. If treatment for worms is recommended, other family members with the same symptom should also be treated.

Further treatment for an itchy bottom

Go back to your GP if your itchy bottom doesn't improve after following self-care measures, such as keeping your bottom clean and dry, and using medication to provide relief from the itching.

Your GP may then refer you to a dermatologist (a specialist in treating skin conditions) or a colorectal surgeon (who specialises in conditions that affect the large intestine and anus).