Irritating, uncomfortable and downright embarrassing, it’s pretty clear that having an itchy bottom is not pleasant. However, the problem is often easily rectified – and depending on the cause, you may not even need to see your doctor about it.
But if you do need further help and advice, never let embarrassment stop you from seeking treatment. Doctors have seen everything, so if you’re at all worried, make an appointment to see your GP.
Dr Andrew Thornber, Chief Medical Officer at Now Patient, offers his expert advice on the most common causes of anal itching:
1.Threadworms and anal itching
Threadworms are tiny worms common in children, which can be found in stools.
★ Threadworms symptoms: an itchy bottom is quite common. If you have threadworms, small white worms can usually be found in stools and/or around the bottom. They are usually white and look like thread, and they usually come out at night, so can cause irritability sleeping. Sometimes they can cause a sore bottom and weight loss, although these symptoms are less common.
★ Threadworms treatment: you should be able to get treatment via a pharmacist, who will usually prescribe a liquid medication or chewable tablet. Advise the pharmacist if you’re treating a child under two years of age, or if you’re pregnant or breastfeeding. It may be advisable to treat everyone living in the same household, as it can be easily spread.
★ Threadworms prevention: threadworms are easily spread and even though medication is prescribed to kill them, they lay eggs around the bottom which, if scratched, can then be spread onto finger nails and passed onto anything you may come into contact with.
The worms take two weeks to hatch, so it’s important to thoroughly clean any areas where you feel the eggs may be and make sure you wash your hands after going to the toilet and before eating.
Top hygiene is paramount to stopping and preventing threadworms, so clean all bed sheets, shower daily and make sure children wear underwear at night (then change them in the morning).
2. Thrush and anal itching
Thrush is a common yeast infection, which affects both men and women.
★ Thrush symptoms: in women symptoms include itching and soreness around the genital area and sometimes the anus, a white discharge (like cottage cheese) from the vagina, and stinging when passing urine or having sex. Men tend to have the same symptoms, but can find their discharge has a funny smell and experience pain when pulling their foreskin back.
★ Thrush treatment: Candida can usually be treated with over-the-counter anti-fungal medication from a pharmacist. They will usually have a private area to chat to you, if you feel embarrassed. A cream and/or a pessary (for women inserted into the vagina) should help clear up the condition. If it comes back or keeps reoccurring, then it would be advisable to see your GP for further tests.
★ Thrush prevention: avoid having sex until it stops (or use condoms), wear cotton underwear, don’t use harsh shower gels when washing, and have showers instead of baths.
3. Pruritus ani and anal itching
Itching around the opening of the back passage (the anus) could be Pruritus ani. It is more common in women than men.
★ Pruritus ani symptoms: the main symptom is itching around the anus. It can sometimes cause the skin to crack and make it sore when opening the bowels.
★ Pruritus ani treatment: it’s important to visit your GP to determine the cause, as there can be many contributing factors and varying treatment options. These include:
- A short course of a steroid ointment or cream, to be applied every day to the area to reduce the itching.
- A course of antihistamine to relieve itching.
- An emollient cream, such as aqueous cream, which should be used instead of soap for washing the area, to avoid the irritating effect of soap and detergents.
★ Pruritus ani prevention: cotton wool balls with warm water are gentler than toilet paper, and more effective in cleaning fissures and skin creases. It’s important to ensure no little bits of toilet paper or cotton wool are left in the area, as this will cause more irritation.
The area also should be rinsed thoroughly after you have opened your bowels. Try not to scratch the irritated area, wear cotton underwear, drink plenty of water, and eat lots of fruit and veg.
4. Haemorrhoids and anal itching
Haemorrhoids (often referred to as piles) are swollen veins in the lowest part of your rectum and anus. Sometimes the walls of these blood vessels stretch so thinly that the veins bulge and get irritated, especially when you go to the toilet.
★ Haemorrhoids symptoms: symptoms often include itching around the bottom/anus area, as well as aching, soreness and sometimes swelling. You may experience pain when going to the toilet for a poo, and there may be bleeding when going to the toilet. A lump can sometimes appear outside the anus.
★ Haemorrhoids treatment: they can (but not always) go away by themselves, if you make changes to your diet (eating more fibre) and try some self-treatment remedies. These include:
- Avoid standing for long periods.
- Press a cold cloth against the area to ease the pain.
- Push the piles back in if they come out.
Healing time is often between one week and one month. There are also creams you can buy from your pharmacist that may help. If your symptoms persist for more than a month, then consult your GP.
★ Haemorrhoids prevention: eat a diet rich in high-fibre foods (such as wholemeal bread, fruit and veg), drink plenty of water and improve your circulation by taking regular exercise.
5. Eczema and anal itching
Atopic eczema is the most common form, which is sometimes also referred to as atopic dermatitis. It’s a condition that causes the skin to become dry, red, cracked and itchy, and is quite common in children.
★ Eczema symptoms: itchy, red, dry and cracked skin. While it is usually found in the insides of elbows, the backs of the knees and the face, in some people it can cause inflamed skin across the whole body, including the anal region.
★ Eczema treatment: you should see your GP if you think you or your child has eczema. There are a variety of different treatments, depending on the severity and person. These include emollients (moisturising treatments) or topical corticosteroids, which help to reduce swelling during flare ups.
★ Eczema prevention: There are some personal self-care routines you can try to help alleviate eczema. Soaps and detergents can trigger it, so be mindful of what you use to wash yourself or your clothes. Stress can also play a part in making the condition worse, as can the weather.
Eczema can be very common in people who have allergies, such as food allergies, asthma and hay fever. It may therefore be worth keeping track of food eaten to see if there is a link, or opt for food allergy testing.
6. Sexually transmitted infections and anal itching
What STIs might cause an itchy bottom? The human papilloma virus (HPV) is a sexually transmitted disease, which can cause anal warts. Scabies, which can be caught and transmitted sexually, can often cause an itchy bottom. An itchy bottom can also be associated with gonorrhoea, anal warts and pubic lice.
★ STI symptoms: STI symptoms vary depending on the type of STI, but usually they can cause problems such as lumps, bumps, itching and discharge.
★ STI treatments: it depends on the STI, it's advisable to visit a sexual health clinic for a full infection screen and treatment.
★ STIs prevention: always practice safe sex and use condoms.
7. Diarrhoea and anal itching
Diarrhoea is usually linked to a stomach bug and should pass within a few days.
The most common causes are norovirus, a stomach bug or food poisoning.
★ Diarrhoea symptoms: stomach pains, watery stools, rushing to the toilet and regular toilet visits. These symptoms are sometimes accompanied by a temperature and/or vomiting. You may find your bottom becomes itchy and sore due to the regular toilet trips.
★ Diarrhoea treatment: diarrhoea should usually pass within a few days. Resting is important, as is drinking lots of fluids (oral dehydration tablets can help replace lost salts). Eat little and often, and try to take paracetamol if you can on a regular basis. A baby's nappy cream can ease a sore bottom.
★ Diarrhoea prevention: it can be spread easily, so make sure you always wash you hands after cooking and/or visiting the bathroom, and always cook food properly.
Last updated: 20-11-19
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