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Dr Phil: Anal itching

Here's an everyday dilemma: you come out into the garden to enjoy the wonder of the butterflies and the buddleia in your best shirt, and your bum starts itching. Anal itching, not something we like to talk about, but an itchy bum is the commonest problem that people log on to embarrassingproblems.com for. So let's just talk through our wonderful anus.

As my consultant used to say, the anus, when it's working properly, can tell the difference between a solid, a liquid and a gas: generally, you know what's coming. It's a fine piece of machinery and you want to look after it. So, why does it itch? It can itch for two reasons.
 
It can itch because you don't wash it enough, little bits of particle (you know what I'm talking about) get caught in the folds, they hang around there and lead to a bit of itching. But, rather perversely, it can also itch if you wash it too much. People get down there, get scrupulous with their anal hygiene, and use detergents, Domestos, wire brushes, they use all sorts of things to punish their anus. So, rule number one, love your anus. If you are going to wash it you only need to wash it with salt water or just ordinary water, maybe two or three times a day. If you're posh enough to have a bidet you can use one of those, otherwise squat delicately over the bath, being careful not to fall in, maybe use the showerhead, and just wash those little particles away. Some doctors are quite keen on aqueous cream, which is a very simple cream you can buy over the counter: that doesn't have anything in it that's going to irritate the anus but you'll find a lot of creams like Germolene, Vaseline, or any disinfecting creams can actually make anal itching worse.
 
So, what if it's more than just a few bits of poo stuck in your crevices? Another common cause of anal itching, particularly in children, are threadworms. These are fantastic little creatures are about a centimetre long, white little slimy worms and they're very, very clever. They live in the gut and come out at night, or the lady worm does, and lays its eggs around the rim of the anal margin, making it intensely itchy. So what do you do in the morning? You wake up with an itchy bum, scratch it, get the eggs under your fingernails, and later in the day you put your fingers in your mouth and the eggs get back into the gut, hatch again and the cycle repeats every 6 weeks or so. As Dr Dog said in one of my favourite books, never scratch your bum and suck your thumb. There is something you can take for threadworm, available over the counter, mebendazole. You've got to take 2 or 3 doses maybe a month apart if you want to wipe it out completely, and you probably have to give everyone in your family a dose too. Some people just say well, let it be, it will die out anyway after 6 weeks or so, but a hot wash for all of your bed linen and your towels should sort it out.
 
Other causes of anal itching, rather perversely, are scratching. People get the itch and they scratch, whether it's caused by threadworm or by something else, and the scratching then makes it worse, you must never, ever scratch your bum if you can avoid it. Wear light cotton pants. Some people put a little dab of talcum powder on a cotton wool ball, just place it nicely between the cheeks and that just seems to take the edge off things.
 
If you can feel a lump or something you don't think should be there, it might be haemorrhoids. Aren't they wonderful, haemorrhoids. They come in three degrees, a bit like the group. They're not varicose veins, they're just like fleshy pads around the anus that help tell you whether it's a solid, a liquid or a gas, and if those pads get swollen, sometimes you get a little bit of leakage that makes things itch, and sometimes the pads themselves can drop down. So your first degree piles stay up and don't cause you any problems, second degree pop down but go in again fairly quickly, third degree come all the way down and are quite hard to push in, fourth degree, that's not going anywhere, but nobody talks about the fourth degree. A bit like Diana Ross. If you feel lumps, that probably is something to show to a doctor. If you get any bleeding, that's also something to show to a doctor. But in the first instance, try plenty of washing in salt water.
 

Written by: Dr Phil Hammond
Edited by: Dr Phil Hammond
Last edited: Tuesday, March 9th 2010

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