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Dr Phil: Anal itching (video)

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 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.
Washing too little or too much. 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.
Threadworms. 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.
Try not to scratch. 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.
The three degrees of piles. If you can feel a lump or something you don't think should be there, it might be haemorrhoids (piles). 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.
See your doctor. 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. Visit our section on Seeing your doctor about an anal problem.

Written by: Dr Phil Hammond
Edited by: Dr Phil Hammond
Last updated: Friday, October 20th 2017

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Comments on this article

Posted by Optional on 18/08/2017 at 02:35

Hi. Dr. i have a problem that i would wish to be helped. i had unprotected sex with my boyfrend some 4 weeks ago but since then i hav had a funny smell from my vigina with a secretion of a white/creamy fluid leading to itchness. alot of back pain and abdominoal pain. so my question is could i be pregnant or could i have been infected with STIS. Please help am stranded

Posted by Clara on 15/05/2015 at 04:34

Thank you for the article. I'd monitor myself whether I wash with soap too much. But if it's saltwater (saline solution) what would the ratio be?

Posted by busi on 30/03/2015 at 04:41

I'm embarrassed to see the doctor. Is there a herb that can be of help?

Posted by Optional on 29/03/2015 at 07:10

There's this black thing on the the tip of my tail bone between the top of my butt it doesn't hurt but if I push on it, it sqeaks and a bubble of some liquid comes out like pus I think it's an ingrown hair what do you think

Posted by sammy on 23/11/2014 at 09:43

Hello i wanna knw wht kind of problem i have my butt is itchy and some lumps are there and i have many hairs on my butt around anus there is no bleeding only itching n lumps i searched on internet about it and im scared it cam be crabs or anal cancer or hemmoroid or maybe worms but there is no worms in my poop so plz help me

Posted by Optional on 05/05/2014 at 07:44, United States

Desonide 0.5% cream saved me from itching. Been itching for years. Also, suffered from some fecal incontinence occasionally, but the itching was incessant. Would tuck a folded up piece of tissue there to catch any leakage. Maybe it was the roughness, chemicals in the tissue, etc. that kept it itching. I got the cream prescribed (just ask for a little tube and in the USA it didn't cost more than $10.00). Within a day itch was gone. I rarely suffer anymore. Might if I get overzealous in my washcloth cleaning. Also, instead of tissue now, I tuck a bit of cotton ball into my anus. You will have to experiment with the right size (too big and it will come out, too small same thing). This really helps. I get organic cotton balls. And then of course, I always wear a small sanitary pad for extra insurance. I believe my problems started when I got pregnant and then with the episiotomy. Certain foods (dairy, corn, wheat, etc.) if I eat too much or on successive days seem to make the incontinence worse. My anal muscles just can't hold it in and a bit of leakage can occur.

Posted by Dottie Hall on 07/02/2014 at 02:26

For almost two years I have been itching. To a point of hysterics. I have no rash. I have gone to every Dr. I can think of and no one can seem to help or ever know what is wrong...I am desperate,i don't want to live the remainder of my life like this,it consumes me..I love to do photography and videography,to edit on the computer and put videos together.since this itching started I cannot do anything but itch...I watch your show and I wish you are someone could help me..Thanks Dottie Hall

Posted by Optional on 28/05/2013 at 03:52

Is it normal to have one side of anus feeling harder to the side of it than the other? While I can feel a 'firmness" on the left to outside of bottom, on the right it seems bigger. It is under the skin and painless although recently my bottom feels sore and a kind of pressure feeling on the right. Do I have a prolapse?

Posted by Optional on 29/04/2013 at 09:43

Intense anal itching flared up a few weeks ago after treatment from the doctor for piles, didn't pay too much attention and then used different anti-itch creams, which made things worst then went onto baby wipes, made things worse, the proper haemroid wipes (okish). Also a fissure which heals then tears again and the anal itching goes on till I am driven to sitting in a bowl of salt water, it helps, also dosing for threadworm, as have been a suffer of that on and off. That helps, now thinks its a allergic reaction to the creams combines with threadworms ( can feel them whipping mornings and nights ) and treatment a barrier cream for nappy rash that works a bit and a aloe vera healing gel. Costing a fortune but will go back to doctor and see what he says. Am hoping to control the condition myself still.....:0(

Posted by khader pasha on 31/01/2013 at 09:46

Hi, i am suffering from piles from long years like more than 4 years, n nw its bleeding in bathroom n after the bathroom its comes n its goes back but from one week its not going back regularly n i am afraid of operation so let me knw the best treatment for my piles n suggest me what to have n what to not have.......pls help me ASAP. Thanking you khader pasha

Posted by Optional on 03/01/2013 at 08:33

Hello Dr Phil, Well I just do not think your video is good enough. You are good and make the person who watches it feel comfortable but the info is lacking. You completely ignore Simply Soothing, specially formulated for this problem. Also, you ignore gut parasites, other than threadworms ,that are found in most cases of IBS and that can cause itching. I am surprised that such a common, universal problem that obviously, as we can see from comments sent in, makes peoples lives unhappy is not being investigated properly. Also,your remedy is not very effective. Simply Soothing is proving to be.

Posted by scotslass67 on 03/01/2013 at 07:55

Had anal itching fir years, nothing works long term. For about 8 months had and itch at tailbone also, to the point of screaming as I can't find the bit to scratch! Hole opened and clear fluid was tested. Came back clear with no sign of pilonidal cyst. This spinal itch is still going on and is driving me bonkers. What can this mystery itch be???

Posted by Optional on 18/10/2012 at 01:59

So what if you are working because mine get more itchy and painful now and then and now i think my boses are sick of my sick note these things started irritating me when i was 15yrs and now im 25yrs old ive been on doctors for severals times and now im broke i have to attend to the government health analyst is their note not going to take away my job thank you for the information you are helping us with

Posted by Embarrassed lady on 30/07/2012 at 12:46

Small lump on anus opening , pain in lower back when needing to poo, bowel movements changed a bit .

Posted by Optional on 16/07/2012 at 11:15

you really should watch how you type these things. Hemorrhoids are not wonderful and tapeworms are not fascinating or clever. They are serious symptoms that many people reading this are worried about. Your insensitive attitude makes you come off as a jerk.

Posted by Geoff on 14/07/2012 at 03:00

Put some TCP on a Kleenex then dab your anus with it. It will sting like crazy for about three or four minutes then it will stop and so will the itch.

Posted by sarah on 24/06/2012 at 09:57

I have piles when got birth to my 3 has been 5 years.but knw whn I pupu it comes out wth blood.can this couse cancer?it itches very much.and I'm scead to see a dr.can you pls help

Posted by Optional on 13/06/2011 at 09:49

This has been most phenomenal to me and tanks to this site. I had always taught the itches around ma anus and some of da signs of piles was going to kill me one day, but i feel relieved now having read about it in this article by Dr. Am really grateful

Posted by John on 30/03/2011 at 11:48

I have just stated with an anal itch and of course you scretch it. Having read the article on anal itching I wont be scratching again. It was very helpful in helping me understand th evarious causes of itching. I'm now working on getting rid of the itching once and for all. Thank you very much!!

Posted by Optional on 09/03/2011 at 02:06

I have very sensitive and itch skin around my anus I seen to many doctor used four deferent cream I had no relief and it worse when I am active, and after used the toilet it's not going away and i feel helpless what should I do.

Posted by Optional on 28/02/2011 at 10:16

Perianal problem. About 5-7 years ago I felt that I pulled out a hair with the toilet paper. It was sore. I dabbed some TCP on it and left it at that. I did not take much notice after that except I did notice something, what felt like a pimple, developed at the site. I was aware that it remained permanently, but it was not a problem. I suppose it must have become bigger - it is hard to say as I never looked at it in the mirror until two years ago, but most of it is under the skin (no discolouration of skin)and probably the shape of a flattened orange pip half inch long. Whatever it is, it is extremely hard and sharp like a piece of plastic pointed at both ends. I can bend it if I use two hands. I feel I could push it through the skin and take it out if I tried. There is no soreness except from the thing trying to cut its way out if I sit on a bicycle. I have discounted a cancer as it has been there too long and is a mobile object that can be slid from side to side. Anyone heard of this please?

Posted by blahblah on 09/02/2011 at 12:51

how much salt needed ?

Posted by Optional on 26/01/2011 at 03:31

Very down to earth and informative. Thank you Dr Phil.

Posted by Optional on 23/01/2011 at 09:42

Dr phil,i think dat i hv a third degree piles..prob is that im also sufferin from a cold right now and weneva i cough,it hurts down hs bin 2days since da piles appeared,hw lng is it goin 2 takes until im bck 2 normal

Posted by keith on 02/01/2011 at 04:35

I have been scratching my bum nightly for 3 months straight. I bought some tucks to use just before going to bed. I have in the past been diagnosed with fissures, and hemorrhoids. The nightly itch has subsided but now I have a sharp pain that comes and goes once every hour or so and last for about 3 seconds. I'm afraid this may be something serious

Posted by Optional steve on 08/12/2010 at 01:48

taking meds that cause farts and ok during day going to bed is when it itches

Posted by Optional on 19/09/2010 at 08:22

This site has given me some great tips and i will try them. fingers crossed they work, can't go on like this much longer!

Posted by Optional on 07/09/2010 at 01:49

I got a problem... there's an itching but constantly on one side. It presents itself as some kind of rash. It is never any side except for the left side by the anus. I find it quite shameful, as I don't know what the cause is.

Posted by Optional on 13/08/2010 at 05:20

thats the itchy arse solved, then. What do you recommend for sore ribs caused by laughing at the itchy arse video?

Posted by Jason on 16/06/2010 at 02:38

Hello Dr. Phil, thanks alot for this wonderful Health information. I am indeed very grateful. I have been experiencing this Pile stuff for sometime now, suspected it though, but a little bit confused. I just saw my doctor quite some days ago and he gave me some prescriptions, which i have adhered strictly to. So Dr. please is there any other thing i can add to make this pile disappear completely in addition to the doctor's prescription? I think mine is a second degree pile. Thanks for your support i am indeed very grateful. Looking forward to hearing from you.

Posted by Optional on 18/05/2010 at 03:28

ive had anal itching for near on two years i hardly sleep. saw dr when it first occured i was not examined just told it was possible piles. ive taken countless threadworm tablets i thought maybe that was the problem but it was not.countless things i have tried but to no avail.I dread being examined but it now is getting me down after such a long time.I just hope i wont be fobbed off by my doctor again.

Posted by lyndsey on 16/02/2010 at 12:13

aswell as the above i get discomfort at the base of my spine/lower back which often coincides with when i have opened my bowels. It comes and goes. it almost feels like a numbness in my spine i also get a tingling sensation in the anus which also comes and goes aswell. I do suffer with piles afew times a year one will protrude and i use cream to shrink it untill it goes back up. Is this all related??