Blog

rich emollient used in the management of eczema, psoriasis and other dry skin conditions.

27Jan

We all have a bottom and private parts and those of us with eczema, psoriasis or a tendency towards sensitive skin may at some point in time experience pruritus ani and/or anal or labial eczema.

Anyone can get this condition, well obviously one of the above is only relevant to the girls, although those with atopic skin, dermatitis, eczema or psoriasis may be more likely to experience it; it can occur for no reason but it is thankfully usually easily treatable.

So what is pruritis ani?

Pruritus ani is an annoying and constant itch around the anus. There can be many different causes but it is often unclear why it occurs. The main symptom is an urge to scratch your bottom, which is almost impossible to resist. The itching sensation may occur at any time but often tends to be more urgent after you have been to the toilet to pass a bowel motion, and at night (particularly just before falling asleep). The itch may be made worse by heat, wool, moisture, leaking, soiling, stress and anxiety.

If you keep scratching, skin can become damaged making it more likely for a skin infection to develop and this kind of chronic itching of the anal/labial area can also lead to feelings of embarrassment and both your mood and sleep can be affected.

For women it can affect the labial skin also which may make you think it’s thrush but if thrush treatments are ineffective it could be just eczema, especially if you also have eczema and sensitive skin. Anal and labial eczema are both really far more common that you might think – it’s just that noone ever talks about it.

What causes it?

There are many things that can cause this problem, eczema being one of them. For a full list of known causes and more information visit patient.co.uk.

It could be triggered by irritation from scented loo roll, soap or sanitary products.

However, itching around the anus can be a sign of many other conditions and Googling can often be very dangerous – indeed up popped a huge list of possible awful causes including eczema, psoriasis, piles, candida, scabies, fungal infection, warts… and worse. If you are concerned I would urge you to seek a medical diagnosis.

If you have eczema or psoriasis or have had sensitive skin or dermatitis in the past it is worth considering, even though it’s embarassing to think about what might be causing eczema to flare-up ‘down there’. Even if you’ve never ever had labial or anal eczema before it could flare at any time, for no reason, or be triggered by something topical or just stress.

There are some very simple tips to help this kind of eczema to heal:

  1. Don’t let that area get too hot and sweaty – always wear cotton, not clothes that are too tight… etc. Sounds pretty easy right, but tight jeans or nylon tights can irritate this condition. Stick to cotton tights if you can and wear looser fitting clothes at least until you get it under control, but ideally avoid the tight clothes if you’re prone to this.
  2. Wash without soap – Use a soft flannel to wash with just warm water, always from front to back for women. No soap. If you find you want to wash too much, with normal soap because it doesn’t feel clean enough you may find yourself in an ‘itch wash’ vicious cycle. You itch so you feel dirty and itchy and horrible and you scratch more and you wash again… But washing with any kind of scented soap is the worst thing you can do. Really any soap, even unscented could irritate when this condition becomes inflamed. Sounds like it won’t work and definitely isn’t clean enough, but if you wash with soap or shower gel in the shower then cleaning during the day after using the toilet (only if you need to, or it’s itching) can be done with just a flannel and plain old water. You could also keep some kitchen roll in the bathroom, which is stronger, dampen it with warm water and wipe clean as above till it shows clean, then you can flush the paper down the loo. Do try this, I promise, despite it seeming totally at odds with what we think about being clean, it should get so much better within just a few days. If you feel you have to use soap, use a non-scented hypo-allergenic variety and rinse well. Make sure you dry the area gently and thoroughly after washing.
  3. Be gentle – it might seem obvious but wipe gently and don’t be rough or rush. Sensitive irritated skin needs a little TLC. If it’s itchy the wiping can turn into an itch/scratch motion so don’t give in. Gently does it.
  4. Less cleaning is better – Girls, this one is for you. And I don’t mean here not to wash, but if you haven’t done any sport or exercise, haven’t got hot and sweaty and aren’t having a shower or bath, don’t wash your labia. Your body has natural oils and secretions which will clean it and over washing can remove these, dry the area out and lead to irritation. If you have very dry, eczema skin then once a day is enough. Clean yourself as you normally do in the shower and not in between.
  5. Moisturise carefully – if you are really itchy down there you could try something really gentle to ease the irritation. Aloe Vera gell 99% or your eczema cream or emollient but avoid using steriods. Apply in moderation, gently, from back to front always and then wash your hands thoroughly afterwards – it can help to ease that dry itchy feeling. Normally you shouldn’t need to use any moisturiser here but when you get a skin flare-up down there, it will really help, just as moisturising other parts of your skin aid healing and alleviate the itch. You could try Anthisan Bite & Sting Creamwhich you can get in Boots or online from Amazon. It is relatively cheap to buy and is advertised as good for insect bites but it’s worth a try. Thanks to Micki Rose of the Pure Health blog for this suggestion.

The problem with this area of the body is that it is very easy for skin to become infected due to the germs that can be present.

You can find yourself in a vicious cycle of constantly itching, and regularly scrubbing clean which is the worst thing. Fight the urge to itch and try these tips above and it should clear up if it’s just simple pruritus ani or labial eczema.

Now I’m not a doctor, if you experience persistent itching you should seek the advice of a doctor. But if you have very sensitive skin, consider first that you might just need a little more gentle care and some moisturiser.

Some of you may have read about my rather unfortunate dabble with scented loo roll which it turned out had a very bad reaction with my skin.

The information I discovered above was invaluable in getting the eczema flare-up caused by the evil scented loo roll back under control and I hope it helps someone else out there. Because this can very lonely – we are a very prudish nation and NOONE talks about ever having an itchy bum or labia. It’s just another body part at the end of the day but if you are at all concerned go to see your doctor.

  

2 Responses to Pruritus ani or itchy bum, labial eczema

  1. George Jerry

    I’m not a Doctor and this is the internet – so you can make up your own mind.

    I’m a 68 year old male in fairly good health. I enjoyed consistent BM’s with no major concerns until Oct 2013 when I had a sudden, unexplained, onset of large hard stool and severe constipation. This brought on a fissure that would re-open at every BM as well as hemorrhoids (external as well as internal?). Shortly thereafter I experienced anal itching and burning that became quickly severe and began to interfere with sleep…and life in general.

    It is now Aug 2014 and I have seen 4 Doctors with no real relief. this prompted me to do my own searching. I still don’t know what caused/is causing this but I have a few suspicions. those are not important now but I wish to pass on what I found…that is relevant to MY SITUATION only and is thus for information purposes only.

    The following is a list of what I have learned and what has offered me 95% relief from the itching and burning.

    After about 9 months I found that the creams, salves and ointments I was using were actually contributing to the problem as it seems I had developed a sensitivity to some or all of them.

    Accordingly, about 6 weeks ago, I ceased using all and went to the baby section of the drug store and bought some 20% zinc oxide. I experienced immediate relief upon the first application that continues till today. After each BM I ceased ‘wiping’ with toilet paper and merely use a small wet rolled pad of same to ‘pat’ clean and then a dry pad to ‘pat’ dry. I have also installed a ‘bidet’ spray nozzle onto the water supply for the toilet and use that to assist in cleaning…the cold water feels WONDERFUL. I also avoid soap AT ALL COSTS as well as any scented toilet paper. Water ONLY to clean .

    Note that the above (and most treatments recommended by Doctors) focus on the symptoms only…and certainly not on the actual underlying cause.

    In order to address the cause I have suspected that the itch and burn is a result of 1) sensitively to creams/lotions/chemical and/or 2) Bacterial irritation.

    I think that the Zinc Oxide creates a ‘barrier’ that is preventing the cause of the irritation to get to the skin in that sensitive area…although I still have a very sensitive and somewhat irritated anal ring…as well as the skin area surrounding the anus and I have to be very careful to clean judiciously without irritating the anus or surrounding skin. It is well known that even a minor/small ‘leakage’ of feces can be very irritating but I have absolutely no indication of this so the actual cause of the irritation remains unknown.

    For the past 5 days I have begun using a freeze dried pro-biotic in order to see if I can retrain my bowels to a one-day cycle rather than the 2-3 day cycle. So far – so good. 5 days and 4 BM’s and the stool is noticeably ‘fluffier’ and easier to pass. Less irritation to the anal ring on evacuation. Here’s hoping for a permanent solution.

    Plus – I’m off for a colonoscopy soon and the surgeon agreed to tie off any hemorrhoids found. I hope this proves positive as my main suspicion is that the irritation might be caused by mucus produced by hemorrhoids that is carrying bacteria with it and presents as a ‘wetness’ around the anus. We’ll see how that works out.

  2. J. David

    So, depending on how you look at it, I’ve suffered from pruritus ani most of my life (now 44 years old, white male). At the start of 2013, I decided finally to go to the doctor to seek relief. I had been assuming for years my troubles (consistently finding blood on the toilet paper, swelling, itching in the middle of the night) had to do with two internal hemorrhoids that were confirmed in a colonoscopy in 2009. I had been a piano mover in my early twenties and knew heavy lifting is commonly associated with hemorrhoids. So, the colon & rectal doctor laser-treated the two hemorrhoids and prescribed me some prescription cream (containing steroids, I do not recall the name). He also instructed me to use an elaborate daily treatment of the area with cotton balls and corn starch “to keep the area as dry as possible.” He also recommended I avoid spicy foods, fruit with citrus and caffeinated drinks. This is when my troubles REALLY began. I followed his instructions TO THE LETTER and used the cream for several months (not realizing long-term use is contra-indicated with creams containing steroids) with the cotton ball/corn starch treatments (which were messy and humiliating) and tried to forgo coffee (which was miserable in itself). To my absolute horror, after about four months of this I developed anal warts!! At this point I went to a dermatologist, who prescribed imiquimod cream, which cleared up the anal warts (and was rather excruciating in the process, but I was glad it worked). Once the warts were gone, the next several months were ‘so-so’ with the pruritus ani. I began to get depressed and even sought relief via pain medication. Finally, I went to another, more experienced dermatologist, who examined the area and prescribed Pramasone, which was a big help in relieving the pain and itching. More importantly, however, the dermatologist said he “has seen (this condition) before (something NO medical professional/MD had said up to that point)” and said that “for some reason (he) has seen this condition only in men.” With the Pramasone he instructed that I buy a skin cleanser/moisturizer called CeraVe (available in any pharmacy) and use it to clean myself after a bowel movement. MOST IMPORTANTLY the dermatologist advised me my condition was likely a contact allergy to toilet paper! Specifically, he said most toilet paper manufacturers use some amount of chlorine to dye the toilet tissue white. I found some toilet paper made without chlorine, but, decided to take this information further, by NO LONGER USING TOILET PAPER AT ALL. So, my practice has been, after a bowel movement, to clean the area with CeraVe using a latex glove. This necessitates a private restroom with a sink. Finally, I bought a portable bidet at amazon.com and use it daily after the cleansing with water as cold as possible. Basically it’s a three-step process: bowel movement, cleaning the area, then rinsing the area. Really, it involves only one additional step to ‘normal’ people’s bathroom activities.
    All this sounds disgusting, odd and downright crazy, right? If you’ve read this I’m assuming you are suffering and desperate for help. I’ve heard that those in other countries think Americans are crazy for using toilet tissue in the way we do, hence the use of bidets in other cultures. Sure seems like the right assessment to me! If you are a person unaffected by this problem, count your blessings and go read something else. As I indicated, after suffering off and on my entire life and moreso the past TWO YEARS after seeking help from the medical community I am only too happy to have to go through the routine I’ve described to keep the symptoms nearly 100% gone. I have yet to endure a hot summer since using the CeraVe and portable bidet but I’m pretty confident. I have a tiny area of psoriasis on my right knee, and this further confounded my efforts to find an answer for my problem, since much medical literature describes ‘inverse psoriasis’ which can affect the anal area. I also realize the appearance of warts probably indicates the presence of something in my system, but I’ve had no recurrence (knock knock) thus far. As I’ve indicated, the past six months have been the most symptom-free of my entire life. I’ve only realized how much depression and lowering of general functionality was affecting me since the symptoms have dropped to their current levels. I truly hope I can make it to one year; in the meantime, I hope this narrative can be helpful to anyone who is experiencing my type of problem. Hang in there. J in ABQ, NM

Add a comment

Your email address will not be published. Required fields are marked *