Itchy bottom 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.
The medical name for itchy bottom is pruritus ani.
What causes itchy bottom?
As itchy bottom is a symptom rather than a condition; many cases have an underlying cause. For example, itchy bottom may be caused by:
- a bacterial infection – such as the streptococcal bacteria that causes streptococcal infections
- a skin condition – such as atopic eczema (where the skin becomes red, dry and flaky)
- Piles (haemorrhoids) – swellings that contain enlarged and swollen blood vessels in and around the anus
In children, an itchy bottom is often caused by worms. However, not all cases of itchy bottom have an identifiable cause.
An itchy bottom can be made worse by:
Some people only have a mild itching sensation. For others, the urge to scratch can be intense.
Read more about the causes of itchy bottom.
Should I see a GP?
See your GP if you’ve had an itchy bottom for more than a few days. They’ll try to find out what’s causing the problem and how to treat it.
You may need to have a digital rectal examination (DRE) to rule out more serious underlying conditions. During the examination, your GP will insert a gloved, lubricated finger (digit) into your bottom. There’s nothing to feel embarrassed about. Your GP will be used to carrying out this type of examination.
Read more about how itchy bottom is diagnosed.
Treating itchy bottom
An itchy bottom is usually easy to treat at home.
Keeping your bottom clean and dry, not using scented soaps, using soft toilet tissue, avoiding scratching and making dietary changes are all ways of easing an itchy bottom.
Your GP can prescribe creams or ointments to help relieve your symptoms while the above 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.
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)
The earlier these complications are diagnosed and treated, the quicker you’ll recover. You should visit your GP if the skin around your anus changes or feels painful.
Read more about the complications of itchy bottom.
Causes of itchy bottom
The cause of itchy bottom isn’t always known. However, it can sometimes be a symptom of another problem or underlying condition.
An itchy bottom may be a sign 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 that causes cold sores
An itchy bottom can sometimes be a symptom of a sexually transmitted infection (STI).
If you’ve had unprotected sex and you think there may be a chance you have an STI, you should visit your local sexual health clinic for advice, testing and, if necessary, treatment.
Gastrointestinal conditions affect your digestive tract (your mouth, throat, stomach, intestines and anus).
Gastrointestinal conditions that may cause an itchy bottom include:
- piles (haemorrhoids) – 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 (leaking stools)
- long-term diarrhoea – passing loose, watery stools
- long-term constipation – an inability to completely empty your bowels
Anal and bowel cancer
Most cases of itchy bottom aren’t caused by cancer, but it’s important that your GP rules out all possibilities.
Anal cancer is rare, with just under 1,200 cases diagnosed in the UK each year. Rectal bleeding, pain, itching and small lumps that develop around the anus are possible symptoms of anal cancer.
Bowel cancer is the fourth most common type of cancer in the UK, with around 41,500 new diagnoses each year. More than 8 out of 10 cases occur in people aged 60 or over.
Typical symptoms of bowel cancer include bleeding from the back passage, blood in your stools, or a change in your normal bowel habits, such as diarrhoea that lasts longer than four to six weeks.
Some skin (dermatological) conditions can affect any area of skin on your body, including the skin around your anus.
Skin conditions that can be associated with 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 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
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 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 topical corticosteroids use – 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.
Never stop taking a prescribed medication unless advised to do so by your GP or other qualified healthcare professional responsible for your care.
Speak to your GP if you’re taking a medicine on a long-term basis and it’s causing an itchy bottom. They may be able to prescribe an alternative.
Diagnosing itchy bottom
You should visit your GP if you’ve had an itchy bottom for more than a few days.
Your GP will look at your medical history and ask questions to find out what may be causing your itchy bottom. They may ask:
- about your washing habits, such as how often you wash and whether you use creams, powders or soaps around your anus
- whether your symptoms are worse after eating certain foods
- about the duration and pattern of your itching – for example, whether there’s a specific time when itching is worse, such as at night
- whether other people in your family are also experiencing itching
- whether you have other symptoms, such as bleeding or a liquid discharge, from your anus
It’s likely that your GP will want to examine your bottom. You may feel awkward, but it’s nothing to be embarrassed or worried about. Your GP will be used to carrying out this type of examination.
By examining your bottom, your GP will be able to gain a better understanding about what may be causing your itchy bottom and how to treat it.
Your GP will start by looking at the skin around your anus, to check for signs of cracking or inflammation and any bleeding. They will then carry out a digital rectal examination (DRE).
Digital rectal examination (DRE)
A DRE is an internal examination of your rectum (the last part of the large intestine, where solid waste is stored).
Your GP will insert a gloved, lubricated finger (digit) into your anus to feel for anything that may be causing your itchy bottom. It will also allow them to rule out serious conditions, such as anal cancer, which can sometimes cause pain and itching around the back passage (anus).
Try to relax when you have a DRE. It shouldn’t cause any pain, but may feel slightly uncomfortable.
Your GP may refer you to a specialist for further investigation and treatment. The specialist you see will depend on what your GP thinks is causing your itchy bottom. For example, you may be referred to a:
- dermatologist – a specialist in treating skin conditions
- colorectal surgeon – a surgeon who specialises in conditions that affect the large intestine (colon) and anus
- colorectal specialist nurse – a nurse who specialises in treating conditions that affect the colon and anus
Treating itchy bottom
Most cases of itchy bottom respond well to simple self care measures and, if necessary, medication.
Following some simple self care measures (see below) for around two months should help prevent your bottom itching.
If you still have an itchy bottom after two months, or if it returns, you may need to follow this advice for longer.
Keep 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.
Self care measures
As well as keeping your bottom clean and dry, there are a number of other self care measures you can undertake. For example, you should:
- use soft toilet tissue
- bath or shower daily
- wear loose-fitting cotton underwear and change it daily
- only put underwear on when your bottom is completely dry
- avoid wearing tight clothing; women should wear stockings instead of tights
- use a light duvet at night so you don’t get too hot
- avoid using scented soaps, bubble bath, perfumes or powders around your anus
- keep your fingernails short to help your skin being damaged from scratching
- wear cotton gloves while sleeping so that you cause less damage to your skin if you scratch
It may be difficult, but you should try to resist the urge to scratch your bottom, as scratching will only make the problem worse.
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:
- spicy foods
- citrus fruits, such as oranges
- dairy products
- excessive amounts of liquids, such as milk, beer or wine
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 have a bowel movement.
Loose stools can irritate your anus. Straining to pass hard stools may cause piles (haemorrhoids) 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 – found in some breakfast cereals
- fruit and vegetables
Read more about why fibre is important.
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 two weeks, because they may start to harm your skin if used for long periods.
Your GP may prescribe an ointment or cream to soothe the skin around your anus. You will usually have to apply it in the morning and at night, as well as after each bowel movement.
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.
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 two 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
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.
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).
Complications of itchy bottom
If you frequently scratch your bottom, you may damage or tear the skin around your anus.
This can sometimes cause problems such as:
- thick and leathery skin (lichenification)
- sore and broken skin (ulceration)
- top layer of skin being worn away (excoriation)
The earlier these complications are diagnosed and treated, the quicker you’ll recover. Visit your GP if the skin around your anus changes or feels painful.
Your GP may not be able to identify the cause of your itchy bottom. If the cause can’t be identified and treated, your bottom may be itchy for long periods of time (known as chronic itchy bottom).
If you have chronic or severe itchy bottom, you may feel embarrassed, anxious or depressed. As the urge to scratch is often worse at night, your sleep may also be disturbed, leaving you feeling tired during the day.
Speak to your GP if your itchy bottom is making you anxious or depressed, or if it’s significantly affecting your sleep.