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Date issued: September 2022 

For review: September 2024

Ref: C-136/colorectal/AC/advice on skin care  v3

PDF:  Advice on Skin care for People with Bowel problems final January 2016.pdf[pdf] 347KB

What is pruritus ani (anal itching)?

Pruritus ani is a common condition of persistent itching or irritation around the back passage (anus). Anyone who has frequent bowel motions, diarrhoea or accidental leakage may get sore skin and/or itching. Taking good care of the skin around your back passage can help to prevent these problems developing.

What are the symptoms? 

The main symptom is an urge to scratch your anus, which may be difficult to resist. This can lead to skin damage and possible infection.  Itching can be worse at night, in warm weather or after having a poo.

What causes pruritus ani?

It has many possible different causes, including piles (haemorrhoids), certain skin conditions and most commonly due to faecal or liquid leakage from the back passage.  These can irritate the delicate skin around the back passaged also make it difficult to wipe effectively. 

It can become a self-perpetuating problem resulting in an ‘itch-scratch’ cycle that can be difficult to break and can cause chronic skin changes.

Having itchy skin around the back passage which is worse at night could suggest that you have threadworm, which can be seen as small threads in the poo.

If you think you may have a sexually transmitted infection (STI), which is the cause of your symptoms and you have had unprotected sex, please discuss with your GP, or attend your local sexual health clinic.

What can you do to help?

Pruritus ani can be difficult to treat, and it may take many months of gentle care to improve the symptoms.  Breaking the itch-scratch cycle is key to treatment. 

There are some things you can do to help:

• Pay special attention to hygiene. Be very careful to keep the area as clean as possible, ideally by careful washing and gentle drying at least once a day or after each bowel motion.

• Use very soft white toilet paper or moist toilet tissue to clean after each bowel motion; and try to avoid excessively wiping.

• Note: Women are advised always to wipe front to back, i.e. AWAY from the bladder and vaginal openings as bacteria from the bowel can infect the bladder and vagina if you wipe from back to front.

• Bidets can be very helpful or alternatively you may find that sitting on the edge of the bath and using a shower head makes washing easier.  Avoid flannels and sponges as they can be rough and are difficult to keep clean.

• If you are out or at work, take a small plastic bottle of water into the toilet to wash with after a poo or use non-alcoholic wet wipes (baby wipes can contain alcohol and are best avoided).

• Dry the area by gently patting with a soft towel or tissue and avoid rubbing. If you are very sore you may find that a hairdryer on a low setting is the most comfortable way of drying the area.

• When washing, AVOID using products on your bottom with a strong perfume such as scented soap, talcum powder, deodorants.

• Choose a non-scented soap e.g. 'Simple', or baby soap).  A good alternative to soap is a light emollient, such as aqueous cream.  You can buy from any pharmacy.

• If you do have a problem with leakage from the back passage, a small amount of damp cotton wool on your fingertip may be used to gently clean into the anus to make sure there is no residue left behind. If your leakage continues after wiping, a small plug of cotton wool outside the back passage may stop the stool coming out to irritate the skin. There are also small specially designed devises called anal inserts, which prevent leakage and protect the skin. Please talk to your nurse or physio.

• Never use any creams or lotions on your bottom except the treatment suggested by your nurse / physio. This includes all creams, deodorants, talcum powder and antiseptics. For some people with sore skin a small amount of barrier cream, such as Sudocrem may be helpful.  Your local pharmacist can advise you.

• If you suffer with diarrhoea or are frequently opening your bowels, your doctor or nurse may suggest using a barrier wipe or cream which forms a protective film over the skin, e.g., Derma-S (available on prescription)

• If you need to wear a pad because of incontinence, try to make sure that no plastic comes into contact with your skin and that you use a pad with a soft surface. The Community Continence nurses can advise you on which pads are best.

• Never put anything in your bath water. In particular, avoid all antiseptics, bath salts, bath oil and bubble bath as this can cause further irritation. You may use a small amount of aqueous cream, as mentioned before.

• Wear loose cotton underwear and change daily. Avoid all manmade fabric coming into contact with your bottom. Women should avoid wearing G-string knickers and wear open crotch tights/stockings, as enclosed tights can cause sweating. You should also avoid tight trousers or jeans and sitting down on plastic chairs for long periods of time.

• Wash your underwear and towels with non-biological washing powder.

Whenever possible, unless you have been advised not to for other reasons, eat a healthy, balanced diet, drink plenty and take as much exercise as you can. Some people find that certain foods (citrus fruits such as oranges, tomato’s, milk products, peanuts, spicy foods, grapes, popcorn, prunes, figs) or drink (coffee, tea, cola, alcohol, beer) can make you more prone to soreness. It may be worth cutting these out on a trial basis, and more permanently if this helps.

Please do not struggle on! Talk to your nurse or physio, especially if your skin is broken. If you have persistently sore skin, which is not healing with the above advice, you may have an infection which needs treatment, and there are other products which can be prescribed to help heal the soreness.                

AC & FCO, Oct 2015, V1

Many thanks to © St Mark’s Hospital & Burdett Institute 2007 3 of 5 Advice on Skin Care for people with Bowel Problems © and Guy’s and St Thomas’s NHS Foundation Trust, Pruritus ani – anal itching.