Date issued: January 2016
For review: January 2018
Ref: C-136/colorectal/AC/advice on skin care
Why is good skin care important?
Anyone who has frequent bowel motions, diarrhoea or accidental leakage (faecal incontinence) may get sore skin around the back passage from time to time. This can be very uncomfortable and distressing. Occasionally, the skin may become so inflamed that it breaks into open sores. These sores can be difficult to heal.
Taking good care of the skin around your back passage can help to prevent these problems from developing.
Why may I get sore skin?
- There are several different reasons why your skin may become sore.
- Your bowel contains digestive juices which break down your food to enable your body to use the nutrients in it. If you have very fluid bowel motions, the diarrhoea will still contain these juices which start to eat away any skin which they contact.
- If you have faecal incontinence, the small quantity of juices left in even normal stool can damage the skin.
- If you open your bowels very frequently, repeated wiping can damage the sensitive skin of your anus.
- With some anal conditions, it is very difficult to wipe your bottom effectively - a little always seems to get left which can start to make you sore.
- Chemicals contained in the bacteria of the bowel motions can cause itching.
- Sometimes, the area around the anus becomes infected.
- If you have incontinence of the bladder and bowel, you will be more likely to get sore, as the urine and faeces react together.
- People who are not eating a healthy balanced diet, not drinking enough or not taking much exercise are more prone to soreness, as are people who are generally unwell and not very active or mobile.
- Some dietary items cause irritation or loose motions in some people, avoid anything that does this to you.
Tips to prevent soreness
With careful personal hygiene it is often possible to prevent soreness, even if you have a bowel problem. The following tips may help you.
- After a bowel action, always wipe GENTLY with soft toilet paper, or ideally the newer moist toilet paper (available from larger pharmacies and some supermarkets). Discard each piece of paper after one wipe, so that you are not re-contaminating the area you have just wiped.
- Whenever possible, wash around the anus after a bowel action. A bidet is ideal (portable versions are available). If this is not possible, you may be able to use a shower attachment with your bottom over the edge of the bath. Or use a soft disposable cloth with warm water. Avoid flannels and sponges, as they can be rough and are difficult to keep clean. Sometimes a little initiative is needed, especially if you are away from home. Some people find that a small plant spray, watering can or jug filled with warm water makes washing easy on the toilet or over the edge of the bath.
- Do not be tempted to use disinfectants or antiseptics in the washing water as these can sting, and many people are sensitive to the chemicals in them. Just plain warm water is best.
- AVOID using products with a strong perfume such as scented soap, talcum powder, deodorants on your bottom. Choose a non-scented soap (e.g. 'Simple', or a baby soap). Many baby wipes contain alcohol and are best avoided.
- When drying the area BE VERY GENTLE. Pat gently with soft toilet paper or a soft towel. Do not rub. Treat the whole area as you would a newborn baby's skin. If you are very sore, a hairdryer on a low setting may be most comfortable (use carefully!).
- Wear cotton underwear to allow the skin to breathe. Avoid tight jeans and other clothes that might rub the area. Women are usually best to avoid tights and to use stockings or crotchless tights instead. Use non-biological washing powder for underwear and towels.
- Avoid using any creams or lotions on the area, unless advised to do so. A few people who are prone to sore skin do find that regular use of a cream helps to prevent this. If you do use a barrier cream, choose a simple one from your chemist. Large amounts stop the skin from breathing and can make the area sweaty and uncomfortable. Make sure that the old layer of cream is washed off before applying more. Some people are allergic to lanolin, and creams containing this should be avoided.
- Your doctor or nurse may suggest using a barrier wipe which forms a protective film over the skin, especially if you have diarrhoea and are opening your bowels very frequently (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 Continence Nurse can advise you on which pads are best.
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 food or drink makes them more prone to soreness, especially citrus fruit such as oranges. It may be worth cutting these out on a trial basis, and more permanently if this helps.
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.
If you are already sore
Follow all the advice above on prevention. In addition:
You may find that damp cotton wool is most comfortable to use for wiping.
Use a barrier cream or ointment as recommended by your doctor or nurse. You can also ask your pharmacist to recommend something for you.
If drying the skin after washing is difficult or uncomfortable, you may try using a hairdryer on a low setting.
Try not to scratch the anal area, however much you are tempted, as this will make things worse. If you find that you are scratching the area in your sleep at night, you may consider wearing cotton gloves in bed (available from your chemist).
Try to allow the air to get to the anal area for at least part of every day.
Don't struggle on forever alone! Talk to your nurse or doctor, especially if your skin is broken. If you have persistently sore skin 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 ©