Itchy butt, itchy butt please go away.

For those of you who've never had an itchy butt, the concept behind this post may seem funny (as my mother would say, both a little "funny ha ha" and little "funny odd"). But for those of us who have ever suffered from an itchy butt, this is no joke.

Itchy butt is disconcerting, anxiety-producing, and downright miserable.

It is one of those super embarrassing topics-- one of those oh-no-my-doctor-has-her-hand-on-the-doorknob-do-I-really-want-to-mention-this-topics, hanging right up there with discussions about the quality of one's sex life, underarm odor, and nose-picking. It's not something people like to talk about, even with their most intimate partners. It makes people feel dirty, anxious, desperate, undesirable, isolated, even crazy.  But estimates are that somewhere between 1% and 5% of the population suffer from itchy butt. So if you're lucky enough to never have suffered, say your prayers that you don't become the next victim.

I've seen young men certain they have a sexually transmitted disease, old women sure they have cancer, little kids (whose parents, having spent time googling, certain their child has pin worms, which sometimes they do) and everyone in between. It's thought that men outnumber women four to one, with the highest occurrence in the 40-50 year age range, but still common in people ages 30-70.

And-- big personal revelation-- I've suffered myself. It's wretched.

Itchy butt in doctor's speak is termed Pruritis Ani. Pruritis means itchiness; ani is an obvious reference to the anus, the anatomical structure that is the exit door for your bowel movements (or, as is my four-year-old's favorite word, poop). Yes, we have an actual medical term for it-- proof that it's prevalent enough to merit it's own diagnosis.

There are two types of itchy butt: primary/idiopathic (i.e. we have NO idea what causes it) and secondary (i.e. caused by something else). Somewhere between 25-75% of cases are secondary. That's a pretty big range-- a stat that basically means we can find an actual cause in only about half of cases. In the other half, who knows what started it?! An uncertainty leading to more feelings of insanity. That's why so many people have the experience of going to their provider to be seen, finally getting the nerve up to say something, and then feeling let down by the lack of answers. Too often, there are no answers to be had. Sorry.

The most common and obvious cause of itchy butt are hemorrhoids (swollen, inflamed veins in your anal region) and anal fissures (basically scrapes or little cuts in the anus that just have a hard time healing because, well, we all use our anus quite frequently). Hemorrhoids are caused by increased pressure down in your bottom. They are super duper common and often happen when people are constipated, have chronic diarrhea, are pregnant, or overweight. About 50% of the population will have a hemorrhoid by age 50. Ugh. Fissures are pretty common too-- you have an especially big poop or an especially hard one, it causes a little abrasion, and it takes awhile for that to heal.

Other less common causes of itchy butt include:
Skin stuff: allergic dermatitis (e.g. eczema or an allergic reaction to soap, lotion, lubricant, toilet paper) , psoriasis, seborrhea (cradle cap of the bottom), squamous cell cancer
Infectious stuff: fungus (e.g. yeast), parasites (pin worms are common, especially in kids)
Some medications: examples include tetracycline, colchcine, quinidine, local anesthetics, and neomycin
Some systemic illnesses: diabetes, lymphoma, obstructive jaundice, thyroid dysfunction, leukemia, chronic renal failure, and aplastic anemia
Foods: perhaps tomatoes, chocolate, citric fruits, spices, coffee (including both caffeinated and decaffeinated), tea, cola, beer, milk and other dairy products
Psych: anxiety, agitation, and stress
Other: fecal incontinence, excessive humidity, the use of soap, excess scrubbing of the anus, chronic diarrhea, and menopause.

Lots of reasons, many of which may apply to you. But, remember, HALF the time, there is no reason to be found.

Here's where itchy butt gets frustrating.

There is something about itchy butt that predisposes people to a vicious itch-scratch cycle in a very innervated area. Yes, our anus is super well innervated. And the combination of that cycle and the insane number of nerve endings down there, often leads to an intolerable impulse to scratch the perianal area. Again and again.The urge is classically worse after bowel movement, worse at night right before going to sleep, and sometimes even worse in the middle of the night.

This often leads to literally clawing the skin. Even for the most controlled human being, the urge to scratch can be tremendous, and even a little extra rub-dab-- with a wet wipe, a cream, a salve. And those very wipes and salves may be part of the problem.

Wet wipes, for example, which may seem to get you cleaner than toilet paper, contain preservatives that are commonly known to cause/worsen contact dermatitis. That means you use a wet wipe thinking it will make your itchy butt better, and it may only be making the problem worse. For these reason, it's reasonable to avoid all wet wipes (even those that claim to be gentle, unscented, etc).

Desperation also leads people to try all different kinds of products, natural and unnatural-- including hydrocortisone, witch hazel, calendula, lotions of a wide variety, Chinese herbs, Benadryl cream, cool water, hot water, comfry leaf, ice cubs. You name it, someone's tried it. Yes, even capsaicin (that's the stuff in chili powder that makes your tongue tingle). And, fortunately, in some cases, SOME of this stuff helps. But I'm here to tell you that, unfortunately, in most cases, most of these things just cause more skin irritation, give you further excuse to rub things on (furthering the itch-scratch cycle) and don't lead to ultimate relief.

The solution MAY be simpler than you would have thought.

Here's my prescription for itchy butt--  ridiculously simple, but often simple is the best!

First, if you are truly worried you might have a hemorrhoid, an STD or some other lesion down there, please go see your primary care provider. Let someone else take a look. If she sees something, she'll treat it.  And maybe you will get better. And try not to be embarrassed. If you've already done that and heard the disappointing, "It looks pretty darned normal back here, nothing to worry about",  please don't despair. It's not all in your head. It's real, it's itchy, but it's treatable. Go for simple.

1) First, STOP scratching! (So much easier said than done). Do anything in your power to stop scratching: cut your fingernails, wear gloves, wear tight pants, wear three pair of underwear, meditate. Anything that works to keep your hands away from those pesky little nerve endings. Break the cycle.

2) Next, stop putting any products down there, including soap when bathing, anti-itch creams, herbs, etc. Most topical formulations are probably contributing to irritating your skin, and you need to give the skin a chance to heal. Plus, any time you put something down there, it's an excuse to give a little scratch. And then you are back at it again.

3) Stop using wet wipes. I know, counter-intuitive, but trust me.

4) Get yourself a squirt bottle or spray bottle or some sort of other water container, and each time you either feel the urge to itch OR have a bowel movement, use water AND only WATER to clean yourself.

5) Resist the urge even to use toilet paper (it's just too tempting to give a little extra rub while your down there, and that little rub is part of the problem). It's not a matter of getting yourself cleaner-- even if you are convinced it's so.

6) If you are unbearably itchy, always go back to the cool water. Squirt, spray or sit in it. Do not rub it on.


No prescription is ever 100% effective, but I can offer you some hope. It really does work! And you can move on from focusing your crazy frenetic anxious all-consuming energy on your anus to somewhere more productive. 



Additional resources:
http://www.patient.co.uk/forums/discuss/browse/pruritus-ani-1740