Itchy bottom

Itchy Bottom (Pruritus Ani)

Overview
Itchy bottom, also known as pruritus ani, is a common condition characterized by irritation and an intense urge to scratch the skin around the anus. It may be a symptom of an underlying condition or occur independently due to local irritation, poor hygiene, or dermatological issues. The problem can become chronic if scratching causes skin damage, leading to a cycle of irritation and further itching.

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Causes

• Local irritation and hygiene

  • Excessive wiping or inadequate cleaning after bowel movements

  • Use of scented soaps, bubble baths, or wet wipes

  • Moisture build-up from sweating or tight clothing

• Medical conditions

  • Hemorrhoids

  • Anal fissures

  • Fungal infections (e.g., candida)

  • Parasitic infections (threadworms, pinworms – especially in children)

  • Inflammatory bowel disease (IBD)

  • Diabetes mellitus

• Dermatological conditions

  • Eczema

  • Psoriasis

  • Contact dermatitis

• Dietary and lifestyle factors

  • Spicy foods, citrus fruits, tomatoes, coffee, alcohol

  • Poor fluid intake and constipation

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Symptoms

• Persistent itching and irritation around the anus

• Redness, soreness, or inflammation of the perianal skin

• Skin thickening or breakdown due to repeated scratching

• In some cases, secondary bacterial or fungal infection

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Diagnosis

• Clinical history and physical examination – to identify possible triggers

• Stool tests – to detect worms or other parasites

• Skin swabs or scrapings – if fungal or bacterial infection is suspected

• Endoscopic evaluation – in persistent or severe cases to rule out underlying gastrointestinal disease

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Treatment

1. General measures

• Maintain good perianal hygiene using lukewarm water; avoid harsh soaps

• Dry the area gently and thoroughly after washing

• Wear loose, cotton underwear and avoid tight clothing

• Avoid scratching – use a cool compress for temporary relief

2. Medications

• Topical barrier creams: zinc oxide, petroleum jelly (protective layer)

• Mild topical corticosteroids: hydrocortisone 1% cream (short-term use only, 5–7 days)

• Antifungal creams (e.g., clotrimazole, miconazole) if fungal infection suspected

• Anthelmintics (e.g., mebendazole 100 mg single dose, repeat after 2 weeks) for threadworm infections

• Antihistamines (e.g., cetirizine 10 mg once daily, loratadine 10 mg once daily) may help reduce nighttime itching

3. Treatment of underlying causes

• Hemorrhoids may require topical treatments, stool softeners, or surgical management

• Anal fissures treated with topical diltiazem or nitroglycerin ointment

• Diabetes or IBD requires disease-specific management

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Precautions

• Avoid scratching to prevent secondary infection

• Limit foods and drinks that worsen symptoms (spicy foods, alcohol, caffeine)

• Use unscented toilet paper or plain water instead of harsh wipes

• Seek medical advice if itching is persistent, severe, or associated with rectal bleeding

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Drug Interactions

• Topical corticosteroids: prolonged use can thin the skin and increase systemic absorption when combined with other corticosteroid therapies

• Antifungals (clotrimazole, miconazole): may interact with warfarin, increasing bleeding risk

• Anthelmintics (mebendazole): interactions with cimetidine (may increase mebendazole levels)