TLDR

Step 1: Break the itch-scratch cycle. This is the single most important treatment and may be enough to cure your itching
Step 2: If this fails, see a doctor. You may need treatment for a medical cause of itching Step 3: Identify and eliminate triggers. Optimise bowel function and toileting behaviour. Minimise lotions, potions, soaps and medications
Step 4: Keep skin cool, dry and protected to prevent recurrence

For the longer version, read on.

Step 1: Gain an understanding of the reasons your butt is itchy. This is the single most important treatment.

Itchy butt is an incredibly frustrating condition to have and treat.

One in twenty adults will have anal itching in their lifetime, with many suffering for years.

There is very little high quality information available to sufferers.

Let’s face it, it isn’t glamorous, and no one dies of the condition. Dermatologists who typically treat skin diseases are not inclined to look down there. The condition involves a junction of two organ systems (the gut and skin) meaning it’s kind of an orphan in the medical world. In addition, there is no magic bullet or simple script the doctor can give you that gets you out the door in time.

Understanding how the itching comes about and is triggered will help more than any medication your doctor can give you.

There are two important considerations. Eliminate medically treatable/important causes, and then find out what works for you.

Here is an example of what the condition typically looks like:

What can be seen here are features of the self perpetuating itch-scratch cycle. The fragile anal skin is irritated by some trigger (there are more than 150 triggers) and becomes inflamed and cracks, like a motor mechanic’s calloused hands. The cracked skin leaks moisture, which itches and irritates the skin further, leading to further scratching. The long term irritation and scratching cause the skin to thicken as a protective mechanism, which leads to further cracking.

The self perpetuating cycle then goes around and around, often for years.

In the photo, you can see the typical shield shaped area (this is the area where the buttocks are opposed when standing, leading to moisture) with central whiter skin which is abnormally thickened, and surrounded by red (inflamed) skin with ulcers. Now that we know what it looks like, and that it is common, let's talk about the next steps above in more detail to break the itch-scratch cycle.

Step 2: Treat common underlying causes Whilst a large number of patients have an itchy bottom all the time, without an easily identified cause, there are a number of known medical conditions that need to be thought about.

• Bowel cancer. This does not commonly cause itching, but in many countries is the second or third most common cause of cancer death. If you have a bowel or anal problem of any kind, it’s important to have a colonoscopy if you are over the age of 45.

• Haemorrhoids. Anything that contributes to moisture around the butt can worsen itching. The type of haemorrhoids that feel like a lump popping in and out of the butt and are best treated by your doctor to reduced moisture around the butt skin.

• Worms. If you have young children, or anyone in the family who has had worms, taking a simple deworming tablet is worthwhile.

• Fungal infections. If you have, of have had fungal nail, foot or groin infections in the past, a trial of a tablet anti-fungal tablet is worthwhile.

• Skin conditions like psoriasis. This is usually obvious as there are further areas of skin around the body affected. These should be treated by your dermatologist.

Step 3: Optimise bowel function and toileting behaviour. Consider bowel function like a driving style, and the butt like the tyres on your car. If the driving style is all over the place, the tyres are going to wear out faster.

Suboptimal poop type, especially those which are too loose or pasty are going to contribute to skin problems around the butt, as any parent who has had a kid with a nappy rash will attest.

Faeces is highly irritant to the skin. It may be related to the acidity/alkaline nature, or just the moisture content. In any event, any person with an itchy butt needs to optimise bowel function. The rectum and butt are designed to deal with a play dough like stool best.

If you have an irritable bowel, see a dietician to remove the triggers for loose bowel movements. Even if you have the best diet possible, take a fibre supplement like psyllium or flax seed.

Conventional toilet paper is an odd western convention, pushed by marketing. The worst outcome for an itching butt is to be subjected to several loose bowel movements daily, cleaned up by rough toilet paper, likely leaving stool residue and moisture as well as sandpapered, irritated skin.

On the other hand, a single daily formed play dough like stool, followed by a water rinse and air dry is optimal. The Japanese do it best with rinsing toilet products like this or this. If you have an itchy butt and are renovating your bathroom, install one of these. There are cheaper versions too like this or this.

**Step 4: Minimise lotions, potions, soaps and medications **Having stressed the importance of keeping the skin around the butt clean, there is a problem in the other direction too, often labeled over-hygiene.

Many patients develop allergies, called ‘contact dermatitis’ to one of the chemical ingredients in soaps or washes available. Keep cleaning to using simple water only where possible.

Commonly prescribed medications are worth a special mention. Many are made with two common ingredients: local anaesthetic creams and steroid preparations. The local anaesthetic acts as a numbing agent, and the steroid acts as a powerful anti-inflammatory.

Local anaesthetic agents, recognised by the use of the letters ‘caine’ at the end (e.g. lignocaine, cinchocaine) cause a contact dermatitis with long term use, and steroid preparations, recognised by the use of the letters ‘sone’ at the end (hydrocortisone, betamethasone), thin the skin down, making it more fragile, and worsen the problem long term. Both of these ingredients are best used for less than two weeks, and if you are using for longer than 2 weeks, see your doctor for advice.

Step 5: Keep skin cool, dry and protected Skin itches when it is hot, moist and irritated. Many sufferers attest that itching is worse at night, after having had a shower (moisture) and getting under a warm duvet in bed (heat). For those in cold climates, if you are itching badly at night, go outside with no underwear and count the seconds until your symptoms disappear.

Cool, dry, protected skin does not itch. Hot, moist, irritated skin itches like crazy.

Consider the way the body registers itch. From the brain’s perspective, itching is classified as a form of low grade pain. It is carried along those dedicated pain nerve pathways, and medical science knows a lot about them.

Think about what we all do when we get an injection, stub our toe or hit our shin on the coffee table. We rub it like crazy. Or consider why a heat pack feels good for period pain, or why an ice pack is good for a sprained ankle. What is going on here?

This phenomenon is called counter-irritation. The nerve pathways are like telegraph poles and can only process sensation at a certain rate. Both pain and itch can be blocked by providing background noise.

The brain is a selective filtering machine, and this is what pickpockets exploit. Bump you on the right, steal your wallet from the left.

We can exploit this to block itching too. There are a limited number of known counter irritants, and these can be used to block itching. Deep heat and Tiger balm are good examples. The key with skin around the butt is that it is sensitive. Getting the level of background noise just right is the tricky part.

The promotional bit.
|At downthere.healthcare we have a mission. We want to educate people as best we can about the common conditions affecting the penises, vaginas and butts, to the best of our ability. Science based, but also admitting where the science doesn’t exist.

We want to liberate conditions that have previously been twittered about and swept under the rug. They are common! We are all born with butts, penises and vaginas, or combinations of and use them in different ways, any they are subject to conditions and illnesses just like anywhere else in the body.

We also want to listen. In medicine there is a concept called ‘Level IV’ evidence, which says that in the absence of a rigorous scientific experiments, the best evidence is expert opinion. We think that aggregated patient data is better, and we’d like to listen to your experiences, opinions and complaints to make a difference.

With that in mind, for the orphan condition ‘pruritus ani’ or itchy butt, we have created a treatment that works in the following ways.

Itchy butt contains: -a calibrated amount of camphor and peppermint oil aimed at providing just the right amount of counter-irritation to block itching signals without producing a burn. This produces a cooling menthol feeling. -skin protectants in the form of plant based waxes and zinc oxide to protect the skin from moisture and contamination-a base uniquely suited to the skin around the butt.

Itchy-butt contains no petrochemical based products, and we have listened to many pruritus ani suffers to get the exact combination right.

You can source at itchybutt.com

We welcome your feedback at contact [at] downthere.healthcare