Perineum Itching – Causes & Treatments

Understanding the Perineum

The perineum refers to the area between the anus and genitals. Perineal pain & itching can affect people of both sexes. In males, the perineum sits just behind the scrotum and extends to the anus. In females, the perineum begins at the front of the vulva and extends to the anus.

This area is near several nerves, muscles, and organs, so it’s not uncommon to feel pain in your perineum. Injuries, urinary tract issues, infections, and other conditions can cause perineum pain.

Persistent scratching of the anal skin can damage the skin and make it more likely to develop a skin infection in that area. Also, chronic itching of the anal area may lead to feelings of embarrassment. Both your mood and sleep can be affected.

What is Pruritus Ani?

Pruritus Ani is the medical term for a persistent (chronic) itchy feeling around the anus. The main symptom is an urge to scratch your anus, which is difficult to resist. The urge to scratch may occur at any time. However, it tends to be more common after you have been to the toilet to pass a bowel motion and at night (particularly just before falling asleep). The itch may be made worse by:

  • Heat.
  • Wool.
  • Moisture or wetness around the anus. This may be caused by sweating, or by incomplete drying of that area after washing. It may also be caused by leaking urine (incontinence).
  • Stools (faeces) being in contact with the skin around the anus. This can be due to leaking of stools out of the anus, or due to incomplete cleaning after opening your bowels.
  • Stress and anxiety.

An itchy bottom (pruritus ani) is a common problem but the exact number of people who develop an itchy bottom is unknown. Some sources suggest around 1 to 5 out of every 100 people have an itchy bottom. It seems to be more common in men than in women. It most commonly affects people between the ages of 40-60. However, it can affect people of any age, including children.

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Causes of Perineum Itchiness

An itchy bottom (pruritus ani) is a symptom, not a final diagnosis. Various conditions may cause an itchy bottom. When the cause is another condition which has been identified, this is known as secondary pruritus ani. However, in many cases the cause is not clear. This is called ‘idiopathic pruritus ani’ which means ‘itchy anus of unknown cause’.

Causes of itchy perineum can include:

  • Moisture (due to sweating or frequent washing),
  • The abrasion caused by clothing,
  • The pressure of sitting,
  • Chemical irritants like laundry soaps, colognes and scented toilet paper,
  • Certain food irritants,
  • Medicines like some antibiotics and laxatives,
  • Infections like STD’s and pin-worms, and
  • Skin problems such as psoriasis, seborrhea and eczema.

How Can Genital Itching Be Avoided?

Females should take the following steps to help avoid genital itching:

  • After urination or bowel movements, wipe from front to back to prevent bacteria from the anus getting into the vagina.
  • Avoid chemical products such as vaginal douches or feminine hygiene sprays, which can upset the acidic balance of the vagina.
  • Avoid scented feminine hygiene products (panty liners, pads, soaps).

Males should take the following steps to help avoid genital itching:

  • Wash the penis well, including the area under the foreskin in uncircumcised men.
  • Keep the area dry, since moisture in the genital area can lead to infections. Cornstarch powders during the summer may be helpful.

Both males and females should take the following steps to help avoid genital itching:

  • Wear loose, natural-fiber underwear and clothing. Change underwear at least every 24 hours.
  • Keep the genital area clean and dry. Use mild soap and rinse well.
  • Use mild, unscented laundry detergents to wash your underwear.
  • Dry off thoroughly after bathing and swimming. Avoid staying in wet clothing for long periods of time.
  • Avoid unprotected sex, especially if you are worried that you or your partner might have an infection.
Photo by Karolina Grabowska on Pexels.com

How To Treat Perineum Itching

Treatment depends on the cause of the problem. It may include self-care measures, changes to your diet, treatment of infections or, rarely, surgery to correct an underlying problem.

  • Avoid any potential irritants:
    • Stop using scented soaps, talcum powder, bubble bath, perfume, etc, near your anus.
    • Use plain, non-coloured toilet tissue. Wipe your anus gently after passing stools (faeces).
    • If any foods or medicines could be causing the itch, try avoiding for a while the foods and drinks listed above (such as fruits and tomatoes). If you take laxatives regularly, some of your stool may be leaking on to your anal skin.
  • Pay special attention to hygiene around your anus:
    • Wash your anus after going to the toilet to pass stools. The aim is to clear any remnant of stool which may irritate the skin. Also, wash your anus at bedtime.
    • When washing around your anus, it is best to use water only. If you use soap, use bland non-scented soap.
    • When you are not at home, use a moistened cloth or a special moistened tissue to clean your anus. You can buy moistened tissues from pharmacies. Avoid scented or perfumed versions.
    • Have a bath or shower daily. If possible, wash your anus with water only. If you use soap around your anus, rinse well.
    • Change your underwear daily.
  • Avoid excessive moisture around your anus:
    • After washing, dry around your anus properly by patting gently (rather than rubbing) with a soft towel. Even better, use a hairdryer, especially if your anal skin is hairy.
    • Do not put on underwear until your anus is fully dry.
    • Wear loose cotton underwear (not nylon). Avoid wearing tight-fitting trousers. If possible, do not sit for long periods and try not to get too hot. The aim is to allow air to get to your anus as much as possible and to avoid getting too sweaty.
    • If you sweat and moisture gathers around your anus, put a cotton tissue in your underwear to absorb the moisture.
  • Consider the ‘itch-scratch cycle’:
    • Scratching can make the itch worse – which makes you want to scratch more, etc.
    • As much as possible, try not to scratch. This is especially difficult at night when the itch tends to be worse while you are trying to get to sleep.
    • You may also scratch in your sleep without realising. To help this:
      • Keep your fingernails short to limit any damage done to the skin by scratching.
      • Consider wearing cotton gloves at night to prevent sharp scratching with fingernails.
      • An antihistamine medicine that makes you drowsy may be worth a try at bedtime. Your doctor will advise.
  • Your doctor may advise a short course of a cream or ointment:
    • A bland soothing ointment may be recommended to use after going to the toilet and at bedtime. There are many to choose from. (However, remember an ingredient of an ointment may sometimes cause sensitivity and itch around the anus.) You should not use a cream such as this for longer than two weeks unless you are advised otherwise by your doctor.
      • A protective ointment that contains zinc oxide (Desitin, Balmex) also may help. If your symptoms are worse at night, please take an antihistamine like Benadryl to reduce itching until topical treatments take effect.
    • A short course (up to 14 days but no more) of a mild steroid cream may ease symptoms if there is inflammation of your anal skin. Steroids reduce inflammation (but should not normally be used on infected skin).
      • Try an over-the-counter (OTC) cream or ointment containing hydrocortisone (Cortaid, Preparation H), but it is to be applied sparingly to the affected area.
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The above measures will usually stop the itch. If symptoms persist for three or four weeks after doing the above then your doctor may refer you to a specialist. This may be a skin specialist (a dermatologist) or a colorectal surgeon (who specialises in problems affecting the colon and anus). Tests may be needed to make sure a known cause has not been missed.

Other possible treatments for an itchy bottom (pruritus ani) are currently being researched. One such treatment is capsaicin cream. The theory is that capsaicin blocks a chemical in the skin that is involved in sensations of pain and itch. Another treatment involves injecting a chemical called methylthioninium chloride (methylene blue) into and beneath the skin of the anus. Further research is needed to clarify the place of these new treatments.

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