Pruritus ani or itchy bum, labial eczema

We all have a bottom and private parts and those of us with eczema, psoriasis or a tendency towards sensitive skin may at some point in time experience pruritus ani and/or anal or labial eczema.

Anyone can get this condition (although labial only gets the girls, obviously) although those with atopic skin, sensitive or dry skin, dermatitis, eczema or psoriasis may be more likely to experience it; it can often occur for no apparent reason but it is thankfully, usually, very easily treatable.

So what is pruritis ani?

Pruritus ani is an annoying and constant itch around the anus. There can be many different causes but it is often unclear why it occurs. The main symptom is an urge to scratch your bottom, which is almost impossible to resist. The itching sensation may occur at any time but often tends to be more urgent 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, leaking, soiling, stress and anxiety.

If you keep scratching, skin can become damaged making it more likely for a skin infection to develop and this kind of chronic itching of the anal/labial area can also lead to feelings of embarrassment and both your mood and sleep can be affected. Let’s face it, you don’t even want to go out in public if you need to keep scratching your crotch or bum!

For women it can affect the labial skin also which may make you think it’s thrush but if thrush treatments are ineffective it could be just eczema, especially if you also have eczema and sensitive skin. Anal and labial eczema are both really far more common than you might think – it’s just that noone ever talks about it.

What causes it?

There are many things that can cause this problem, eczema being one of them. For a full list of known causes and more information visit patient.co.uk.

It could be triggered by irritation from scented loo roll, soap or sanitary products.

However, itching around the anus can be a sign of many other conditions; Googling can often be very dangerous – indeed up popped a huge list of possible awful causes including eczema, psoriasis, piles, candida, scabies, fungal infection, warts… and worse. If you are concerned I would urge you to seek a medical diagnosis.

If you have eczema or psoriasis or have had sensitive skin or dermatitis in the past it is worth considering, even though it’s embarassing to think about what might be causing eczema to flare-up ‘down there’. Even if you’ve never ever had labial or anal eczema before it could flare at any time, for no reason, or be triggered by something topical or just stress.

There are some very simple tips to help this kind of eczema to heal:

1. Don’t let that area get too hot and sweaty – always wear cotton, not clothes that are too tight… etc. Sounds pretty easy right, but tight jeans or nylon tights can irritate this condition. Stick to cotton tights if you can and wear looser fitting clothes at least until you get it under control, but ideally avoid the tight clothes if you’re prone to this.
2. Wash without soap – Use a soft flannel to wash with just warm water, always from front to back, especially for women. No soap. If you are out and don’t have a flannel, all you need is a wad of damp kitchen roll or the paper you dry your hands with. Dampen before entering the cubicle if you think you need to wipe, and especially during an itchy flare up. Don’t put this down the loo though, sneak it out into the bin after you’ve finished cleaning up. If you find you want to wash often or too much, with normal soap because it doesn’t feel clean enough you may find yourself in an ‘itch wash’ vicious cycle. You itch so you feel dirty and itchy and horrible and you scratch more and you wash again… But washing with any kind of scented soap is the worst thing you can do. Really any soap, even unscented could irritate when this condition becomes inflamed. Sounds like it won’t work and definitely isn’t clean enough, but if you wash with soap or shower gel in the shower then cleaning during the day after using the toilet (only if you need to, or it’s itching) can be done with just a flannel and plain old water. You could also keep some kitchen roll in the bathroom, which is stronger, dampen it with warm water and wipe clean as above till it shows clean, then dispose of this thicker paper in the bin. Do try this, I promise, despite it seeming totally at odds with what we think about being clean, it should get so much better within just a few days. If you feel you have to use soap, use a non-scented hypo-allergenic variety and rinse well. Make sure you dry the area gently and thoroughly after washing. It can help to fill a bottle with warm water and some salt, sit on the loo and pour this over the perineum to clean that area. A bit of a faff but gentler than other methods. Hopefully you will find that after it’s cleared up you may not need to keep on with quite the same strict regime but it can’t hurt.
3. Be gentle – it might seem obvious but wipe gently and don’t be rough or rush. Sensitive irritated skin needs a little TLC. If it’s itchy the wiping can turn into an itch/scratch motion so don’t give in. Gently does it.
4. Less cleaning is better – Girls, this one is for you. And I don’t mean here not to wash, but if you haven’t done any sport or exercise, haven’t got hot and sweaty and aren’t having a shower or bath, don’t wash your labia. Your body has natural oils and secretions which will clean it and over washing can remove these, dry the area out and lead to irritation. If you have very dry, eczema skin then once a day is enough. Clean yourself as you normally do in the shower and not in between.
5. Moisturise carefully – if you are really itchy down there you could try something really gentle to ease the irritation. Aloe Vera gell 99% or your eczema cream or emollient but avoid using steroids. Apply in moderation, gently, always from FRONT to back, and always wash your hands thoroughly afterwards – it can help to ease that dry itchy feeling. Normally you shouldn’t need to use any moisturiser here but when you get a skin flare-up down there, it will really help, just as moisturising other parts of your skin aid healing and alleviate the itch. You could try Anthisan Bite and Sting Cream which you can get in Boots or online from Amazon. It is relatively cheap to buy and is advertised as good for insect bites but it’s worth a try. Thanks to Micki Rose of the Pure Health blog for this suggestion.

The problem with this area of the body is that it is very easy for skin to become infected due to the germs that can be present and because it is often hot and warm down there.

You can find yourself in a vicious cycle of constantly itching, and regularly scrubbing clean which is the worst thing. Fight the urge to itch and try these tips above and it should clear up if it’s just simple pruritus ani or labial eczema.

Now I’m not a doctor, if you experience persistent itching you should seek the advice of a doctor. But if you have very sensitive skin, consider first that you might just need a little more gentle care and some moisturiser.

Some of you may have read about my rather unfortunate dabble with scented loo roll which caused a very bad reaction with my skin.

The information I discovered above was invaluable in getting the eczema flare-up caused by the evil scented loo roll back under control and I hope it helps someone else out there. Because this can be very lonely – we are a very prudish nation and NOONE talks about ever having an itchy bum or labia. It’s just another body part at the end of the day but if you are at all concerned go to see your doctor.

Photo by Oleg Magni from Pexels