Overview

Rectal problems are common. Almost everyone will have some rectal itching, pain, or bleeding at some time. These problems are often minor. They may go away on their own or with home treatment.

Rectal itching

Rectal itching (pruritus) usually isn't a sign of a serious disease. At first, the skin of the anal area may look red. Itching and scratching may make the skin become thickened and white. Common causes of rectal itching include:

• Poor cleaning of the area after a bowel movement. Itching and discomfort may happen when pieces of stool become trapped in skin folds around the anus.
• Medicines, especially ones that cause diarrhea or constipation. Antibiotics are one example.
• Cleaning of the anus with very hot water and strong soaps. The anal area is normally oily. This oil barrier protects against the irritation of bowel movements. Repeated cleaning or showering will remove these oils. It can lead to a cycle of itching and scratching that can be hard to stop.
• The use of scented toilet paper, scented soap, or ointments (such as those that contain benzocaine).
• A dry skin condition that affects the whole body. This condition is more common in older adults.
• Hemorrhoids. These are enlarged veins near the lower end of the rectum or outside the anus.
• An infection of the anus or rectum. It may be caused by viruses (such as genital warts) or bacteria. Or it may be caused by pinworms, scabies, fungus, yeast, or parasites. Some infections are passed on by animals. Pinworms are the most common cause of anal itching in children. An infection you get from an animal is called a zoonosis (say "zoh-uh-NOH-sus"). Some infections can seem mild, but others can be quite serious. You can get an infection from a pet, a farm animal, or a petting zoo.
• Certain foods. These foods may include coffee, tea, cola, alcoholic drinks, chocolate, tomatoes, spicy foods, and large amounts of vitamin C.
• Some people get infections while travelling that can cause rectal itching and other problems. If you are planning to travel to another country, see a doctor several months before you leave. It will give you time to get vaccines (immunizations) that you may need.

Rectal pain

Rectal pain may be caused by diarrhea, constipation, or anal itching and scratching. Rectal pain caused by these conditions usually goes away when the problem clears up.

Other less common causes of rectal pain include:

• Enlarged, swollen veins in the anus (hemorrhoids).
• Structural problems, such as anal fissures and fistulas or rectal prolapse.
• Infection. Examples include sexually transmitted infections, prostate infections, an abscess, and pilonidal cysts.
• Injury from foreign body insertion, anal intercourse, or abuse.
• Diseases, such as cirrhosis of the liver, diabetes, lymphoma, Crohn's disease, or ulcerative colitis.
• Cancer of the rectum or the prostate or skin cancers, such as squamous cell cancer and Bowen's disease.
• Previous treatment, such as surgery or radiation therapy to the rectum or pelvis.
• Rectal spasms (proctalgia fugax).

Rectal bleeding

Many people have small amounts of rectal bleeding. Irritation of the rectum from diarrhea or constipation, a small hemorrhoid, or an anal fissure can cause a small amount of bright red blood. You may see the bright blood on the surface of the stool or on the toilet paper. Hemorrhoids and anal fissures usually occur after straining during a bowel movement because of constipation. This type of bleeding can cause pain during a bowel movement. It doesn't make the toilet water bloody. It isn't serious if there is only a small amount of blood and the bleeding stops when the diarrhea or constipation stops. Home treatment is usually all that you need.

Bleeding can happen anywhere in the digestive tract. The blood is digested as it moves through the digestive tract. The longer it takes the blood to move through the tract, the less it will look like blood. Often blood that is caused by bleeding in the stomach will look black and tarry. A tarry stool has a black, shiny, sticky appearance. It looks like tar on a road. Blood that has moved quickly through the digestive tract or that starts near the rectum may look red or dark red.

Certain medicines and foods can affect the colour of the stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food colouring can turn the stool black.

Self-Care

You can take steps at home to help with rectal problems. Depending on the cause of your problems, you may not use all of these tips.

• Clean the rectal area.

  Gently clean the area with water-moistened cotton balls, a warm face cloth, or premoistened towelettes, such as Tucks or baby wipes. A mild ointment, such as A+D Ointment or Desitin, can be applied lightly. It can help soothe the skin and protect it against more irritation.

• Try a warm sitz bath.

  Taking a sitz bath 3 times each day and after each bowel movement will help keep the area clean and relieve itching. After the bath, dry the area carefully. You might use a hair dryer set on low.

• Use unscented toilet paper, soaps, lotions, and creams.

  Scented products may irritate the skin. Coloured toilet paper may also irritate the skin.

• Avoid tight-fitting clothes.

  If you sweat a lot, avoid wearing tight-fitting underwear. Wear cotton undergarments. You may use talcum powder to absorb moisture, but don't use cornstarch. Cornstarch may cause a skin infection. Before you put on talcum powder, dry your rectal area with a hair dryer set on low.

• Avoid foods that can increase rectal itching.

  For at least 2 weeks, try not to eat or drink foods like coffee, tea, cola, drinks that contain alcohol, chocolate, tomatoes, and spicy foods. Also avoid taking too much vitamin C. Slowly add the items back to your diet, one at a time, to help find the cause of the itching.

• Try antihistamines to control itching.

  Scratching leads to more itching. Taking an antihistamine at night may help reduce your nighttime itching. These medicines may not be safe for children younger than age 6 or for people who have certain health problems. Before you use them, check the label. If you do use these medicines, always follow the directions about how much to use based on age and, in some cases, weight. You may need to check with your doctor about using these medicines.

• Be careful with ointments if you have itching.

  Apply an ointment that has 1% hydrocortisone. Don't use other steroid creams on this sensitive area of your body. They can cause skin damage. Hydrocortisone cream should not be used for longer than 7 to 10 days without talking with your doctor. Don't use creams or ointments that have antihistamines, such as Benadryl cream.

  You will need to check with your doctor first if you need to use the cream for a child younger than age 2 or for use in the genital area.

• Avoid certain medicines when you have rectal bleeding.

  Rectal bleeding can be caused by constipation, diarrhea, or hemorrhoids. Don't take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). They can cause bleeding in the digestive tract. That can increase the amount of blood in your stools. These medicines can also make bleeding hemorrhoids bleed more. If you need to use something for pain, try acetaminophen, such as Tylenol.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse pain.
• Stools that become red or black, or increased blood in the stool.
• New swelling or a lump in or around the anus.
• Symptoms occur more often or are more severe.

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