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Bleeding from the back passage is something that you should always see your doctor about, even if you are convinced it is piles or an anal fissure. The reason you need to be checked is that bleeding from the back passage can be a symptom of bowel (colon or rectum) cancer. If you don’t like the idea of being examined in that area, look at Seeing your doctor about an anal problem.
In general, if the bleeding is bright red and you have anal pain, especially when you pass a stool, it is probably a non-serious condition such as anal fissure or piles – but your doctor needs to make sure.
If the bleeding is dark red, or in clots, or mixed with a lot of slime, or mixed in with the faeces it could be a more serious condition (such as colitis, diverticular disease or cancer of the rectum or colon) that needs prompt treatment. Other symptoms that might be serious are a decreased frequency and/or hardness of faeces, or an increased frequency and/or looseness of faeces.
What do you know about bowel cancer?
A survey by BUPA, a private healthcare organization in the UK, showed that people do not know much about bowel cancer. When prompted with a list of eight possible symptoms, only 57% of men and 70% of women in the UK named rectal bleeding as one of the main symptoms of bowel cancer.
Anal itching
Anal itching can be just an annoyance, or can be so troublesome that it dominates your life. It is usually made worse by warmth, and is often most troublesome in bed. The skin round the anus easily becomes irritated and inflamed. This is because it is difficult to keep the area round the anus clean and dry; the skin is crinkly and traps tiny faecal particles. It is also sweaty and airless, and it may be moist from an anal or vaginal discharge. When it becomes irritated, scratching is a natural reaction, but this allows damages the skin further – the itch/scratch cycle. Ointments and creams can cause further problems by keeping the area damp.
Although it is very unpleasant, anal itching seldom means anything serious. If you have pain as well as itching, look at the section on anal pain.
Causes of anal itching
Washing too much or not enough. Poor hygiene can be responsible for anal itching, but so can excessive cleaning, especially if you use harsh soaps or a brush.Pre-moistened toilet tissues (wipes), bought from chemists and supermarkets, can sometimes cause anal itching. The reason is probably perfume, alcohol or a preservative in the wipes.
Sensitivities and allergies to other chemicals, such as bubble baths and perfumed soaps, may be responsible.
Ointments and creams are notorious causes of anal itching. If you have itching, it is a natural reaction to buy an anaesthetic gel for the anal area. Most of these are labelled ‘for haemorrhoids’ and contain lignocaine, tetracaine, cinchocaine, pramocaine or benzocaine with other ingredients. At first they help, but then the itching returns because you have become sensitive to one of the ingredients in the cream or ointment and they are keeping the area moist. Don’t use them for more than 1 week.
Skin conditions, such as psoriasis or eczema, can affect the skin round the anus and cause itching. Piles can sometimes be itchy, partly because of the slimy discharge they produce.
Fungal infections, similar to thrush or athletes foot are another common cause. Fungi love warm, damp and damaged skin, so if you have an itchy anus for any reason and then damage the skin by scratching, fungi can take hold and make it worse.
Sexually transmitted infections are what most people worry about, but are not usually the reason. Genital warts (vulva or penis, caused by papillomavirus, thrive in warm, moist conditions such as the skin near the anus and can be very itchy. Genital herpes (caused by herpesvirus) can also infect the anus, and causes itching just before the sores appear and also during the healing stage. Both these viruses are easily transferred to the anal skin on the fingers, and can therefore occur round the anus in heterosexuals as well as homosexuals. The anus may be the only site of infection; the fact that you don’t have genital warts or herpes elsewhere doesn’t rule them out.
Threadworms (pinworms) are tiny worms, about 13 mm long, which live in the lower part of the bowel. The female worms creep out of the anus at night – how they know it is night, and why they come out only at night, is a mystery. They lay thousands of eggs on the skin of the anus, causing intense itching at night. When you scratch, the eggs lodge under your fingernails, and it is easy to transfer them to your mouth and reinfect yourself.
Certain foods can irritate the anus during defaecation. Beer and curry are obvious examples. Some people find that citrus fruits, grapes, tomatoes, coffee or tea can cause problems.
Anxiety tends to make the brain hyper-alert to body feelings that we may otherwise be able to ignore, so if you are going through an anxious period, a symptom such as itching can become magnified.
Pleasure. It is worth asking yourself whether you are deriving a perverse, almost erotic, pain/pleasure from scratching the itchy area, which is keeping the irritation going