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Rectal Problems

Topic Overview

Rectal problems are common. Almost everyone will experience some rectal itching, pain, or bleeding at some time during his or her life. These problems are often minor and may go away on their own or with home treatment.

Rectal itching

Rectal itching (pruritus) is usually not a sign of a serious disease. At first, the skin of the anal area may appear 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 occur when pieces of stool become trapped in skin folds around the anus.
  • Medicines, especially medicines that cause diarrhea or constipation, such as antibiotics.
  • Cleaning of the anus with very hot water and strong soaps. The anal area is normally oily, and this barrier protects against the irritation of bowel movements. Repeated cleaning or showering will remove these oils and 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 generalized dry skin condition that affects the entire body. This condition is more common in older adults. For more information, see the topic Dry Skin and Itching.
  • Hemorrhoids. Hemorrhoids are enlarged veins near the lower end of the rectum or outside the anus. For more information, see the topic Hemorrhoids.
  • An infection of the anus or rectum, which may be caused by viruses (such as genital warts), bacteria, pinworms, scabies, fungus, yeast, or parasites. Pinworms are the most common cause of anal itching in children. For more information, see the topic Pinworms, Scabies, or Genital Warts (Human Papillomavirus).
  • Certain foods, such as coffee, tea, cola, alcoholic beverages, chocolate, tomatoes, spicy foods, and large amounts of vitamin C.

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:

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 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 and does not make the toilet water bloody. It is not 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 is needed.

Bleeding can occur 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 digestive 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 and looks like tar on a road. Blood that has moved quickly through the digestive tract or that begins near the rectum may appear red or dark red.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Home Treatment

Home treatment for rectal itching depends on the cause of the itching.

Treat causes of anal itching

Try these home treatment measures for the following causes of anal itching:

  • Poor hygiene. Clean the area gently with water-moistened cotton balls, a warm washcloth, or premoistened towelettes, such as Tucks or "baby wipes." A mild ointment, such as A+D Ointment or Desitin, can be applied lightly to help soothe the skin and protect it against further irritation.
  • Scented or colored toilet paper or scented soaps.
    • Buy white, unscented toilet paper.
    • Do not use scented soaps, which can irritate skin.
    • Apply an ointment that contains 1% hydrocortisone. Do not use other steroid creams on this sensitive area of your body, because skin damage can occur. Hydrocortisone cream should not be used for longer than 7 to 10 days without talking with your doctor. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to.
  • Reactions to topical creams. Apply an ointment that contains 1% hydrocortisone. Do not use other steroid creams on this sensitive area of your body, because skin damage can occur. Hydrocortisone cream should not be used for longer than 7 to 10 days without talking with your doctor. Do not use creams or ointments, such as Benadryl cream, that contain antihistamines.
  • Excessive sweating. For anal itching caused by excessive sweating, avoid wearing tight-fitting underwear, and wear cotton, rather than synthetic, undergarments. You may use talcum powder to absorb moisture, but do not use cornstarch. Cornstarch may cause a skin infection. Before applying talcum powder, dry your rectal area with a hair dryer set on the low setting.

To control itching

To control itching, try the following:

  • Break the itch-scratch cycle, because further scratching leads to more itching. Take an oral antihistamine at night to help lessen your nighttime itching. Don't give antihistamines to your child unless you've checked with the doctor first.
  • Take a warm sitz bath 3 times each day and after each bowel movement. Following the bath, dry the anus carefully. You may wish to use a hair dryer set on low.
  • Avoid foods that can increase rectal itching, such as coffee, tea, cola, alcoholic beverages, chocolate, tomatoes, spicy foods, and excessive amounts of vitamin C, for a minimum of 2 weeks. Gradually add the items back to your diet, one item at a time, to help determine the cause of the itching.
  • Trim your fingernails short if you find yourself scratching irritated skin at night. Wear cotton gloves or socks on your hands at night to help stop the unconscious scratching that can occur while you sleep.
  • Control your stress. Being under stress and feeling anxious or worried can cause some people to experience skin itching. If you find you are scratching your anal area when you are anxious, try to take relaxation breaks throughout the day, especially before bedtime. For more information, see the topic Stress Management.

For rectal bleeding

When you have rectal bleeding, do not take aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and other NSAIDs, such as ibuprofen, can cause bleeding in the digestive tract, which 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 taking acetaminophen, such as Tylenol.

Rectal bleeding can be caused by constipation, diarrhea, and hemorrhoids.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Pain increases or does not improve.
  • The blood in your stool increases, or your stools become red, black, or tarry.
  • Swelling or a lump in or around your anus develops.
  • You develop a fever.
  • Symptoms become more severe or more frequent.

Prevention

To prevent rectal problems:

  • Use white, unscented toilet paper.
  • Do not use scented soaps, such as Irish Spring and Coast, which can irritate skin.
  • Practice good hygiene. Gently wipe the area with toilet paper after each bowel movement. If irritation starts, use water-soaked cotton balls to clean the area and then pat the area dry with dry cotton balls. Premoistened pads, such as Tucks or "baby wipes," may be less irritating.
  • Do not sit on the toilet for long periods of time.
  • Eat a high-fiber diet that includes plenty of fruits and vegetables and bran cereal every day.
  • Avoid foods that can cause rectal problems. Examples of such foods include:
    • Regular or diet cola.
    • Coffee.
    • Beer and other alcoholic beverages.
    • Dairy products.
    • Any other items that you know cause you to have gas or indigestion.
  • Avoid constipation. For more information, see the topic Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
  • Avoid diarrhea. For more information, see the topic Diarrhea, Age 11 and Younger or Diarrhea, Age 12 and Older.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • Is your main problem rectal pain, itching, or bleeding?
  • Are your symptoms:
    • Present all the time, or do they come and go?
    • Present only with bowel movements?
    • Steady?
    • Getting worse?
  • How long have you had this problem? Did it come on suddenly or gradually?
  • Have you ever been treated for a similar problem? If so, what was the treatment? Did it help?
  • What home treatments have you tried for your current problem? Have they helped?
  • Have you had leaking of mucus or stool from your rectum?
  • Have you noticed a change in the color, consistency, size, or frequency of your stool?
  • Do you have a history of hemorrhoids or rectal disease?
  • Do you have a family history of colon cancer, ulcerative colitis, inflammatory bowel disease, or Crohn's disease?
  • If you have had a full-term pregnancy, did you have a vaginal delivery?
  • Have you ever had radiation therapy to your pelvic area?
  • Did your symptoms begin after an injury, insertion of a foreign body, anal intercourse, or a bowel movement?
  • Do you think that your problem may be related to sexual activity?
  • Do you engage in high-risk sexual behavior, such as having unprotected sex or multiple sex partners?
  • Have you ever been treated for a sexually transmitted infection (STI)?
  • Do you have other symptoms such as fatigue, unexplained weight loss, fever, or pain elsewhere in your body?
  • Have you recently traveled to a foreign country?
  • What prescription and nonprescription medicines do you take?
  • Do you have any health risks?

For rectal itching

  • Is there itching or a rash present on any other part of your body?
  • Are other members of your family also experiencing rectal itching?

For rectal pain

  • How severe is your pain? Is it constant or does it come and go? Is it getting worse? Is it related only to having a bowel movement?
  • Does the pain feel like it is coming from the inside or the outside of your anus?

For rectal bleeding

  • What does the blood in your stools look like? Is the stool mixed with blood, or does the blood coat the outside of formed stools? Are there large clots of blood in the toilet water?
  • Do you have bleeding from your gums, blood in your urine, large skin bruises, or a skin rash that looks like measles?
  • Is your rectal bleeding painful?
  • Is the blood bright red or dark purple?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer David Messenger, MD
Last Revised April 14, 2011

Last Revised: April 14, 2011

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD

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