Today, a patient asked for advice on treating his "IBS," which I took to mean his Irritable Bowel Syndrome. But then he explained that he was actually talking about "the other IBS," his "itchy butt syndrome."

I couldn't help but laugh, and I appreciated the joke since many patients shy away from talking about pruritus ani (the real name for this embarrassing syndrome). The reality is that many people—very often women, especially after childbirth—are afflicted with itching around the rectum.

What causes this version of "IBS"? Most commonly, external hemorrhoids arise when small bits of inner rectal tissue bulge out so that you can feel little lumps near the exit of the rectum. These often bleed and can be outrageously itchy. The itching is most often exacerbated by a bit of residual stool in that area after passing a bowel movement. The symptoms can come and go, as can the little protruding lumps. Thereafter, any degree of straining during stooling, as with constipation or very frequent bowel movements (like with diarrhea), can cause them to act up or become inflamed.

What other things can contribute to this infernal itch maker? Infections, especially with pinworms, may be the cause, but that's uncommon. Skin troubles such as like yeast infections can sometimes be the cause. Food allergies can also be at play, with a common culprit being the tomato.

What to do?

• Talk with your doctor. Check in with your physician the first time you have these symptoms to find out if anything specific is causing them.
• Keep the area clean. You can use any type of soft, moistened towelettes but I usually recommend baby wipes because they're sold in large quantities at reasonable prices. Specific hemorrhoid and "personal" wipes might come in smaller, less conspicuous packaging that will fit in your purse, but they're no better than baby wipes and cost more.
• Apply soothing lotion. Over-the-counter hydrocortisone is my first suggestion for treating an inflamed hemorrhoid. Prescription cortisone suppositories are available if the topical one isn't working. Also consider applying a diaper ointment to protect the area from being further irritated by later bowel movements. I favor Boudreaux's Butt Paste^® but you can try any ointment or just some Vaseline^®.
• Stop bad bowel habits! If you're having trouble with constipation, add a fiber supplement. With adequate amounts of water, the fiber will keep the stools soft and regular and will also reduce spells of diarrhea.

Last, ask your doctor for specific advice, especially if you have any other symptoms of concern in your skin, belly, or bottom.