How to Soothe a Sore Backside When You Have IBD

Dealing with an itchy or irritated bottom is just one of the many hassles of managing inflammatory bowel disease (IBD). While most of the general population has some familiarity with hemorrhoids , anal fissures , and anal itchiness known as pruritus ani, people with IBD are more prone to conditions that cause anal discomfort, especially during a flare.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cce69fe5-7569-4c6e-819f-ceb6817c5e14e60dc2a1-f33c-4a05-9b50-8e3e8e597629ce0b2b3a-f499-4e40-acb6-e2d49b2bcd3c In fact, one Swedish study found that 19.7 percent of people with Crohn’s disease and 8.6 percent of people with ulcerative colitis (UC) had perianal (in or around the anus) disease, including fistulas, fissures, and abscesses, compared with 2.2 percent of people without IBD. Researchers noted that the rates of perianal disease found in other countries were similar.e60dc2a1-f33c-4a05-9b50-8e3e8e59762954473fdc-26cb-4c2d-ab22-e8c85dff5ff7 “When you have IBD, issues around the anus can easily lead to complications or signal an infection that needs to be treated, so please talk to your doctor and have it checked out,” says Serre-Yu Wong, MD, PhD , a gastroenterologist at Mount Sinai in New York City. Here are some common causes of anal discomfort associated with IBD and what to do about them.
Perianal Dermatitis Perianal Dermatitis Irritation of the skin around the anus is quite common when an IBD flare leads to diarrhea . “Patients are prone to discomfort from overuse,” says Stefan Holubar, MD , a colorectal surgeon at Cleveland Clinic in Ohio. “Their diarrhea causes a lot of wiping, and that leads to perianal dermatitis.”e60dc2a1-f33c-4a05-9b50-8e3e8e597629fa40ffa1-c75f-4f20-8b55-92e529f79ec0 “The anus has a thin layer of protective oil that can be wiped away from overuse,” says Dr. Holubar.e60dc2a1-f33c-4a05-9b50-8e3e8e597629670e633a-ff0f-42ae-aa4a-8fc9b7e1b8d5 He recommends using a topical treatment with calamine or a zinc-based product to soothe the irritated skin around the anus. These are commonly sold as diaper rash or eczema (dermatitis) treatments.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cc300887-d09a-472f-b308-d4a42188fe20e60dc2a1-f33c-4a05-9b50-8e3e8e59762945a6e45f-2625-4f77-b743-13b56091822b “It’s best to put it on as a protective layer before making a bowel movement, so the diarrhea touches the ointment rather than the skin,” he says. To decrease wiping, he also advocates for using a bidet or a perineal irrigation bottle (peri bottle) to clean the area.e60dc2a1-f33c-4a05-9b50-8e3e8e59762900e45866-b3a6-4f41-b3ea-dd1f0ad864d4 You can also opt for wet wipes or baby wipes that contain emollients intended to reduce the amount of friction from wiping. Choose products aimed at sensitive skin, and check for ingredients that might irritate, such as fragrance.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299283193a-ce6d-469f-a88b-2e73fac6ee9b
Anal Fissures Anal Fissures Anal fissures are small tears in the tissue of the anal canal that can be painful or itchy. Sometimes they pass blood in the stool. Fissures are often caused by pressure created by constipation or passing a large stool.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fb9688f8-0836-4107-8863-78530511ff69 “The opposite is the case in IBD,” says Holubar. “IBD patients have low-pressure fissures from overuse and chronic diarrhea, so the key to treating it is getting the diarrhea and the inflammation under control with medication.”e60dc2a1-f33c-4a05-9b50-8e3e8e59762919a9b6d1-ce50-4350-ba91-cd4d653d605c However, because there is ongoing inflammation close to an open wound, there is an increased risk of infection, notes Dr. Wong.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a9856f2f-f3e3-44f2-b6f3-805783193f28 To ease irritation, Holubar recommends a sitz bath (a shallow warm-water bath you sit in to relieve discomfort) and a protective ointment, as previously mentioned.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab895b99-9180-41c8-9c43-248f2eeeff6e “At home, it’s very important to keep the area clean and dry,” says Wong. “Even after a sitz bath, you can use a low-heat hair dryer to dry without wiping and then wear cotton underwear to make sure you’re comfortable, clean, and dry.”e60dc2a1-f33c-4a05-9b50-8e3e8e597629bce2f872-e455-416b-b2da-de364c262f9b Wong insists that people with IBD call their doctor to have their fissures checked because an underlying issue or an infection may be present. Topical treatment is an option; antifungals and other medications are sometimes used. Making sure your medication regimen is working to control Crohn’s disease inflammation is the best way to avoid or manage anal fissures related to the condition.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297f71e13a-0645-4cb4-bdf4-a2b03aa3c14e
Perianal Fistulas or Perianal Crohn’s Disease Other Perianal Conditions People with Crohn’s disease, but not ulcerative colitis, are at an increased risk of perianal fistulas caused by chronic inflammation, which are tiny tunnels that form between the anus and the skin around the opening of the anus.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fb94cfae-815a-4095-a6ef-d307f9fafd00 Because there is no sphincter muscle controlling the opening, fistulas can easily leak blood, stool, or pus from an abscess. And because they are open, they are easily infected and very uncomfortable.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291c52aae6-35e8-43d9-acfe-a0abb797c45e In one r eview, researchers found that people with perianal Crohn’s disease had a 66-percent higher chance of getting colorectal cancer compared with people who had Crohn’s disease without perianal disease. In the subgroup of patients who developed colorectal or anal cancer, 50 percent had perianal Crohn’s disease.e60dc2a1-f33c-4a05-9b50-8e3e8e59762925fa472d-49e0-4a59-84d5-b69310d5d7ef “The presence of perianal fistulas is an independent predictor of disability, complications , and poorer outcomes [in Crohn’s],” says Wong.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a5b0b94c-f8ea-4d88-b961-1a9b5766d6ece60dc2a1-f33c-4a05-9b50-8e3e8e59762974abc2bb-e271-482a-9b93-b0c8b176c967 “Because they can be dangerous, they need treatment from a medical professional.”e60dc2a1-f33c-4a05-9b50-8e3e8e597629533b6401-523e-4b07-bdd6-e478997394ea Perianal fistulas may require a surgical procedure or a seton drain, which holds the fistula open and allows it to drain as it heals. A doctor may also need to drain any perianal abscesses in the fistula. After the procedure, perianal fistulas require medication to heal the inflammation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629344c741e-e9f2-452b-bd77-210cfc9a1d4d As with fissures, you can aim to manage fistulas by finding a medication regimen that keeps your Crohn’s disease in check.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fb2bdb2a-f582-4401-8061-71f6a2a169e9 “If you suffer from perianal fistulas, it’s important to get the Crohn’s disease under control and to stay in touch with a colorectal surgeon,” advises Wong. “Your medical team really needs to monitor your progress and watch closely for any worsening.”
The Takeaway People with inflammatory bowel disease (IBD) are more likely than the general population to have issues that cause irritation and pain in and around the anus (perianal conditions). Issues like perianal dermatitis, anal fissures, and perianal fistulas or perianal Crohn’s disease require medical attention and treatment with self-care, medication, and sometimes surgery. Perianal Crohn’s disease is a serious form of the condition that puts people at higher risk of disability, complications, and poor outcomes, including colorectal and anal cancer.
Resources We Trust Mayo Clinic: Anal ItchingCleveland Clinic: Anal FissuresGuts UK: Perianal DiseaseInternational Foundation for Gastrointestinal Disorders: Anal Fistula TreatmentCrohn’s & Colitis Foundation: Fistulizing Crohn’s Disease

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