Too much wiping & cleaning is a common cause of anal itch.
Here’s something I diagnose all the time that patients never see coming. Anal itch is one of the most common complaints that people see me for. Sometimes it’s painful, sometimes there’s a little bleeding, and it can definitely get in the way of sex. And no, it’s not just hemorrhoids.
The diagnosis is too much wiping and cleaning.
“But I’m keeping everything so clean!”
That’s what almost every patient tells me. They’re doing everything right, they’re diligent, and they can’t understand why they’ve been itchy for months or even years. Then I tell them the cleaning is the problem, and they’re in disbelief. Nobody teaches us that there’s such a thing as too much wiping. But there is, and the symptoms (itching, burning, rawness, bleeding) all come from something we do every single day. The good news is that it’s a habit, and habits can change.
I always tell them to keep the toilet paper and soap out of the butt. The skin inside your anus is delicate. It’s actually a lot like the inside of your cheek. Imagine scrubbing the inside of your mouth with toilet paper or rubbing soap in there. You’d irritate it fast. When we scrub, dig, or use soap on the inside of the anus, we’re doing the same thing. Neither toilet paper nor soap belongs on the inside.
Fortunately there’s an easy fix: adequate fiber and hydration. A lot of over-wiping starts with stool that doesn’t pass cleanly, so you end up doing more cleanup. The fix is getting enough fiber and water that your bowel movements come out well-formed and pass completely.
Most people need 25 to 38 grams of fiber a day, and even people who eat really healthy tend to fall short. I routinely recommend a fiber supplement:
- Psyllium husk (the main ingredient in Metamucil, Konsyl, and many store brands) my go-to for this issue, and the one with the most evidence behind it.
- Methylcellulose (Citrucel) is a great alternative that often has fewer side effects.
Start slow. If your body isn’t used to fiber, dumping in a big scoop is a recipe for gas and bloating. Here’s the ramp-up:
- Week 1: 1 teaspoon a day, mixed into about 8 ounces of water
- Week 2: 2 teaspoons a day
- Week 3: 3 teaspoons (1 tablespoon) a day
One tablespoon is about what most people do well with. Some people do better taking it with meals, others without. If you have frequent bowel movements (several a day can be totally normal), you may do better splitting the dose throughout the day. Prefer capsules? About 6 psyllium capsules typically equals a tablespoon (check the label), so you have to take enough for it to work.
Wet wipes are not the solution. They cause some of the worst cases of this I’ve ever seen. We’ll come back to this in a later post.
Some over-the-counter solutions that can be helpful:
- Balneol (or a generic): A lotion you apply to the toilet paper to make it soft, so wiping is less irritating.
- Barrier ointments: Zinc oxide (Calmoseptine, Desitin, Resinol) or A&D ointment. They’re soothing for skin that’s been wiped raw.
- A bidet, on light pressure: I love a bidet and have one at home. You can still overdo it, though. If you’re power washing, you’re back to irritating things. Keep the pressure gentle, and never spray water internally. There are plenty of affordable attachments out there. I use a Tushy (but I don’t promote for them).
After years of chronic irritation, the broken-down skin becomes vulnerable. Viruses, fungus, and bacteria that normally wouldn’t cause trouble can set up shop, and I see fungal and bacterial infections as a result. I sometimes pick up anal strep or staph infections in my patients.
The Bottom Line
- Less is more when it comes to toilet paper
- Lose the wet wipes
- Get your fiber and fluids in (consider a supplement)
- Invest in a gentle bidet but don’t power wash
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