We’re often all too happy to talk about our ailments over a coffee with friends but when it comes to anal health, many of us prefer to keep schtum about our bum. When it comes to matters of the posterior, people tend to shy away from talking about any problems.
Thankfully things are changing (albeit slowly) and GPs are seeing less reluctance from patients seeking help.
Dr Rachel Ward says people are gradually becoming more comfortable with discussing their bowel habits and bottoms – but it’s been a work in progress.
“The medical profession has worked hard to reassure people that problems like bleeding from the back passage can signify a serious condition and we want to talk to you about it,” she tells HuffPost UK.
“We look at all parts of people’s bodies every day and we don’t consider it any different if we need to examine a hand, ankle or anus. We treat every examination with respect and gain appropriate consent.”
There are a whole host of issues that can affect this relatively small area of the body. The five common symptoms Dr Ward comes across among patients include: bleeding, itching, pain, lumps and discharge – all of which you should seek help for. While these symptoms are often related to relatively harmless issues, they can also signify more serious problems like cancer.
Here, Dr Ward talks us through six of the most common anal issues she comes across with patients and how they’re typically treated.
The most common issue by far is haemorrhoids (commonly known as piles) which are “vascular cushions around your anus that can cause bleeding, itching and discomfort,” explains Dr Ward.
People with piles might notice lumps in and around their anus, or pain in that area. Other symptoms include bleeding (bright red blood) after having a poo, itching, feeling like you still need to poo after going to the toilet, and noticing slimy mucus in your poo or in the toilet.
In some case, your GP might be able to diagnose haemorrhoids by talking though the symptoms over the phone – in other cases, you may need to be examined to get a diagnosis. Either way, it’s nothing GPs haven’t seen or heard about a hundred times before.
“Many cases of haemorrhoids can be treated with suppositories and creams,” says Dr Ward, “but sometimes they needs surgical intervention such as banding.”
This is where a band is placed around the lumps on your anus to make them drop off. Sometimes surgery is required to remove them completely.
2. Anal fissure
An anal fissure is a split in the skin of the anus which causes pain and bleeding – especially when you’re going to the toilet. You might find that you have a poo and experience a really sharp pain initially, followed by a deep burning pain that lasts for hours afterwards. You might also spot bright red blood in your toilet bowl or on the tissue when you wipe.
The symptoms are so specific that it’s usually quite easy for doctors to diagnose this in conversation, however an examination is sometimes necessary. This involves a doctor popping a gloved finger just inside your anus to check for cuts.
“It can be treated by making sure your stools are soft (using laxatives if needed) and creams to heal the fissure,” explains Dr Ward. “Sometimes, if there is no healing happening, a surgical procedure may be needed.”
People with anal fissures might find it helpful to change aspects of their diet to ensure their stools are soft – especially as the cuts can often be caused by constipation. Get lots of fibre in your diet, drink plenty of fluids, and exercise regularly to keep your bowels moving-and-a-grooving.
3. Skin problems
Just like we can develop skin problems on our face, arms, legs and torso, we can also get issues around the anus – often cause itching, dryness and discomfort.
“A condition called lichen sclerosis presents with itchy, uncomfortable, white skin patches,” explains Dr Ward. “This can also occur on the penis and vulva.”
This can impact people of all ages (children included) but is most common in women over 50. Unfortunately it can’t be cured, but can be managed with steroid cream. People with this particular skin condition might also find it helpful to wash with emollient soap substitutes instead of regular soap, regularly apply a barrier cream or ointment (such as petroleum jelly) to affected areas, wear cotton or silk underwear and use lubricant if sex is painful.
“The appearance is characteristic but diagnosis is confirmed with a skin biopsy,” says Dr Ward. “Lichen sclerosis increases your risk of developing cancer of the vulva or penis, so it requires annual monitoring.”
Thrush is also a common condition around the anus, causing itching, soreness, redness or fissures. It can be treated with cream from your GP or pharmacist, says Dr Ward, although it’s worth noting that some of these creams can weaken latex condoms, diaphragms and contraceptive caps.
Thrush typically goes away on its own, but if you find it keeps returning, it’s worth getting checked out as it might signify an underlying issue like diabetes.
Another cause of anal itching – especially at nighttime – is worms. Specifically threadworms which look like, yes you guessed it, little bits of white thread in your poo.
The issue can spread through households, so if you think you’ve spotted them Dr Ward advises treating the whole household with medication (mebendazole) available from your pharmacist.
“There are several important hygiene steps to minimise the spread of worms such as stringent hand hygiene and hot washing sheets and towels,” says Dr Ward. You can find out more about preventing worms on the NHS website.
5. Anal cancer
Anal cancer can be tricky to diagnose because it can present like many other benign conditions of the anus: itching, bleeding or discomfort are predominant symptoms, as well as anal discharge and incontinence.
If you have any of these symptoms and they’re not going away, you should speak to your GP who can arrange for more tests. “Anal issues should always be discussed with a clinician so symptoms can be monitored and further investigations can be arranged if anal cancer is suspected,” says Dr Ward.
The main treatment is a combination of radiotherapy and chemotherapy, however some people might have one or the other, and others might require surgery. While anal cancer is still relatively rare, incidence rates increased by 76% in the UK between 1993 and 2017, with women impacted more than men.
6. Sexually transmitted infections (STIs)
Like other forms of sexual interactions, unprotected anal sex can lead to transmission of STIs.
Chlamydia, gonorrhoea, HIV, syphillis, herpes, hepatitis B and warts can all be passed on by anal sex, says Dr Ward. “These may not cause any symptoms initially or may lead to skin changes and anal discharge. The key is to practice safe sex and get regular STI checks.”
If you have any of the above conditions, it’s likely you’ll experience discomfort or reduced enjoyment when having anal sex.
If you are using medication for a condition, Dr Ward recommends just checking with your GP that you’re able to continue having anal sex during treatment. She adds: “If you are able to do so, using non-irritating lubricant and condoms are important to protecting the anus from further irritation.”