Anal Itching and Bleeding: Possible Causes and Solutions

There is itching in the anal area, occasional pain when washing (without using a hemorrhoid toilet), and today there was bleeding for the first time?

Hello, doctor.
In the past, I occasionally experienced brief abdominal cramps (similar to muscle spasms), but they were not as prolonged as the pain from food poisoning, and I did not need to use the restroom because of it.
At the same time, I have been experiencing persistent itching in the anal area for quite a while, and I have a bad habit of scratching the itchy area.
After having a bowel movement at night, when I use a bidet to clean myself, I often feel a sharp pain (I usually clean with toilet paper first, and there is sometimes a little blood from dry wiping).
Today, after finishing my bowel movement, I wiped about 4-5 times; the first 1-2 times were mostly from stool, but on the third wipe, I suddenly noticed a pool of bright red blood.
After that, on the 4th and 5th wipes, I used wet toilet paper to clean the anal area, and the bleeding seemed to decrease.
I have never had constipation; I usually have a bowel movement at least 1-2 times a day.
Recently, my stools have been well-formed and thick (about the size of a five to ten cent coin), but there are also some that easily break apart (not diarrhea).
From my personal observation, it seems that after eating oily foods, my stools become less formed (e.g., potato chips, American burgers).
This issue seems to have started in my early thirties; previously, I would only have loose stools if I had very greasy food.
I generally eat home-cooked meals and include vegetables and fruits in my diet, with a variety of light and dark green vegetables, and multiple types of fruits (I do not eat fruit at every meal, but I sometimes eat a large amount of vegetables and sometimes just enough to accompany my rice).
Given this, what could be the cause of the bright red blood I noticed today when wiping? P.S.
I am not sure if I have hemorrhoids; mainly, my anus itches, and I tend to scratch or pinch the itchy area, which leads to a tearing pain, and using water can also be quite painful.
However, today was the first time I saw bright red blood on the toilet paper...

Danxin de nanzi, 30~39 year old female. Ask Date: 2015/12/09

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on bowel movements.
You may also purchase over-the-counter hemorrhoidal suppositories for use.
It is advisable to avoid scratching the anal area due to itching, and the use of topical ointments should effectively alleviate the symptoms.
If bleeding persists, it is best to consult a physician for evaluation.

Reply Date: 2015/12/09

More Info

Anal itching and bleeding can be concerning symptoms that may arise from various underlying causes. Based on your description, it seems you are experiencing a combination of anal itching, discomfort during bowel movements, and the presence of fresh blood on toilet paper after wiping. Let's explore some potential causes and solutions for these symptoms.

Possible Causes
1. Hemorrhoids: One of the most common causes of anal itching and bleeding is hemorrhoids. These are swollen veins in the lower rectum or anus that can cause discomfort, itching, and bleeding, especially during bowel movements. The blood is typically bright red, indicating that it is fresh and likely from the anal area rather than higher up in the gastrointestinal tract.

2. Anal Fissures: An anal fissure is a small tear in the lining of the anus, often caused by passing hard or large stools. This can lead to sharp pain during bowel movements and bleeding. The blood may appear bright red and can be seen on toilet paper or in the toilet bowl.

3. Skin Irritation: Itching around the anal area can also result from skin irritation due to moisture, hygiene products, or certain foods. If you have a habit of scratching or rubbing the area, this can exacerbate the irritation and lead to bleeding.

4. Dietary Factors: You mentioned that your bowel movements can become less formed after consuming oily foods. A diet high in fat and low in fiber can lead to softer stools, which may irritate the anal area. Additionally, certain foods can cause allergic reactions or sensitivities that might lead to itching.

5. Infections: Fungal infections, sexually transmitted infections, or pinworms can also cause anal itching and discomfort. If you have any additional symptoms such as unusual discharge or odor, it may be worth considering these possibilities.

6. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause gastrointestinal symptoms, including bleeding. However, these conditions usually present with additional symptoms such as abdominal pain, diarrhea, or weight loss.

Solutions and Recommendations
1. Consult a Healthcare Provider: Given the presence of fresh blood and ongoing symptoms, it is crucial to consult a healthcare provider for a thorough evaluation. They may perform a physical examination, and possibly a rectal exam, to determine the cause of your symptoms.

2. Dietary Adjustments: Consider increasing your fiber intake through fruits, vegetables, and whole grains to help form softer stools and reduce straining during bowel movements. Staying hydrated is also essential.

3. Hygiene Practices: Maintain good hygiene by gently cleaning the anal area with mild soap and water. Avoid using harsh soaps or scented products that may irritate the skin. After bowel movements, consider using moist wipes instead of toilet paper to reduce irritation.

4. Avoid Scratching: Try to avoid scratching the anal area, as this can worsen irritation and lead to further injury. If itching persists, over-the-counter hydrocortisone cream may help reduce inflammation and itching.

5. Warm Sitz Baths: Taking warm sitz baths can provide relief from discomfort and help soothe the anal area. This can be particularly beneficial if you have hemorrhoids or anal fissures.

6. Medications: If hemorrhoids or fissures are diagnosed, your healthcare provider may recommend topical treatments or medications to alleviate symptoms.

7. Monitor Symptoms: Keep track of your symptoms, including any changes in bowel habits, the appearance of blood, and any associated pain. This information can be helpful for your healthcare provider in making a diagnosis.

In summary, while anal itching and bleeding can be caused by various factors, it is essential to seek medical advice to identify the underlying cause and receive appropriate treatment. Early intervention can help prevent complications and improve your quality of life.

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