Why is good skin care important
Anyone who has frequent bowel motions, diarrhoea or accidental occasional leakage or faecal incontinence may get sore around the back passage from time to time. This can be very uncomfortable and distressing. Occasionally the skin may become so inflamed that it breaks into open sores. These are then difficult to heal. Taking good care of the skin around your back passage can help to prevent these problems from developing.
Why may I get sore skin?
There are several reasons why your skin may become sore:
- The scientific reason for itching is that it is due to chemicals contained in the bacteria of the bowel motions.
- Your bowel contains digestive juices and acid which break down your food to enable your body to use the nutrients in it. If you have very fluid bowel motions, the diarrhoea will still contain these juices and acid, which start to irritate the skin on contact. If you have faecal incontinence, the small quantity of juice and acid left in even the normal stool can damage the skin.
- If you open your bowels very frequently, repeated wiping can damage the sensitive skin of your anus.
- With some anal conditions it is very difficult to wipe your bottom effectively – a little always seems to get left.
- Sometimes the area around the anus becomes infected.
Tips to prevent soreness
- With careful personal hygiene it is often possible to prevent soreness, even if you have a bowel problem.
- After a bowel action, always wipe gently with soft toilet tissue or moist toilet paper. Discard each piece of paper after one wipe, so that you do not re-contaminate the area you have wiped.
- Whenever possible, wash around the anus after a bowel movement. You may be able to use a shower attachment with your bottom over the edge of the bath. Or use a soft disposable cloth with warm water. Avoid flannels and sponges. Sometimes a little ingenuity is needed. Some people find that a small plant spray or jug filled with warm water make washing easier on the toilet or over the edge of the bath.
- Do not be tempted to use disinfectants or antiseptics in the washing water as these can sting and you may be sensitive to the chemicals in them. Just plain warm water is best.
- Avoid using products with a strong perfume such as scented soap, talcum or deodorants on your bottom. Many baby wipes contain alcohol and are best avoided.
- When drying the area be very gentle. Pat gently with soft toilet paper or a soft towel. Do not rub. Treat the whole area as you would a newborns skin. If you are very sore, a hairdryer on a low setting may be most comfortable. (Use carefully)
- Wear cotton underwear to allow the skin to breath. Avoid tight jeans and other clothes that might rub the area. Women are usually best to avoid tights and to use stockings or crutchless tights instead. Use non-biological washing powder for underwear and towels.
- Avoid using any creams or lotions on the area, unless advised to do so. A few people who are prone to sore skin do find regular use of a cream helps prevent this. If you do use a barrier cream, choose a simple one like castor oil, Vaseline or Zinc. Just use a small amount and rub it in. Large amounts stop the skin from breathing and can make the area sweaty and uncomfortable. Make sure the old layer of cream is washed off before applying more. Some people are allergic to Lanolin and creams containing this should be avoided.
- You Doctor or Nurse Specialist may suggest using a barrier wipe which forms a protective film over the skin, especially if you have diarrhoea and are opening your bowels frequently.
- If you need to wear a pad because of incontinence, try to make sure that no plastic comes into contact with your skin and that you use a pad with a soft surface. The Continence Nurse can advise on which pads are best.
- Whenever possible, unless you have been advised for other reasons, eat a healthy diet, drink plenty and take as much exercise as you can. Some people find that certain foods or drink makes them prone to soreness, especially citrus fruit such as oranges. It may be worth cutting these out on a trial basis and more permanently if it helps.
- Note: Women are advised always to wipe from front to back, i.e. away from the bladder and vaginal openings as bacteria from the bowel can infect the bladder and vagina if you wipe from back to front.
If you are already sore
Follow all the advice above on prevention. In addition:
- You may find that damp cotton wool or damp toilet paper is more comfortable to use for wiping.
- Use a barrier cream or ointment as recommended by your surgeon or Nurse Specialist. If you have to use your own try Sudocrem, Vaseline or something similar. These are available from your chemist.
- If drying the skin after washing is difficult or uncomfortable, you may try using a hairdryer on a low setting.
- Try not to scratch the anal area, however much you are tempted, as this will make things worse. If you find that you are scratching the area in you sleep at night, you may consider wearing cotton gloves in bed. (Available from your chemist)
- Try to allow air to get to the anal area for at least part of every day.
- Don’t struggle on forever alone! Talk you your Nurse Specialist or Doctor, especially if your skin is broken. If you have persistent sore skin you may have an infection which needs treatment and there are other products which can be prescribed to heal the soreness.