You Need To Keep Your Butthole Oily & Other Tips From A Colorectal Surgeon

“You need to keep your butthole oily,” my friend shared in one of those no-longer-TMI conversations women are capable of having about our health in middle age. After a visit with a colorectal surgeon regarding some long-term discomfort in that lower region, she had a lengthy list of corrected misconceptions about anal health care to share. Or, more accurately, the knowledge that there was such a thing as anal health care.

Before chatting with my friend, it would have never occurred to me to seek out a colorectal surgeon.

“It’s not an uncommon thing,” Marianne Cusick, M.D., a colorectal surgeon with UTHealth Houston and Memorial Hermann, tells Scary Mommy, referring to my friend’s experience struggling to diagnose her issue. Dr. Cusick shared that it’s not uncommon for patients to struggle for a while before they get to a colorectal surgeon who can give them good advice. Often, issues are brushed off or simply attributed to doing something wrong with hygiene.

As much as I feel comfortable talking to my general practitioner and gynecologist about my reproductive health, I can get squeamish about health care in that other essential hole.

“We’re colorectal surgeons. You don’t get into this field without a sense of humor,” Cusick assures me, offering a wealth of knowledge we can all use.

“It’s not a hemorrhoid until it’s proven it’s a hemorrhoid.”

You need to get your anus examined. Cusick shared how many patients will come to her office with what has been diagnosed (and often treated) as a hemorrhoid, but no physician has looked at the area. What is mistakenly identified as a hemorrhoid could be other things made worse by hemorrhoid treatments.

“First, let’s eliminate the big, bad, scary things, and then we’ll get to the annoying things,” Cusick says. “It’s not a hemorrhoid until it’s thoroughly evaluated and all the other things are ruled out.”

Cusick listed other potential things a misdiagnosed hemorrhoid could be, such as an anal fissure, which causes similar symptoms, such as pain and bleeding, pruritus ani (we’ll get into this more in a minute), genital warts, colon polyps, and even anal cancers.

“No amount of bleeding is normal. This is not an area that should be bleeding,” Cusick emphasizes, getting ahead of the qualifications many of us already make in our mind, telling ourselves that it’s just a small amount, or it doesn’t happen that often, or “This is the way I’ve always been.” She reiterates, “No amount of bleeding is normal, so any bleeding should be evaluated.”

You don’t have to live with pelvic floor dysfunction.

Pelvic floor dysfunction can include things like fecal urgency, leakage, or incontinence. But a lot of women are uncomfortable having conversations with their primary care physicians, and sometimes, doctors don’t ask questions because they don’t know what options are available.

“There are options available for pelvic floor strengthening and management of fecal urgency, emergency, or poor coordination of bowel movements,” Cusick shares, adding these issues are really common postpartum.

This isn’t the same PT rehabbing a runner after knee surgery. Pelvic floor physical therapists are trained in working with your pelvic floor.

It’s time to talk about pruritus ani (Latin for “itchy anus”).

“The anal skin is different than the skin on your arms, legs, hands, and feet. It is different than a baby’s bottom as well. There does need to be some amount of natural oils for lubricant around the anal area to minimize friction and irritation,” Cusick explains.

Cusick shared the vicious cycle that can happen around our anus. Unlike other areas, something will injure the skin, and the skin around our anus can’t create a scab. The secretions that come from injury can be intensely itchy. Of course, the first thing people go to is the thought, “I didn’t clean well enough.” They clean more aggressively, further traumatizing the area.

A colorectal surgeon can properly evaluate the area, making sure there’s nothing else contributing and making sure there are no cuts or tears around the perianal skin (the area from the posterior vagina all the way back to the tailbone).

For those panicked about an anal exam, Cusick shared what an exam would entail. “We look at the outside skin [and] we look at the inside anal area, which is a well-tolerated, quick office exam that looks at the lowest 1 to 2 inches.” The exam helps “to make sure there’s no pathology or concerning findings on the inside of the anal canal that’s causing the outside skin to be irritated or inflamed.”

Another component is to investigate the patient’s hygiene regime to determine whether something else is going on or if it’s something the patient is doing to themselves.

Our bums are not the same as a baby’s, and we should wipe accordingly.

Speaking of hygiene, Cusick recommends avoiding wet wipes or baby wipes. “Baby skin generates more oils, so it can tolerate things like baby wipes, [as] opposed to adults — we don’t have that luxury, and it can cause some skin irritation.” (Again, your b-hole needs to retain those natural oils to help keep things copacetic!)

For cleaning, Cusick suggests gently cleaning with water, such as with a wet wash rag or bidet, and thoroughly drying. Specially formulated over-the-counter hygienic cleansing lotions and skin barrier ointments are also available, which are safe to use and allow the skin to heal without further trauma.

Toilet paper also works. However, as Cusick notes, “Overcleaning is a real risk, and that can traumatize the skin, and that can wipe away the natural oils in this area, then kind of putting the risk for these microscopic skin tears and irritation.”

Start colorectal cancer screening at 45.

Speaking of big, bad, and scary, it’s important to flag the importance of colorectal screening. Personally, I thought I had a longer runway until the dreaded colonoscopy, but the guidelines have changed. “The American Cancer Society recommends that people at average risk* of colorectal cancer start regular screening at age 45.”

Cusick also emphasized that this recommendation is “for somebody that truly has no symptoms, so if there’s bleeding, that doesn’t include that person; if there’s a change in bowel habits, that doesn’t include that person. Truly patients that are asymptomatic.”

Advocate for your ass.

“I’m a big fan of patients advocating for themselves and advocating for the care that they’ve received,” says Cusick.

In terms of bringing up these issues with your physician, Cusick had great advice to lead with your symptoms.

“I think that everyone needs to be comfortable with the diagnosis based on the exam they have received, and also I would not recommend coming in with the assumption that it is a hemorrhoid. A hemorrhoid is a diagnosis. What I always try to bring patients back to is their symptoms. So symptoms can paint a picture for a diagnosis as long as the physical exam goes with that,” Cusick continues. “I would present the symptoms that they’re having to their physician, their care provider, and allow that to drive the conversation.”