Curtis Asbury, MD sees it all the time. A patient comes in with blotchy, red, irritated rectum and insists they’re not doing anything unusual. Peering into their sore bottom, Asbury nods solemnly, then delivers news most people never expect to hear.
“You’re not wiping correctly,” he says.
A dermatologist practicing in Selbyville, Delaware, Asbury has seen an uptick in the number of people coming in expressing dissatisfaction with their rectal hygiene. Whether it’s due to misguided parental instruction during toilet training or wiping on sheer instinct, some of us are simply not maintaining one of the most potentially dirty crevices of our body. And the consequences can be irritating.
“It’s called perianal dermatitis,” Asbury tells Mental Floss, describing the kind of topical irritation that afflicts people who are wiping poorly, infrequently, or overzealously. In an attempt to clean their rear end, some people scrub so violently that the American Society of Colon and Rectal Surgeons has given a name to the resulting tenderness: Polished Anus Syndrome, or PAS.
Fortunately, the key to avoiding PAS and other rectal misadventures is relatively easy. Here are some pro tips for a clean butt.
GIVE UP WET WIPES
For starters, Asbury recommends that people stop using the pre-moistened cloths, which are heavily marketed to promote a sparkling cavity. Use of the wipes has been associated with allergic reactions to methylisothiazolinone, a preservative used to inhibit bacterial growth while products are on store shelves. “Even the all-natural ones can cause problems,” he says, since any kind of chemical present in the wipes isn’t usually rinsed off right away.
Does that mean you should reach for dry toilet paper instead? Not quite. “It’s healthier, certainly, to clean your body with water," Asbury says. "Nobody takes a dry piece of paper, rubs it over their skin, and thinks they’re clean.” Even the Greco-Romans (332 BCE–395 CE) knew this, as one historical account from the philosopher Seneca revealed that they used a damp sponge affixed to a stick as a post-toiletry practice. Of course, some ancient cultures also wiped with pebbles and clam shells, among other poor ideas, so perhaps we should stick with contemporary advice.
INVEST IN A BIDET
Asbury is an advocate of the standalone or add-on toilet accessory that squirts a spray of water between your cheeks to flush out residual fecal matter. While bidets are common in Europe and Japan, the West has been slower to adopt this superior method of post-poop clean-up; others might be wary of tapping into existing home plumbing to supply fresh water, even though DIY installation is quite easy. For those patients, Asbury has developed an alternative method.
TRY PAPER TOWELS AND WATER
“What I tell people to use is Viva, a really soft, thick paper towel made by Kleenex,” he says. “You get a squirt bottle and you leave it near the toilet and moisten the paper towel.” Regular toilet paper is usually too flimsy to stand up to a soaking, while normal paper towels are too harsh for rectal purposes. Viva is apparently just right. (And no, Asbury is not a brand ambassador, nor does Kleenex endorse this alternative use.)
This advice does come with a major caveat: Viva wipes are not flushable and might very well clog your pipes if you try to send them down the drain. When Asbury recommends the technique, he advises people to throw used towels in the trash. If you find that idea appalling, and provided your butt is not already red from bad wiping strategy, lightly moistening a wad of durable toilet paper should do the job.
DRY THOROUGHLY BUT GENTLY
Once you’ve wiped enough to see clean paper, take a dry square and mop up any excess moisture. Whether it’s wet wipes or bidets, some people don’t bother with this step, but “it would be weird not to dry,” Asbury says. Occasionally, moisture can lead to intertrigo, which is irritation in skin folds, or a fungal infection.
You also want to have a soft touch. “I see people scrubbing hard,” Asbury says. “That just makes the problem worse.” Excessive wiping can lead to micro-tears in the anal tissue, causing bleeding and discomfort.
WIPE IN THE RIGHT DIRECTION
Make sure to go from front to back, pushing waste away from the groin. This has traditionally been advised for women to keep poop away from the vaginal canal and prevent urinary tract infections. While Asbury hasn't found specific studies to back up this advice, he still believes it's likely more hygienic. There’s also something to be said for sitting while wiping, since ergonomically, it may keep your perianal area open. But if you’re uncomfortable reaching into the toilet to wipe, standing should suffice.
Assuming you’ve done all that and you’re still feeling discomfort, Asbury warns it might be something else. “If you’re not feeling clean, there could be issues with your sphincter,” he says. Weakened muscles can cause leakage. But generally, it’s dry-wipers who have trouble getting everything they need to get. For the hard-to-clean, Asbury advises that they make the switch to a bidet.
“It’s cold at first,” he says. “But you get used to it.”