BUM, anus, rear end - whatever you choose to call the back passage, it’s rarely brought up in conversation. 

Even with a doctor, it can be excruciatingly awkward to mention symptoms anywhere down there.

One doctor is urging women to overcome their embarrassment.

Julie Bowring, a gynaecologist at London Gynaecology and colposcopist, told The Sun: “We know there is already a stigma with women’s vaginas, and I suspect it's even harder, or equally as hard, to talk about your bum.”

Julie sees dozens of women every day who have been brave enough to come forward and admit something could be wrong down there.

Most of the time, it turns out to be something that’s easily fixable. 

Julie said: “The worst thing people probably worry about is if their symptoms are related to cancer.

“Anal cancer is relatively rare, but due to where the anus is located, it's hard for a patient to see or know for sure what's going on there. 

“Most often lumps, bumps etc., will be something benign.”

Anal cancer is diagnosed in 1,500 or so people in the UK every year, meaning it accounts for less than one per cent of cancer cases. 

Its symptoms include itching, bleeding, pain and small lumps around and inside the bottom.

But these symptoms around the entrance to the bum can have other, less worrying, causes. 

Julie said: “If your symptoms are persistent, that's when to get them checked out.”

It's also important to be aware of any symptoms related to your bowel - such as blood in the poo and any changes to your stools.

Itchiness around the bottom could be due to a bout of diarrhoea, tight underwear, sweat or cleaning between your butt cheeks too much. 

But if none of these are an obvious cause, there may be an underlying skin issue, Julie says.

“Eczema, psoriasis, or irritation due to really simple things like fabric washing detergent,” she said.

Eczema and psoriasis make the skin red, dry and flaky. 

Julie said: “All of these things need to be checked out.”

Itchiness is also a key sign of piles, medically known as haemorrhoids, which is when blood vessels inside and around the anus become enlarged.

It also causes bleeding after pooing, a slimy mucus, and lumps and pain around the anus. 

It’s not clear exactly why piles happen, but risk factors are thought to include pushing too hard when going to the toilet, constipation, pregnancy and heavy lifting.

A pharmacist can help with treatment of piles. But if there is no improvement after a week, or the problem is persistent, you should see your GP. 

Bleeding is one of the more concerning but less common symptoms, Julie said.

“But again, that could be related to something easily treatable like piles,” she said. 

“Occasionally women develop small cuts on the skin, which is known as a fissure.”

An anal fissure is when there is a tear or open sore in the lining of the large intestine, near to the anus. 

It causes pain when trying to poo, which can last a few hours, and bleeding.

There are dozens of causes of fissures, from pregnancy to constipation and IBS, and doctors are familiar with diagnosing them - so don’t be shy.

Julie said: “Bleeding should be looked at by a GP.”

Blood in your poo or from the back passage is also a key sign of bowel cancer.

“Some women can notice lumps or little raised skin around the anal canal or bum, and a common reason for that could be a skin tag,” Julie said.

On the outside skin, small raised lumps could also be harmless warts.

They may be so small they’re unnoticeable, blending into your skin colour. 

Julie said: “Not all patients are happy with this plan, but when the warts are tiny, they don't need treatment. Some patients need to just wait and see.”

The warts may grow and become uncomfortable and more noticeable to the eye, especially if they cluster together. 

There are various treatments for anal warts, including freezing them using liquid nitrogen and creams. 

Genital warts, including anal warts, are caused by human papillomavirus (HPV) - an infection spread through sexual contact that is very common and most people get at some point in their life. 

It usually goes away on its own without treatment, but if it lingers, it may cause genital warts.

HPV can also sometimes cause cervical, anal, and penile cancer. But the type of HPV that causes genital warts rarely leads to cancer.

Meanwhile, larger lumps that can be felt poking out from the anus could be caused by piles or prolapse.

Rectal prolapse is when the rectum - the last part of the large intestine - slips and falls down out of the anus.

It can create a bulging feeling, like sitting on a ball, as well as pain and bleeding.

Julie said: “Prolapse is unusual in younger women. But rarely, post menopausal women may experience prolapse of the retum.”

Lastly, pain could be a symptom of any of the conditions previously described - fissures, piles or prolapse.

Less common causes of anal pain include proctalgia fugax – a condition that causes episodes of sudden, severe anal pain that last for a few minutes at a time.

The NHS says medicine that relaxes the muscles in the pelvis may help with this condition.

Julie said: “A combination of all these symptoms might also suggest infection, and if you’re worried, there are tests to look for that. 

“You could go to a sexual health clinic or your GP can include it in their testing.

“If you look at things like chlamydia or gonorrhoea, it’s most likely to be in the vulva. But in some cases it’s relavant to do an anal swab.”

So with all that said, when should you take a little itch here, or a painful trip to the toilet there, seriously? 

Julie said there is no length of time that warrants you getting checked out.

If you are concerned about your symptoms that won’t go away, don’t delay - see your GP.

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