Cleveland Clinic Fire in the Hole Review

Thank you for allowing us to trial your product.  My patients have found that it has helped with itching in particularly peculiar places as well as fellow employees alleviating bug bites.  I have had patients use it on eczematous areas with relief.  It is nice to have a product to help control and soothe itching without being a steroid.

This product appears to have many uses and we will continue to challenge them all. Thanks for a great product!

Valerie A Dailey, PA-C, MPAS


Cleveland Clinic is ranked as one of the top hospitals in America by U.S.News & World Report (2013).

Fire in the Hole Press Release

Contact: Neal Andrews                  FIRE IN THE HOLE-MULTI ITCH SPRAY

1504 Rutgers Place

Harbor City, CA 90710

Phone: (800) 499-1372







Fire in the Hole® blows up in the Great Outdoors

Doctor Developed Itch Relief Remedy Goes Global

Los Angeles, CA May 16, 2013:  Fire in the Hole® Multi-Itch Relief Spray signaled a move into the outdoor adventure market with a proven anti-itch relief solution that targets bug bites and irritation caused by poison oak, ivy and sumac.  Developed by doctors and surgeons for use in post op procedures the Fire in the Hole formulation had witnessed fifteen years of solid growth in the professional medical market prior to launching in retail in January 2013.  Today Fire in the Hole retail sales have seen a dramatic 40% increase in the highly competitive anti-itch market dominated by Tucks and Preparation H.


Fire in the Hole® developers attribute the rapid growth in the brand to a unique approach to treating irritation which avoids corticosteroids and instead uses a unique compound of amino acids to help soothe the irritation that causes the most common types burning and itching.  Consumer trends in the anti-itch category indicate an increased reluctance to using steroids to treat skin irritation problems.

“Many retailers and e-tailers see Fire in the Hole® Multi-Itch relief as a vanguard brand in this emerging category,” said Neal Andrews one of the co-developers of the brand.  He added, “We’re not surprised to see a high level of customer retention and reorder rates on the retail side because frankly, nothing works like this product and we saw the same thing from our professional customers over the past decade.”


For adventure enthusiasts the Fire in the Hole® multi-itch approach is a welcome addition to any outdoor toolkit because the product provides a remedy not only to plant based irritants like poison ivy and poison oak, it also provides instant relief to irritation caused by bug bites like mosquitos, chiggers, biting flies and gnats.  In addition Fire in the Hole® also works quickly to help heal irritation like jock itch caused by long sweaty hikes and anal itch caused questionable camp food.


Anticipating a strong international market Fire in the Hole® products will launch in the UK and Australia in the 4th quarter of 2013.  In addition multiple line extensions are planned including Fire in the Hole® Travel Towelettes, 7 Summits Sunscreen, Serious Sunburn Recovery Serum and a revolutionary Diabetic Daily Spray that combines oxygen with the Fire in the Hole® formula to help heal diabetic wounds and provide daily skin care to diabetic patients with skin related issues.


Fire in the Hole® is manufactured by Arenal LLC located in Harbor City, California in a certified F.D.A. regulated facility.



General Tips to Help Ease Anal Itching

Most cases of IBS (Itchy Butt Syndrome) respond well to simple self care measures and, if necessary, treatment with medication.

Following some simple self care measures (see below) for around two months should help prevent your bottom from itching.

If you still have an itchy bottom after two months, or if your itchy bottom returns, you may need to follow this advice for longer.

We recommend consulting with your DOCTOR immediately if your problem persists because severe anal itching can be symptomatic of more serious conditions.  More often than not itchy butt syndrome is managable with a few changes to personal hygiene and diet.

Fire in the Hole focuses on a natural remedy to these issues using amino acids to quickly help heal irritation that causes itching and we encourage you to seek a more natural path to relief.

Keep clean and dry

If you have an itchy bottom, you should keep your bottom as clean and dry as possible.

The best way to do this is to use water to gently clean your anus and the skin surrounding it. You should clean your bottom in this way after every bowel movement and before going to bed each night.

You can use soap to clean your bottom but make sure it is mild and un-perfumed so it causes less irritation to your skin. Wash all of the soap away afterwards.  Fire in the Hole Doctor do not recommend powders (especially scented powders) to help with itching because the fragrance itself can irritate the area and powders tend to clump and over dry problem areas.

After washing, gently dry your bottom. Avoid rubbing the area vigorously because it may irritate your skin. Instead, gently pat the skin dry using a soft towel. If you find it easier, you can dry your bottom using a hair dryer on a low heat setting.

When you are away from home, you can use damp toilet paper after passing stools, before gently patting your bottom dry.

If you have a tendency to sweat, or if your bottom becomes very moist, putting a cotton tissue in your underwear will help absorb the moisture around your anal area.

Self care measures

As well as keeping your bottom clean and dry, there are a number of steps you can take to help keep your itchy bottom under control. You should:

  • use soft toilet tissue
  • bath or shower daily
  • wear loose fitting cotton underwear and change your underwear daily
  • only put underwear on when your bottom is completely dry
  • avoid wearing tight clothing and women should wear stockings instead of tights to prevent getting too hot
  • use a light duvet at night so you do not get too hot
  • avoid using scented soaps, bubble bath, perfumes or powders around your anus
  • keep your fingernails short to limit damage to your skin from scratching
  • wear cotton gloves while sleeping so that if you scratch you cause less damage to your skin

It may be difficult but you should resist the urge to scratch your bottom. Scratching the area is likely to make your itchy bottom worse and will increase the urge to itch.


Some foods may make your itchy bottom worse. If the urge to scratch your bottom is greater after eating certain foods, try reducing the amount of them that you eat.

Foods that may make your itchy bottom worse include:

  • tomatoes
  • spicy foods
  • citrus fruits, such as oranges
  • nuts
  • chocolate
  • dairy products
  • coffee
  • excessive amounts of liquids, such as milk, beer or wine


Your Doctor may recommend you follow a diet that keeps your stools well formed and regular.

This means your stools will not be loose (runny), but you will not need to strain when you have a bowel movement.

Loose stools can irritate your anus. Straining to pass hard stools may cause haemorrhoids to develop. Haemorrhoids, also known as piles, are swellings that contain enlarged and swollen blood vessels in and around your anus.

Your Doctor may recommend you increase the amount of fibre in your diet because eating more fibre will make your stools softer and easier to pass. Fibre can be found in:

  • grains – such as in wholegrain bread
  • pulses – edible seeds that grow in a pod, such as peas, beans and lentils
  • oats – found in some breakfast cereals
  • fruit and vegetables

Read more about why fibre is important.


While waiting for the above self care measures to take effect, your Doctor may prescribe medication to help ease your itchy bottom.

However, you should not use topical treatments (those applied directly to your skin) for more than two weeks because they may start to harm your skin if used for long periods.

Soothing ointments

Your DOCTOR may prescribe an ointment or cream to soothe the skin around your anus. You will usually have to apply it in the morning and at night, as well as after each bowel movement.

No Touch Sprays

Fire in the Hole is the first amino acid based spray on the market designed to give you cooling, instant relief without the need to touch the affected area with your hand during product application.

Topical corticosteroids

If the skin around your anus is sore and inflamed due to itching, your DOCTOR may prescribe a mild topical corticosteroid (an ointment that contains steroids). This is applied directly to the affected area to relieve inflammation and ease the urge to scratch.  While we try to avoid the use of corticosteroids they may be necessary from time to time if your problem is severe.

For most people, using a topical corticosteroid will help ease the itch. However, it can sometimes make the itching worse. Speak to your DOCTOR immediately if, after using topical corticosteroids, you find your itchy bottom is getting worse.

Read more about topical corticosteroids.


If your sleep is disturbed due to itching at night, using an antihistamine may help.

Antihistamines are medicines that work by counteracting the action of histamine (a chemical released during an allergic reaction). Some antihistamines also have a sedating effect (make you drowsy).

Your DOCTOR may be prescribe chlorphenamine or hydroxyzine. These should be taken at night and should not be used for longer than two weeks because after this time the sedating effect may no longer work.

If you are prescribed a sedating antihistamine you should take care because:

  • they can affect your ability to drive or operate machinery
  • the sedating effect may be stronger if you drink alcohol

Treating an underlying cause

When your DOCTOR is diagnosing itchy bottom, they will try to determine an underlying cause.

If your DOCTOR identifies a cause, such as a bacterial infection or skin condition, it will also need to be treated in order for your itchy bottom to be properly managed.

For example, a bacterial infection may need to be treated with antibiotics. If the underlying cause is left untreated, your itchy bottom may return.

Anal Itching In Children

Anal Itching and Burning in Children

Children can develop itchy bottoms, and when this happens it can be quite alarming to parents. Sometimes anal itching in children can be as simple as excessive sweating or poor hygiene, washing children in luke warm, soapy water, can halt itching in the anus. Another common cause for anal itching in children is pinworms. Pinworms are little worms that infect the intestines; they are 1-2cm long and are most prevalent in school aged children.

Pinworms are contagious and are transported by children through their fingers or under their fingernails – it is important to know that pets do not spread pinworms. Children who don’t wash their hands after playing, and who suck their thumbs are at high risk. Children with pinworms frequently scratch their bottoms, move around in their sleep, and may even report seeing worms in their stool. Washing clothing and bedding, keeping fingernails short, changing underwear, and showering everyday will help to rid and prevent pinworms.

What is Anal Itch?

Anal itch can be defined as an intense itching around the anal area.The itch can be so insistent that resisting the urge to scratch may be difficult or impossible, often anal itch can worsen at night, causing sufferers to lose sleep. This can understandingly become an extremely uncomfortable situation and many times people suffering from rectal itching feel embarrassed to talk about it with their doctors.

Anal itch is also known as pruritus ani. Treatment for anal itching is normally prescribed after establishing the underlying cause of symptoms.

Symptoms of Anal Itch

The symptoms and signs of anal itch include:

  • Burning
  • Itching
  • Irritation
  • Soreness
  • Pain
  • Chafing
  • Dryness

Diagnosing Anal Itch

Anal itch is a condition which affects males and females equally, and knowing what to expect before entering a doctor’s office can help ease anxious sufferers. A doctor will ask a number of questions about overall health and symptomsto determine the underlying cause of anal itch. Since rectal itching can be caused by a number of reasons, both internal and external, specific tests may be performed to pinpoint the cause and adequate treatment plan for pruritus ani.

Although anal itch is an embarrassing condition, the more information about the condition a doctor can receive from a patient, the easier it will be to find proper treatment and symptomatic relief.

What Causes Anal Itch?

Pruritus Ani During and After Pregnancy

Pruitis ani, otherwise known as anal itch, is not specifically related to pregnancy, but is still a familiar complaint in pregnant women. Many pregnant women feel symptoms of pruritus ani due to the development of unwanted, but very common, hemorrhoids. Hemorrhoids are swollen pouches formed underneath the mucous membranes inside or outside the rectum, and exhibits uncomfortable symptoms such as itching, burning, and pain.

Women with constipation during their pregnancy have a higher risk of hemorrhoids due to the straining during bowel movements, causing increased pressure on the rectal veins. Hemorrhoids develop in pregnant women in the third trimester and will usually go away on their own after delivery. Soaking in a warm sitz baths and applying cold compresses, provides some relief for hemorrhoid symptoms. Seek medical advice if itching in the rectum becomes unbearable or persistent.

Chronic Anal Itching

Chronic anal itching is defined as a persistent itch in the rectum. Two underlying causes include, yeast infections and diet. Some individuals with chronic anal itch may have a fungal infection. Fungi, especially Candida, love warm, moist places, like inside and around the anus. When a person scratches the area where the Candida is living, it creates more damaged skin, and a great place for fungi to take hold and worsen.

Keeping the anus dry is the most important remedy for fungal infection, powders, and clean dry underwear can help to ensure a dry anal area. Certain foods can cause irritation during a bowel movement causing anal itching. Common foods are curry, peppers, jalapenos and anything spicy.

More uncommon foods are citrus fruits, like grapes, tomatoes, lemons, and oranges, all of which can cause chronic itching if eaten in excess or on a daily basis. Cutting out these foods, or changing diets to a more fibrous meal plan can help to quell itching after defecation. In any case, when changing diet or washing the anal area does not help chronic itching, a physician should be consulted.

Help for Anal Itch

There are various treatment options, depending on the cause, to relieve the symptoms of anal itch. Although the urge to scratch may be extremely strong, scratching will only aggravate the problem.

If scratching during sleep is suspected, wearing cotton gloves at night until the symptoms subside is highly recommended. There are also a number of steps to find relief from anal itch and prevent possible future occurrences.

Natural Treatments to Stop Anal Itch:

A lot can be done to naturally maintain and promote anal skin health. It is a good idea to support overall systemic balance by eating lots of fresh fruit and vegetables and whole grain foods, ensuring plenty of fresh air, adequate sleep, moderate sunshine and regular exercise. Also avoid tight clothing and synthetic underwear.

  • Add some oatmeal to your bath water. Oatmeal has naturally soothing qualities that help soften and heal irritated and itchy skin.
  • Promote tissue healing with Aloe Vera. Aloe Vera mixed with olive oil or tea tree oil can be applied to the area to promote healing.
  • Keep the anal area clean. Moistened toilet paper or wipes are gentle on the skin and make it easier to thoroughly cleanse the anal region.
  • Keep the anal area dry. Unscented baby powder or cornstarch can be applied to the area to keep moisture at bay and prevent chafing and irritation.
  • Eat plenty of fiber. A common cause of anal itch is constipation. Increasing your fiber intake will promote healthy digestion and stools and possibly relieve symptoms and prevent future occurrences. Fruits, vegetables and whole grains are great sources of dietary fiber.
  • Wash undergarments with a mild soap. Laundry detergents can be extremely irritating due to the chemicals present in some of them. The same goes for fabric softeners. Wash underwear with a mild unscented soap to prevent future irritation and itch.
  • If thrush or candida is suspected, there are herbal remedies which can help to maintain candida levels in your body within the normal range.
  • Herbal remedies may also be recommended to help with anal itching. Some examples include Fagopyrum, Croton and Aesculus. Combination remedies are often most likely to be helpful. Make sure that you source your herbal remedies from a reputable company to ensure maximum safety, effectiveness and therapeutic dosage.

More Information on Anal Itch

Anal itch can be a symptom of a number of serious medical conditions. If anal itch is accompanied by weight-loss, bloody stools, or painful bowel movements; it is important that to consult a health-care provider immediately.

Nighttime Anal Itching

Anal itching, also known as itchy bottompruritus ani oranusitis, is irritation and sometimes inflammation of the anus – located at the exit of the rectum. Itching severity varies and is usually exacerbated by such factors as type of clothing worn, whether the patient is seated or upright, moisture levels, pressure and general rubbing of the anal area. Anal itching can become so severe that some people find it intolerable, describing the sensation as one of incredible burning and soreness.

Anal itching is not a disease in itself, but rather a sign or symptom. In the majority of cases, there is an underlying cause or condition which causes the anal itching. However, sometimes the underlying cause is never found.

Regardless of the cause, virtually every type of anal itching sign or symptom can be successfully treated.

Anal itching is much more common than people realize, probably because it is not exactly something most people will reveal to others, apart from the their doctors. According to the National Health Service (NHS), UK, about 1 in every 20 British people experience “itchy bottom”. It is four times more prevalent in males than in females. Although anybody can develop anal itching, people aged 40 years and more are more likely to get it, compared to younger individuals.

According to Medilexicon’s medical dictionarypruritus ani is “itching of varying intensity at the anus; may be paroxysmal or constant, associated with seborrheic candidiasis or moniliasis, with irritated and enlarged hemorrhoidal veins, or may occur independently of any cutaneous lesions in association with systemic disease.”

What are the signs and symptoms of anal itching?

A symptom is something the patient feels or reports, while a sign is something that other people, including the doctor detects. A headache may be an example of a symptom, while a rash may be an example of a sign.

Most humans and other animals sometimes scratch their bottoms. For a person with pruritus ani (anal itching) the urge to scratch around the anus is very strong and persistent. Although the urge may occur at any time of day or night, it is more common after going to the toilet; especially if stools are liquidy. Some patients say the itching becomes more intense just prior to falling asleep in bed at night.

The symptoms of anal itching are self explanatory – “itching of the anus and the anal area”. The patient generally experiences:

  • Burning
  • Intense itching
  • Soreness
  • Pain (sometimes)

Symptoms may be short-term or persistent. Some individuals may experience irritation that is so intense that the desire to scratch must be satisfied there and then – this can be embarrassing.

What can set off anal itching or exacerbate it?

  • Anxiety
  • Heat
  • Mental stress
  • Moisture
  • Soiling (defecating or pooing in one’s clothing)
  • Some clothing or bedding materials, such as wool
  • Having nowhere private to go into nearby

What are the causes of anal itching?

Anal itching is usually a sign or symptom of a harmless physical problem with no long-term health consequences. Unfortunately, it can also be an indication of something more serious, such as:

    • Skin type – if the skin around the anal area is too dry there is a significantly greater risk of developing persistent and sometimes severe anal itching.


    • Moisture levels – if moisture levels around the anal area are high, the chances of having anal itching are raised. High moisture levels can be the result of several different factors, including over-sweating, allergies, diarrhea, very wet and sticky stools, inappropriate clothing, fecal incontinence, and not having access to toilet paper or any means of cleaning oneself.


    • Abrasive rubbing – cleaning your bottom with toilet paper can aggravate anal itching if the sensitive skin area is rubbed too hard, for too long, or too often.


    • Over-washing the anal area – if harsh soaps affect the skin, especially if not rinsed off properly, the chances of itching in the anal area may increase.


    • Some chemicals – some substances found in some soaps, douches, laundry detergents and body sprays may irritate the skin and cause anal itching.


    • Type of toilet paper – the texture and substances added to toilet paper may irritate and inflame the skin in the anal area, resulting in itching.


    • Some foods – some people may develop anal itching after consuming certain types of hot sauces or spices. The irritation may occur when the food is anywhere in the digestive system, even when stools are exiting through the anus.

      If a stool is not smooth and does not come out with the minimum of friction, irritation may occur and then subsequent itching – some people find that their anus becomes irritated after passing stools which originated from eating tomatoes, nuts, popcorn, chocolate, and even drinking alcoholic beverages. If some foods make people have diarrhea, their risk of developing anal itching is greater (because of the diarrhea).


    • Some medicines – some medications, such as antibiotics can cause diarrhea, which can cause anal itching.


    • Laxative abuse – if laxatives are used inappropriately and the patient has diarrhea or very liquidy stools, the probability of anal itching occurring becomes much greater.


    • Hemorrhoids – when the veins around the anus or in the rectum are swollen or inflamed the patient has hemorrhoids. Hemorrhoids can occur both inside and above the inside of the anus. They can also appear externally, under the skin of the anus. People with hemorrhoids commonly suffer from anal itching.


    • STDs (sexually transmitted diseases) – also known as STIs (sexually transmitted infections) cause anal as well as genital itching.


    • Parasites– some parasites may cause anal itching. Parasites are more commonly a cause of anal itching in tropical countries, or tropical regions of countries.


    • Skin conditions – such as eczema, seborrhea, and psoriasis, which may include itching in many parts of the body’s surface, often have characteristic focal areas of irritation. People with these skin conditions commonly experience anal itching.


    • Some yeast infections – this generally affects women. Yeast infections which affect the genital area, may spread to the anus, causing intense irritation.


    • Forced bowel movement – if the stool is dry and large and the individual heaves and still pushes it through, there is a risk of an anal abrasion (small tear in the anus). A deeper tear is called an anal fissure, which may also cause itching.


  • Tumors – a tumor in the anal region may cause anal itching. The tumor may be cancerous (malignant) or non-cancerous (benign). This is rare.

How is anal itching diagnosed?

In order for doctors to diagnose the cause of your symptoms, they will need to know your medical history. They might ask what soaps, creams or powders you use on your anus or if your symptoms worsen after the consumption of certain food types.

Your GP may also ask about when the itching is at its worst, and how long it lasts. They might also want to know if anyone else in your family has had or is suffering from anal itching. The doctors may be able to come up with a diagnosis just from these questions alone; however, if the cause is not clear you may be referred to a proctologist (doctor specializing in rectal and anal problems) or dermatologist (skin expert).

Diagnosis might be made just from a rectal exam. This will involve a GP checking the anal area for any skin that is inflamed, cracked or bleeding. An internal exam may then be required; the doctor inserts his/her finger into the patient’s anus. Doing this can help determine what is causing the anal itching as well as eliminating more serious conditions, such as colorectal cancer. Sometimes a more detailed exam of the digestive system, such as a colonoscopy or a proctoscopy may be required.

What are the treatment options for anal itching?

Most of the time itchy bottom is easy to treat and responds well to treatment. However, this does not stop it from recurring in the future. The type of treatment chosen is dependent on the cause of the anal itching. The various methods of treatment may include:

    • Anal cleanliness/dryness – When suffering from anal itching, keeping your anus clean and dry is very important. Each time you pass a stool and before going to bed it is advised that the skin around the anus is carefully cleaned using water and then dried thoroughly.

      When drying, be gentle, avoid vigorous rubbing as this could further irritate the area. Another option is using a hair dryer on low heat or patting with a dry pad.


    • Be careful when washing with soap – When washing the skin around the anus avoid perfumed soap, try using one which is mild and unscented, and be sure to rinse away all the soap with water.


    • When travelling – The above options may not be possible when on the move or away from home. In this case try using damp toilet tissues to clean yourself.


    • If the area keeps getting moist due to sweat – Putting a cotton tissue in your underwear will absorb the sweat/moisture and reduce itching.


    • Avoiding consumption of certain foods – There are a number of food types that can make the anal itching worse. If you notice the urge to itch getting worse after eating a particular kind of food, you should try to cut down on it. Below is a list of foods that are known to make anal itching worse:
      • Chocolate
      • Citrus fruits
      • Coffee
      • Dairy Products
      • Nuts
      • Spicy food
      • Tomatoes
      • Unnecessary amounts of liquids


    • Things you can do yourself – There are some other ways you can keep control of your anal itching symptoms. These are as follows:
      • Use colorless plain toilet paper
      • Make sure you have a shower every day
      • Wear underwear that is made of cotton and not too tight.
      • Be sure to wear clean underwear every day.
      • Trim your fingernails regularly; scratching the anal area with long fingernails can damage the skin. Ideally scratching the area should be avoided altogether, as it can make the itching worse.


    • Prescription Medication – Doctors can prescribe medication to help relieve the symptoms.


    • Creams – Doctors can also prescribe creams or ointments.


    • Corticosteroids – Patients with anal itching where the anal area is tender and inflamed may be prescribed a short course of corticosteroids (less than 7 days). It is applied onto the skin around the anus and will relieve the itching impulse and inflammation. It is known on occasion to make the itching worse, if this is the case it you should stop taking it and contact your doctor.


    • Antihistamines – This is to be taken at night and can alleviate your itching and help you sleep.


  • Treating the underlying cause – If the anal itching is the result of an underlying cause, the doctor will nead to treat that first. In most cases, if that underlying cause is effectively treated, the anal itching will resolve itself.

What are the complications of anal itching?

Scratching the anus too often can cause damage to the skin and may tear it. This can lead to the following complications:

  • Lichenification – the skin around the anal area becomes thick and leathery.
  • Ulceration – the skin becomes sore and breaks.
  • Excoriation – the top layer of the skin wears away.
  • Infection– this complication can be easily treated if the patient has prompt treatment.

Even though these complications are unpleasant, most of them can be treated effectively if you see your doctor as soon as symptoms appear.

Sources: National Health Service (NHS), UK, The Mayo Clinic, Wikipedia, HHS (Department of Health and Human Services USA), NIH (National Institutes of Health, USA).

Written by Mike Paddock

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Fire in the Hole Anal Itch Spray at HEB Stores

H-E-B locations in Texas.

Fire in the Hole Itch Relief Spray is now available at HEB Stores throughout the state of Texas.

Every H-E-B delivers fresh food, quality products and convenient services all designed around the specific needs of the each community.  With stores in more than 150 communities around Texas you’re sure to find one near you.  Click the logo to see a map with H-E-B location that carries Fire in the Hole near you!