Anusitis or pruritis ani is the irritation of the skin around the anal opening, causing symptoms such as pain, burning, itching and blood visible on the toilet paper. Anusitis is rarely related to hemorrhoids but is most commonly due to irritation of the anal canal caused by acidic foods in the diet. This results in a discharge to the outside that is extremely irritating to the anal skin. Stress may alter your dietary habits but is not the direct cause of anusitis. Smoking is not a cause of anusitis.
In order to stop the symptoms, the anusitis must be controlled. Methods of treatment will help improve the symptoms, but long-term improvements can only be achieved if the causes are eliminated.
Diet is the main cause of anusitis. In decreasing order of importance, try avoiding the following from your diet:
- Red wine
- Italian sauces
- Carbonated drinks, including soda water and Perrier
- Citrus fruits and juices (orange, grapefruit and lemon)
- Cranberry juice
- Iced tea
- Apple juice
- Red meat (except veal)
- Fatty meats (especially pork)
- Strawberries and fruits with seeds
- Hot peppers
- Excesses of vinegar, black pepper and tomatoes
The ideal way to identify the causes of the problem is to go on a strict diet for 3 weeks and then reintroduce the foods you eliminated every 2 to 3 days, one food at a time. You should notice returning symptoms within 24 to 48 hours.
Safe foods to consume while on the diet are: Tea, Water, Milk, White Wine, Chicken, Fish, Meat, Rice, Potatoes, Vegetables, Breads, Cereal, Eggs, Cheese and Bananas.
One to three large, soft, regular bowel movements each day is ideal. A higher fiber diet along with more water (6-8 glasses/day) may be necessary to achieve this goal (refer to Bowel Habit instruction sheet). Avoid taking mineral oil and take laxatives only if absolutely necessary. Use glycerine suppositories just before a bowel movement if you expect a hard stool.
Do not use coloured toilet paper after a bowel movement. Try using large balls of cotton batting, first to wipe, then to wash and finally to pat dry. Ideally you should have a shower after each bowel movement – use a mild soap (i.e. Aveeno). If this is not possible, then use Tucks (non-prescription) to clean after a bowel movement.
Use Tucks at other times as well when there is an anal irritation and discharge. Cornstarch powder can be applied liberally and may help. Finally, use the Anurex if symptoms are severe. Anurex, a cold reusable suppository, helps relieve irritation by quickly soothing the area by cooling. Other suppositories and some skin creams may also help, but do not work as effectively. During treatment, every effort should be made to keep the anal skin as clean and dry as possible.
- Never scratch! Cut your nails short and file them daily with an emery board. Scratching during your sleep just perpetuates the vicious cycle.
- Prevent moisture in the anal area by applying cornstarch two to six times daily. Lay a cotton ball with cornstarch powder over the anal opening. Use it before and after perspiring i.e. jogging, golfing, etc. Do not use Vaseline or oily ointments.
- It is imperative that the whole cycle of rectal irritation, discharge and anal moisture followed by scratching be broken. The pruritus will disappear if no other pathology is present. If not, further investigation and treatment is necessary.
- Keep on the diet and medication until long after your feel better or the problem may recur. If excessive spices, alcohol, etc. are consumed within the six months after symptoms are gone, use Anurex that night and the next one to prevent a recurrence. Anurex will last for nine months.