What is Anusitis and Pruritus Ani?
Irritation of the skin around the anal opening (anusitis or pruritus ani) causes pain, burning, itching, and blood on the toilet paper. Anusitis is occasionally related to hemorrhoids, but most commonly is due to irritation of the anal canal due to certain foods in the diet (such as acidic foods); this results in a discharge to the outside that is very irritating to the anal skin.
Itching & Discharge
In order to stop the itching and discharge, we must control the anusitis. This irritation can be treated with some creams, ointments, and suppositories, as well as Sitz Baths (using Epsom Salts) and Anurex which soothes the area by cooling. In the meantime, you should try to keep the anal skin clean and dry. These methods treat the symptoms but long-term improvements will only occur if you eliminate the causes.
What Causes Anusitis and Pruritus Ani?
Diet is the main cause of anusitis. Avoid in decreasing order of importance: coffee, beer, red wine, garlic, pizza, Italian sauces, curry, carbonated drinks (including soda water), citrus fruits and juices (orange, grapefruit, and lemon), cranberry juice, ice tea, apple juice, chocolate, nuts, popcorn, red meat, fatty meats (especially pork), strawberries and fruits with seeds, hot peppers, chilli, vinegar, black pepper and tomatoes.
The ideal way to identify the causes of the problem is to go on a strict diet for a couple weeks and then reintroduce the foods you eliminated every couple days, one food at a time. You should notice returning symptoms within 24-48 hours.
Safe Foods to Eat
Safe foods to eat while on the diet are tea, water, white wine, milk, chicken, fish, meat, rice, potatoes, vegetables, breads, cereal, eggs, cheese and bananas.
Stress & Smoking
Stress may alter your dietary habits but is not the direct cause of anusitis. Smoking does not cause anusitis.
One to three large, soft, regular bowel motions each day is ideal. You may need a higher fiber diet and more water (6-8 glasses/day) to achieve this goal. Avoid taking mineral oil and laxatives, unless absolutely necessary.
Do not use coloured toilet paper after bowel movements, 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 (eg. Aveeno or Dove).
Prevent moisture in the anal area by applying cornstarch 2-6 times daily. Lay a cotton ball with cornstarch powder over the anal opening. Use it before and after perspiring (i.e. sports and physical activities). Do not use Vaseline or oily ointments.
It is important that the whole cycle of anal irritation, discharge, and anal moisture followed by scratching is broken. The pruritus will disappear if no other pathology is present. If not, further investigations and treatment may be necessary.
Keep on the diet and medication until long after you feel better the problem may recur.
Remember – No Quick Fix!