Patient Info: Anusitis and Pruritis Ani

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Irritation of the skin around the anal opening (anusitis or pruritus ani) causes pain, burning, itching and blood on the toilet paper. Anusitis is very occasionally related to hemorrhoids, but most commonly is due to irritation of the anal canal due to acidic foods in the diet; this results in a discharge to the outside that is extremely irritating to the anal skin.

Itching & Discharge

Therefore, in order to stop the itching and the discharge we must control the anusitis. This irritation is quickly soothed by using Anurex, a cold reusable suppository, that soothes the area by cooling. Suppositories and some skin creams may also help but take longer to work.

In the meantime, we 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.

The Cause

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 and Perrier, citrus fruits and juices (orange, grapefruit and lemon), cranberry juice, iced tea, apple juice, chocolate, nuts, popcorn, red meat (except veal), fatty meats (especially pork), strawberries and fruits with seeds, hot peppers, chilli, 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 Eat

Safe foods to eat while on the diet are tea, water, milk, white wine, 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 is not a cause of Anusitis.

Bowel Habits

One to three large, soft, regular bowel movements each day is ideal. You may need a higher fibre diet and more water (6-8 glasses/day) to achieve this goal (see our bowel habit instruction sheet). Avoid taking mineral oil; take laxatives only if absolutely necessary. Use glycerine suppositories just before a bowel movement if you expect a hard stool.

Anal Hygiene

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, use Tucks (no prescription necessary) to clean after a bowel movement. Use Tucks at other times when there is an anal irritation and discharge. Finally use the Anurex if your symptoms are severe. Cornstarch powder can be applied liberally and may help.

Miscellaneous

• 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 you feel better or the problem may recur. If you take excessive spices, alcohol etc. in the next six months use the Anurex that night and the next one to prevent a recurrence. Anurex will last for nine months.

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