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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

Diet is the main cause of anusitis. In decreasing order of importance, try

avoiding the following from your diet:

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 Chili 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.

Bowel Habits:

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.

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, then use Tucks (non-prescription) to clean after a bowel movement.

Medications:

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.

Note: Miscellaneous: