Have you tried any lotions or creams? There’s a lot out there you can try. Barrier cream, which prevents the acids from touching the skin as they exit. Or calmoseptine lotion (not sure if the spelling is correct) which has some menthol that cools the area. I use a bidet which works well. Some people say pepto helps with diluting the acids for when they come out. 

Another option are wet wipes (instead of a bidet, or if you’re away from your toilet and you need to clean up) or Balneol, which is a general cleanser that you can use with any toilet paper. That will moisturize your skin after a bowel movement. 

Also, are you taking any Imodium or anything to decrease the number of stools you have? That might help if you’re going less. 

Thanks for letting me know Calmoseptine contains menthol.  I was considering buying some from Amazon, but I am as allergic as heck to menthol.

As far the other things, I have tried them, but taking measures so I am less acidic has helped tremendously.

I had similar burn and Calmoseptine just made it worse. The only skin barrier that works for me (on very acidic stool) is Ilex paste but use after every BM. You must dry thoroughly before using the paste (hair dryer on cool is best after using a bidet).

Oh that’s good to know- don’t use if you’re allergic! Ilex paste works well too. I was given Coloplast barrier cream at the hospital and use that sometimes too. 

Have you had the skin looked at? Maybe it’s a yeast infection? Just throwing out random stuff. Yeast tends to grow if it’s really wet/damp. 

I highly recommend pawpaw ointment

I would recommend a visit to your doctor. Have you ever had a fistula? They are painful and feel inflamed all the time.

Anyone try lidocaine and hydrocortizone spray? I hear that it numbs the area and treats the itching/burning. 

Calmo is my best friend. But when things are raw, from stomach acid and bile that have not been reabsorbed, even calmo or other barrier creams are not enough.

If you have diaper rash (candidiasis of the skin), everything burns and is completely miserable. I made a cocktail of zinc based barrier cream, ketoconazole ointment (prescription, but your doc will call it in for you), and lidocaine ointment, and it got me through a few really horrible days. If you want to keep them separate, put on the lidocaine first in a thin layer, and then ketoconazole, and then zinc cream/calmo.

If you are like me, you have the joy of leaking bile and stomach acid every morning. I find that this can be mitigated by eating something that absorbs it well (complex carbs, fat, etc.; eggs make mine worse) so you’re not just passing it out of the body. I also had to give up eating large quantities of tomato sauce or tomato soup, because they increased the burn. 

Controlling stomach acid production can really help, as it sounds like you have discovered. But irritated skin needs to heal; I get tears from all the wiping, and that makes the burning that much more fun. Reapplying barrier cream each time is tedious and messy, but it does help. If you have a rim of irritated skin beyond the anus (you’ll know because it will feel raised and painful on either side of the crease), the cocktail of creams can help get rid of that. If you have liquid leakage, I’ve been told that some people put a gauze between their ‘cheeks’ to help keep it off the skin. Skin doesn’t like stool. I remember how horrid it was every time I had a stoma leak with my loop ileostomies... my skin was burned raw from the effluent. It was so miserable... and then the barrier flange doesn’t stick well, and there’s more leaking... 

Don’t eat spicy food. That is something I learned the hard way. I can’t even handle a jalapeno anymore. Without a colon, the capsaicin (the hot stuff in peppers) doesn’t get neutralized before passing out in the stool, so it is free to burn the perianal skin. I call this ‘fire-butt’. Every time I eat something a little bit too spicy, even if my palate thought it was fine, I pay for it horribly. Serious fire upon exit. There’s not enough Calmoseptine in the world to make that better. I am so careful now... only have spice if there is coconut milk or cream or something to make it mellow, and keep it to ‘gringo’ levels!!!

I think a bidet is a great thing to reduce the skin irritation from wiping and to help with cleanliness of the skin. There are bidet seats you can install onto your existing toilet, and they come on big sale periodically at Costco. They look so fancy... I want to try one. My aunt and uncle have them in their house and will not go back to paper. I use an inexpensive squirt bottle with a curved spout—a chemistry type bottle so it squirts at an angle easily—to wash when it’s too irritated to wipe. But I don’t love the cold water in wintertime, so the bidet (which has heated seat and heated water) sounds much more civilized!

Best of luck...

Have you been tested for pouchitis? Maybe you have this and need antibiotics.

Another thing to try is a prescription cream (at least a prescription is required in Canada) of Nefedepine or a Nitro based cream. I tried both in the past, but could not tolerate the Nitro based cream and it can gives head-aches as a side effect. Nefedepine based cream helped me a lot (just make sure you are not allergic to any of this stuff).

Good luck!

Solomin