Lifelong Rash

I've been getting rashes around my anus as early as high school (I'm a 37 y.o. male now). It seemed then (and still now) that after a bowel movement, and wiping thoroughly, a little more would come out over the following hours. My only solution then was to put a few layers of toilet paper as a kind of tampon for those following hours (usually replacing it once). Sometimes I would use Penaten cream with mixed results. My anus would always have some form of dryness or rash. For as long as I can remember I've seen a little bit of blood on the toilet paper from these rashes around the anus, irritated by the wiping. Wiping was always painful until I eventually was given steroid cream.

About ten years ago, I started getting intermittent bleeding (unrelated, at least directly, to the rash) after a bowel movement — the problem would usually last a week a few times a year, where a decent amount of red blood came at the end of a bowel movement but completely painless. I saw a specialist who did a few rounds of "banding" which may or may not have helped with the intermittent bleeding problem (months later the bleeding returned so instead of more banding I was given colonoscopy which apart from a polyp came up inconclusive). Anyway, after my first appointment with the banding Specialist I was prescribed a steroid cream for the rash and since then I've had a few different dermatologists, convinced that it is eczema, prescribe me different steroid creams and different application regiments. These regiments always clear up the rash/irritation problem as long as it isn't leaking (I guess, as long as my stool is relatively hard). The first time my anus felt normal in my adult life was after a few days of using steroid cream — that was three years ago.

Recently, my girlfriend looked at my anus and described to me what she thinks is a malformation (describing what she sees as a "lip", which she images being difficult to clean). I am aware of this "lip", and have had to clean behind it for as long as I can remember. I haven't seen many anus's to compare it to. When things are bad it gets irritated and kind swollen, you could say. Every dermatologist I've spoken to has disregarded this as a factor, which seems crazy to me.

So to summarize, my anus feels healthy and normal as long as my stool is relatively hard, that I shower with "soap free" shower gel after which I dry the region thoroughly with a hair dryer and then apply steroid cream, sometimes applying again in the evening. If for some reason my anus is a bit leaky after a bowel movement (which is rare, because the regiment keeps the area "tight" — the best way I have to describe it), I have to use the toilet paper tampon on top of it all.

I know that this is unsustainable, most of all because steroid cream can't be used in perpetuity. I've heard it gradually thins the skin and will cause worse problems... I need to find another solution. Please, what should I do?

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