What's wrong with my butt?

As gay men, either as tops, bottoms, or versatile, much of our thoughts about the anus come from a sexual perspective, but your butt has a day job that has nothing to do with another guy’s dick. We thought it was time to have a quick chat about ways to keep your anus happy and healthy.

What is the anus?

The opening of the rectum through which stool passes out of your body. Two sphincters control the exit of feces from the body during an act of defecation, which is the primary function of the anus but not the only one. Just behind the anus, in the anal canal, lie an exterior sphincter and an interior sphincter. A sphincter is a circular muscle that constricts and expands. Anal sphincters tighten to retain feces and expand, allowing it and flatus (gas) to pass during defecation. The anal canal is the first 2 inches of skin after the anus; It is closed while resting and open during defecation and penetration. It leads to the rectum, the cavity that runs vertically from the end of the colon to the anal canal. The rectum is approximately 5 inches long and 1 1/2 inches wide. It stores feces before defecation.

The abundance of nerve endings in the anal region and rectum makes anal sex pleasurable for many men. However, it is not uncommon for guys to have medical issues and complications around and inside of their anus, which may or may not have something to do with anal sex. The most common concerns include:

Hemorrhoids: Swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids have several causes, although often, the cause is unknown. They may result from straining during bowel movements or anal sex, and hemorrhoids are prevalent. Nearly three out of four adults will have hemorrhoids from time to time. Sometimes they don’t cause symptoms, but at other times they cause itching, discomfort, and bleeding.

Abscesses: An infected cavity filled with pus found near the anus or rectum. Ninety percent of abscesses result from an acute infection in the internal glands of the anus. Occasionally, bacteria, fecal material, or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, which may then collect in an abscess cavity.

Fissures (cracks): A small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Fistula: Caused by an infection in the glands of your anus, often when a piece of stool gets caught in the glands. If the infection does not go away on its own, it can burrow through the tissues around your anus until it bursts through the outer skin. Anal fistulas cause unpleasant symptoms, such as discomfort and skin irritation, and won’t usually get better on their own. Surgery is recommended in most cases.

Anal warts: Are caused by the human papillomavirus (HPV), the most common sexually transmitted disease (STD). Warts affect the area around and inside the anus, but may also develop on the skin of the genital area. They first appear as tiny spots or growths, often as small as a pinhead, and they can grow quite large and cover the entire anal area.

Anal cancer: The risk for anal cancer is a concern for men who have anal sex. It can produce malignant tumors inside and outside the anal canal. Many people with early anal cancer have no symptoms. The primary risk factor for anal cancer is infection with HPV. Many LGB practitioners advise routine anal Pap smears to detect the early changes that may indicate a risk of developing anal cancer. There are no long-term studies, but some providers recommend that any male with a history of having anal sex should be screened. Guys with HIV should be checked regularly as this is a known increased risk factor.

Molluscum: A contagious skin infection caused by a virus. A pin-sized pimple with a crater center appears within one to three months. You can usually see a cheesy white center under the crater. The anus is one of the most common infection points, but it is also found frequently on the inner thighs, groin, genitals, and lower abdomen.

Crohn’s disease: For some, only the last segment of the small intestine (ileum) is affected. In others, the condition is confined to the colon (part of the large intestine). The most common areas affected by Crohn’s disease are the last part of the small intestine and the colon. Signs and symptoms of Crohn’s disease can range from mild to severe. They usually develop gradually but sometimes will come on suddenly, without warning. You may also have periods when you have no signs or symptoms (remission). We included Crohn’s disease because some symptoms mimic others on the list and is often misdiagnosed.

Tips for Proper Anal Care and Maintenance

Hygiene
Condoms to prevent many STD infections
Lubrication during anal intercourse
Relaxation during bowel movements and sex (don’t strain or push!)
Soft toilet paper for bowel movements and be gentle when wiping
Avoid overbathing and harsh materials/chemicals when cleansing
A healthy diet including fruits, vegetables, and fiber
Yogurt for intestinal health and “good bacteria.”
Avoid anal douching (or keep from excessive use)

Warning Signs:

Like any other part of your body, your anus deserves attention, care, and maintenance, but sometimes things can and will go wrong. Yes, we must all stay on alert regarding STDs, but not every issue with our gay male bodies has to do with sex. Even if you follow the expert advice, you may still develop medical problems in and around your anus. Here are some things to be on the lookout for. Don’t wait until things get worse; see a doctor for proper medical care.