As gay men, either as tops, bottoms or versatile, much of our thoughts about the anus comes 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 constrict to retain faeces and expand to allow 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 prior to defecation.

The abundance of nerve endings in the anal region and rectum makes anal sex pleasurable for many men but, 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 a number of causes, although often the cause is unknown. They may result from straining during bowel movements or anal sex.Hemorrhoids are very common. 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 are the result of 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, where it may then collect in a cavity called an abscess.  

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 papilloma virus (HPV), the most common sexually transmitted disease (STD). The 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 pin head. 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 major risk factor for anal cancer is infection with HPV. Many LGBT practitioners are advising 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 advise 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. Within one to three months, a pin-sized pimple with a crater center appears. You can usually see a white cheesy center under the crater. The anus is one of the most common points of infection, 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 disease 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 of time when you have no signs or symptoms (remission). We included Crohn’s disease because some of the 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 over bathing and harsh materials/chemicals when cleansing
  • Healthy diet including fruits, vegetables and fiber
  • Yogurt for intestinal health and “good bacteria”
  • Avoid anal douching (or keep from excessive use)

Warning Signs:

Just like any part 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 all of the expert advice, you may still develope medical issues in and around your anus. Here are some things to be on the look out for. Don’t wait until things get worse, see a doctor for proper medical care.

  • You have severe rectal pain.
  • Your stools are black or tarry or have streaks of blood.
  • Rectal bleeding lasts for more than 1 week or happens more than once.
  • Stools are narrower than usual (they may be as thin as a pencil).
  • You still have rectal pain after a full week of home treatment.
  • Any unusual material or tissue seeps or sticks out of the anus.
  • A lump near the anus gets bigger or more painful, and you get a fever.

A happy anal sex life begins with having a happy and healthy anus. Now, go out and play!

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