Anal Sex and Anal Fissures & Hemorrhoids

Published:

Dr. Myrtle,

I really can’t believe that anal penetration doesn’t cause anal hemorrhoids & fissures. I see anal sex listed as a cause on the internet--why?


Here’s the problem: if you look in the scientific literature regarding causes of anal hemorrhoids, you find lists of causes, most of which I agree with. They list:

  • increased abdominal pressure (obesity, pregnancy),
  • increased abdominal venous pressure (cirrhosis, liver disease), and/or
  • pelvic floor high-tone dysfunction (constipation, straining at stool, prolonged sitting on toilet--reading magazines, etc.).

If you continue to search, you’ll then find several articles written in the 1980’s documenting traumatic anal penetration of men having sex with men (aka gay anal sex), and in them they list blunt-force anal trauma from fists, forearms, etc. in addition to foreign objects, prevalent sexually transmitted infections which increase anal-area inflammation leading to a higher incidence of both anal hemorrhoids and anal fissures.

The question I ask, is all anal penetration the same? Does all anal penetration lead to "blunt-force trauma" of the anal sphincter, anal canal, and anal skin?

I don’t think so. Does the literature back me up on this? No: and who exactly is going to get NIH funding for studying the incidence and prevalence of hemorrhoids in persons engaging in consensual anal penetration? We can’t even get unbiased sex education for ADULTS!, so how would this study be done? And even if done, who would publish it?

Beyond that, is there any evidence that relaxation or anal massage could help reduce the muscle tightness which leads to anal hemorrhoids? Clearly, relaxation generally is helpful, even in these persons undergoing surgical remediation. This study shows that relaxation directly reduced muscle tension associated with defecation after surgery.

I agree that aggressive, non-lubricated friction-enhanced penetration of the anal sphincter could cause tearing of the hemorrhoidal pads. What I don’t agree is that the gentle manipulation of the anal sphincter, the pelvic floor accessed through the anus, and anal penetration done comfortably and consensually will lead to the type of trauma that will drag the hemorrhoidal pads. Additionally, I believe that there is good evidence that mechanical relaxation of the anal sphincter, massage of the posterior portion of the pelvic floor (levator ani, specifically), as well as a conscious connection between the person’s mind and their level of anal tension (conscious relaxation), all reduce the pressure which leads to hemorrhoids in the first place. It is based upon this conclusion that I maintain that consensual anal penetration, when practiced with the proper attention to the pleasure needs of the person being penetrated is not only un-related to hemorrhoids, but is likely to be beneficial to the general health of their anal musculature, venous structure and nervous system generally.

I also think that in this world where procedures determine health care, we tend to leap towards surgical options rather than working with stress, massage, diet manipulation, bowel habits, and taking the time to take care of some of our most basic health issues. We hate something that takes work, and just want to have things "stopped" or "cut off". I’m not alone: see this opinion.

"...The focus on a surgical intervention for the anal fissure or hemorrhoid is an expression of a viewpoint that sees no value and sees no intelligence in the symptoms someone with such a condition is experiencing. Instead of seeing the symptom of an anal fissure, for example, as the way in which one’s body is complaining of the diet, stress, bowel habits and anxiety one is under, conventional treatment sees the symptom of blood in the stool, rectal pain or abdominal pain as something that needs to be stopped. No regard is shown for the big picture of a person’s life and how one’s symptom are a response to this big picture. As we have said elsewhere, it is our view that the symptom is the way our bodies are trying to communicate. If we simply try to refuse to understand the message because we don’t understand the body’s language, we needlessly suffer and don’t deal with the root problem prompting the symptom. We continue to suffer. (end quote)

Remember, I’m not saying that anal penetration is important, necessary, mandatory, or even intriguing for every person. It’s not of interest to many people, and since sexual activities should be consensual, this is completely appropriate. However, I become very concerned when physiological data such as I have presented are ignored in favor of culturally-biased opinions, which are then propagated extensively as though they are fact.

Chronic pelvic tension and venous pooling cause hemorrhoids. Anal sphincter relaxation directly contradicts the causes of hemorrhoids by promoting relaxation of pelvic tension, and releasing venous pooling.

Take Care.

Dr. Myrtle