Anal fissures: A real pain in the butt


A man in pain from anal fissures is in front of a background of peach emojis.

Dr Rhys Young gives the low down on anal fissures: what causes them, how they can be treated and if you can still have sex. 

Sitting down for a number two should be a relaxing experience where one can catch up on some TikToks (or Instagram reels if you’re over 30).

Anal fissures can turn that situation into a nightmare. And don’t get me started on how they can impact anal sex. So, rather than sitting on your anal fissure, let’s talk about how to nip it in the bud!

What is an anal fissure?

An anal fissure is a tear of the skin in the anal canal. It’s like a decent papercut in an area where the skin has to stretch to let things in or out. They can bleed – often bright red fresh blood. They also can cause a decent amount of pain, almost like passing glass.

When the fissure occurs, the anal sphincter (the muscle that stops you from having an accident) goes into spasm, causing a deeper throbbing sensation that can last for minutes to hours. You might even get this sensation when sitting or driving. 

What causes anal fissures?

As I mentioned, this area is designed to stretch to let things in & out. An anal fissure is often caused by trauma where things may have stretched too much or too quickly. Trauma can occur when you’re constipated (straining to pass a hard poo) or from bottoming during anal sex.

The muscle spasm I mentioned earlier impairs blood flow to the fissure, which in turn prevents healing. Then you have a horrible cycle of tearing, pain, muscle spasms, less blood flow, poor healing and further tearing. 

How can you prevent anal fissures?

The best treatment for anal fissures is prevention. To stop that tear from happening in the first place, we need to form a healthy relationship with our sphincter.

You can start by increasing your fibre intake to ensure smooth poos. You may have heard me talk about psyllium husk before – this works great.

Keep an eye on your water intake as well; dehydration often leads to constipation. To prevent anal fissures while bottoming, make sure you’re using plenty of lube. Also, talk to your sexual partners about going slow until you’re nice and relaxed down there. 

How do you treat anal fissures?

Treatment is all about breaking the cycle. If you see a GP, they might suggest some creams that include glyceryl trinitrate, an ingredient that helps to relax the muscle sphincter.

Warm baths may help lower muscle spasm pain and can help with symptoms.

If you’ve had a fissure that’s been present for a while, surgery is often required to remove the fissure and allow the skin to heal. It might seem like a scary option, but it will mean you can finally go back to normal poos and butt play!

What about sex with anal fissures?

If you’ve already got a fissure, you might need a short break from bottoming. There’s a higher risk of HIV transmission if you’re exposed to HIV during anal sex if you have a fissure.

Bottoming with a fissure can also keep that cycle going. You might not necessarily notice the initial sting, but the muscle spasm in the sphincter can continue after you have sex and impair healing.

My most important message: if a fissure is impacting your sex life, don’t sit in silence!

Read next:

The Great Anal Sex Playlist

The Doc Q Guide to Better Bottoming

The Doc Q Bottoming sequel: Top Tips for Tops

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Dr Rhys Young

QNews, Brisbane Gay, App, Gay App, LGBTI, LGBTI News, Gay Australia

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