Every now and again, Lifehacker asks a medical professional the health questions that you wish an expert would answer but you can't quite bring yourself to ask. Today, we're helping out a reader who has a very personal and intimate butt question.
Illustration by Chelsea Beck/GMG
Hello! This will be anonymous… right?!
I'm a middle-aged female who's had haemorrhoids since I was 19. I was horrified when I first realised something was wrong "down there". I screwed up the courage to ask my mum what was going on, and she calmly replied, "Yeah, those are haemorrhoids. You'll have them forever. Get used to them." Specifically I have both internal and external haemorrhoids that are Stage 3 (closer to Stage 2 than Stage 4). I have no skin tags and almost no bleeding, but a constant dull ache for many, many hours after a bowel movement.
I've tried everything to deal with them: Metamucil, Miralax, scandalous amounts of fibre through beans, exercise, sleep… I'm scrupulously clean and use a bidet to completely clean with water after every bowel movement. They're a pretty permanent part of my body at this point. I've had a couple of rubber band ligations, but those just made me sore and didn't improve the overall situation. My colorectal surgeon also said that I was just shy of the miserable limit that would show I could benefit from the newest surgeries.
I have had anal sex twice and loved it. I want to have anal sex again, but both times I was terribly self-conscious. I'd prepared quite a bit beforehand, mostly mentally. (I don't believe in doing enemas or anything crazy in order to have sex.) I chose the exact times based on when I'd last gone to the bathroom. It's been four years since all the stars have aligned (meaning I'm ready, my husband is ready, my mind is ready, and I haven't had a difficult bowel movement in the last 18 hours) and I am desperate to do it again. I can occasionally handle being touched on the outside of my anus and I love that, too, but again, I'm often symptomatic and so self-conscious that I rarely allow it.
Here's the issue and my question:
I really enjoy anal stimulation and anal sex, but it isn't going to happen until I can make my anus look better and feel better. I simply cannot handle anyone seeing ugly bulges the size of small grapes during intimacy, whether it's PIV sex or anal sex, because of the pain and the embarrassment. Is there ANY process/procedure I can go through that will help me out? I've heard of doctors in LA or NYC who work with gay men to create a better back door landscape, but are they my only option?
"A little sad to hear the story of someone who wishes for safe and comfortable anal stimulation but can't, when there are so many people 'better equipped' who won't," says Stuart Spitalnic, a clinical professor at Brown. The bad news for our letter writer is that there's no surefire way of eliminating all haemorrhoids forever painlessly. But there are some things that can help make the situation a little better.
First of all, let's tackle the embarrassment issue. Just because somebody is having sex with your butt does not mean they have to look at your butt. Dr Spitalnic quotes Benjamin Franklin as saying, "In the dark, all cats are grey." Ever the responsible journalist, I looked up the source of that quote, expecting it to be some misquoted old saw, but in fact Franklin used the phrase in a letter on why old women make the best mistresses. So that's a thing we know now.
Besides doing it in the dark, Michael Reitano, physician in residence at men's health service Roman, also points out that there's no rule saying you have to spread your cheeks and stick your butt in the air. "Rear entry can be performed while lying flat, eliminating any visualisation of the haemorrhoids," he says.
Dr Reitano also hopes that you're approaching anal play in a safe and smart way. It sounds like you probably know what you're doing, but for the readers who are just catching up: You want to start small, like with your own finger at first, and lubricate lubricate lubricate. You can also work on anal sphincter exercises in your spare time, which are like the butt version of Kegels. They help you get more control over the muscles involved.
And finally, let's talk about your options for cleaning up the landscape, as you put it. This is tricky, because figuring out whether a surgery or procedure works will depend on how you define "works". For example, the banding procedures you mentioned probably made the individual haemorrhoids go away, but you say they didn't make you feel better overall.
"There are ultrasound guided artery ligations and devices specifically designed for haemorrhoid removal," Dr Spitalnic says. But they aren't magic bullets. The haemorrhoids may come back, or you may have pain even after the surgery, including pain with defecation. There's also a risk of incontinence. And those are just the outcomes that have been studied! He points out: "unfortunately 'return to pleasurable anal sex' is not an oft reported research measure."
What this all means is that if you don't want your partner to see your haemorrhoids, you're going to have to spend a lot of time talking to doctors about your haemorrhoids. Dr Spitalnic doesn't trust websites advertising rejuvenation; it's too hard to tell which ones are scammy. Instead, he suggests asking a surgeon you trust whether they can recommend someone who is experienced in the more advanced techniques. And be honest with that person about why you're asking and what you hope to achieve.
In the meantime, enjoy your anal as best you can, and consider all your options there, too. Dr Reitano points out that people who have a lot of anal can end up with faecal incontinence, and haemorrhoids might make that more of an issue. Instead, he says, why not try toys? "Anal stimulation with a vibrator or manually, without penetration, may be an interim way to derive pleasure while pursuing a permanent resolution to the haemorrhoids."