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Sex educator Zachary Zane and Dr. Evan Goldstein share their top tips on how to prevent anal fissures
#Anal Play Advice#Bootipedia#Sexual Health

Complete Guide to Anal Fissures

Last Updated: Apr 17, 2024 / By Zachary Zane

What causes anal fissures, and how can they be prevented? How long should you wait before engaging in anal sex after experiencing a fissure? We asked Dr. Evan Goldstein, the most renowned anal surgeon, to answer your frequently asked questions!

My boyfriend had been crushing hard on this other couple, desperately wanting to get naked with them, so we set up a double dinner date. When they asked if we wanted to go back to their place for a nightcap, we both enthusiastically nodded yes. I wasn't sure if we were all going to have sex. It wasn't something that we discussed, but my boyfriend and I hoped—prayed—we'd have the opportunity.

We did, and when they both pulled down their undies, my boyfriend and I looked at each other with both awe and fear. These men were big—real big. How were we expected to take these anacondas?

With nothing more than hope and prayer, I bent over and took these bad boys. We used a ton of silicone lube, but they got a little too excited—thrusting away before I adequately loosened up. I should have said something, but alas, this was years ago, before I felt comfortable verbalizing discomfort during sex. When we finished, I felt incredible. The sex was even better than I imagined it to be, but I definitely had some pain while doing it—and not the good type of pain. I went to freshen up after everyone orgasmed, and when I wiped my behind, it was all blood.

"Well," I thought, "This definitely isn't good." I ended up seeing my doctor and learned the source of my pain and blood were anal fissures—a very common injury that sometimes occurs with anal sex.

To learn all about anal fissures, including what causes them, how to prevent them, and how to treat them, I spoke to the butt guru, Dr. Evan Goldstein, founder and CEO of Bespoke Surgical, an anal surgery practice.

What are anal fissures?

An anal fissure, a.k.a. rectal fissure is a small tear that occurs in the skin, roughly at the entrance of your anus, a.k.a. the rim. "The overlying skin or underlying muscle reaches its maximal capacity, from defecating or anal play, and then the skin splits, exposing the underlying muscle," Goldstein says. "Tears are actually quite common, causing significant pain and bleeding."

What causes anal fissures?

There are a lot of different ways to develop anal fissures. Believe it or not, something as simple as a strenuous bowel movement can do the trick or any type of anal play—it's not just when one is having rough anal sex, like yours truly.

"The local pressures from all of these [BM or anal play] acts can be quite high, and the skin and the underlying muscle have a breaking point, literally," Goldstein says. "Once it's met or worse, exceeded, that's when things split, and you find yourself with an anal fissure."

How do you prevent anal fissures?

To help avoid anal fissures, it's critical to make sure you understand your anatomy and also all that you're asking your hole to perform, Goldstein explains. Most people don't talk about anatomy and the role skin and muscle in the anal region play in, well, anal play. Let's not make that mistake.

Here are 4 ways (in no particular order) to prevent anal fissures during anal play:

1. Prepare with appropriate dilation (i.e., loosen up that hole over time).

"You can't just go from nothing to something overnight," Goldstein says. "Your skin and muscle need adequate time to stretch in order to be able to accommodate your average toy or penis."

Using an anal training kit to dilate your sphincter muscles can minimize the risk of anal fissures

ANSWERED: What is anal training?

This is where an anal training kit or dilating set comes into play. Over the course of weeks, yes, weeks, you can stretch your anus using various plugs or dilators until you reach a toy that's the size of a penis (or dildo or whatever larger object you plan to put up your booty).

2. Don't let your eyes be bigger than your hole.

Sometimes we see a big butt plug or a meet peen and think, "Yes, that looks amazing. I want to take all of that!" In good time, my friend, in good time.

Using ample amounts of lube can reduce the risk of anal fissures

Start off small with an anal massage before progressing to anal fingering. Once you have a finger that's easily slipping in and out of you with wiggle room, then add a second finger. Then work your way up to a butt plug, and so on. There is no rush!

3. Don't over-douche.

"Most people over-douche, which means using too much liquid, either in one shot from a bulb that's bigger than it should be or by rinsing continuously for 30-60 minutes," Goldstein says. "Believe it or not, the more you douche, the messier things are likely to get."

MASTER: How to prepare for anal sex like a pro!

Over-douching has been known to cause anal fissures

Over-douching can increase your likelihood of getting anal fissures. And pushing a stiff nozzle into your rectum without lube can also cause ripping and tearing, so make sure to lube up the nozzle before putting it in your rear end and go slowly. (Starting to see a theme here?)

4. Steer clear of poppers.

Poppers, slang for alkyl nitrites, are a staple in the gay community. It's an inhalant you can buy over the counter at bodegas or sex shops, and they're used to get a little head rush during sex and loosen up your anus.

The use of poppers and number creams may lead or worsen the condition of your anal fissures

Poppers work by relaxing the smooth muscles in your body, including your sphincter muscles. Often, people snort poppers to relax to take bigger penises and toys. "If you're using them to mask or dull pain—that means you either haven't dilated enough and you aren't ready for anal play or you may have an anal fissure without even knowing it," Goldstein says. So if you can't take the penis or toy without poppers, then you shouldn't take it with poppers!

What do you do if you have anal fissures?

Treating anal fissures—If you think you have an anal fissure, the best thing to do is seek out a medical professional specializing in both anal care and someone who understands the intricacies of anal play.

"Depending on the severity of your anal fissures, they may recommend suppositories, like Calmol 4, Epsom salt baths, or other OTC remedies, and they will definitely suggest avoiding any kind of anal play," Goldstein says. "In worse off situations, a specialized physician-prescribed compound cream works wonders, with a steroid to reduce inflammation, an actual blood pressure medicine to relax the underlying muscle, and a numbing gel to help with the localized pain. Sometimes, an in-office anal Botox is necessary to truly diminish the anal pressures during an acute situation."

How long should you wait to have anal sex after getting an anal fissure?

Okay, so in case it wasn't clear, you need to stop putting anything up your rear end if you get an anal fissure! No bottoming for you! You need to wait until the fissure heals before you start taking (tiny!) things up your rear again.

"Using the above protocol of Calmol 4, Epsom salt baths, and lotions for a week or so should allow for healing," Goldstein says. "The key is to have the inevitable scar tissue form." Once this happens, you can begin anal training again, starting with the tiniest little plug or dilator and working your way up. This time, you'll be extra cautious not to get another anal fissure!


Found this article on anal fissures useful? Check out our most popular guides on anal sex positionsanalingus techniqueshow to prep for anal, and prostate play!

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