Don't let your tushie troubles get in the way of your anal sex experiences! Dr. Evan Goldstein walks us through the precautions and busts the myths behind butt stuff and IBS.
At my surgical practice, which focuses on anal sex health and wellness, I commonly have clients ask if there are ways they can still have and enjoy anal sex, despite having IBS. While it can make anal sex difficult, the good news is that with the right diet, anal preparation, and planning, there are ways to experience success (read: pleasure) in the bedroom. Let me help you get to the bottom of this.
IBS stands for Irritable Bowel Syndrome, and experts estimate that 10% to 15% of the adult population in the United States have it, making it the most common disease that gastroenterologists diagnose.¹ IBS is a group of symptoms that affect your digestive system, mainly your large intestine. Most people experience excessive gas, abdominal pain, and cramps due to a functional gastrointestinal issue, where the gut-brain interaction is the primary connective problem. Doctors classify IBS as one of three types: bouts of diarrhea, bouts of constipation, or oscillation between the two. These symptoms are linked to common triggers that include certain foods, medications, someone's stress levels and/or prior traumas, as well as genetics.
Before someone with IBS tries anal sex, they need to try to establish a solid foundation to help control symptoms, or at least as best as they can. Because if someone has a triggering event or is experiencing an active flare-up, no matter what they do to prepare (like douching), they're setting themselves up for failure. Typically, the first step in building this foundation is to keep a food diary to get a better understanding of which foods and drinks cause gastrointestinal distress. Hopefully, patterns will appear, which will tell someone what to avoid when anal sex is on their mind. For me, it's coffee and dairy. While I enjoy both of them, I also know they trigger my IBS, so avoiding them puts me on the right path to enjoy whatever — or whomever — may come my way.
Unfortunately, there is no 100% success rate for IBS treatment. What medical professionals can do is help you analyze which type you have and what the potential causes may be, which will set you up for intermittent success with anal sex. I use the word "intermittent" because I want to manage your expectations. There will no doubt be days where you simply don't feel confident or comfortable in anal sex. And that's perfectly okay. The most important part about participating in any sexual act is prioritizing your desire to participate in the first place. Sometimes, we may feel like the timing is right, only to experience discomfort or a "mess" after the fun starts. And it's also important to find a partner(s) who shares these same values. This affirmative dynamic can actually help create more successful sessions, knowing that we won't be judged no matter what happens.
When someone takes the right steps, they can help reduce risk — whether that's encountering fecal matter or contracting an STI — from engaging in anal sex with IBS.
Start by getting to know how your own anatomy functions; specifically your pelvic floor. The best way to do this is through toy work. I am a huge advocate of using anal dilators to explore your body to learn what feels good, what doesn't, and even as a means of determining whether or not you'll run into any fecal matter during playtime with your partner.
Additionally, many with IBS have concomitant pelvic floor dysfunction. In layman's terms, their anal sphincters are too tight, especially for those who suffer diarrhea symptoms. What happens is, all day you're so afraid of having to go to the bathroom that you squeeze and hold the pelvic floor, leading to spasms. Ironically, this actually perpetuates the problem. When you get into a regular routine of practicing anal training with a dilator, you not only allow yourself to be a better bottom over time, but you also set yourself up for more complete bowel movements. Try to set aside 3-5 minutes, 2-3 times a week to train your sphincters to relax. This also helps strengthen and stretch the skin and muscle in the area to withstand the pressures of anal sex (and even intense bowel movements).
STIs are indeed a possibility, regardless of IBS; however, it has not been proven to have higher incidences after diagnosis. It's more about the potential inflammation cause by over-douching or over-defecating and the sequelae of those, as it relates to potential STI transmission.
You've trained your ass and now you're ready to dive in. There are two steps to get your booty and body prepared for what's next: supplements and douching.
While diet is incredibly important, so is supplementing with fiber and probiotics daily. Fiber bulks stool and encourages complete bowel movements, while probiotics help encourage a healthier digestive system and anal microbiome. Not all probiotics are created equal and it's worth seeking those specifically developed for anal play, like Future Method Butt & Gut (disclaimer: I co-founded it).
Douching may seem like a pre-play requirement, especially if you have IBS, but it's not so simple. When you're using toys, I don't recommend douching ahead of time. You should analyze how the anal training sessions go, not only to understand your anatomy and the pleasure it creates but also to see how "ready" you are in relation to how you feel. Why is this important? Because being ready is more often actually feeling ready. The area of the body where everyday toy play and sex take place is a reservoir that should be void of any stool, unless you're experiencing a bout of IBS-related symptoms. Stool is stored much higher in the sigmoid colon, so I encourage people to perform a toy test before playing with their partner to see if there's any residual fecal matter present in the rectum (where sex actually takes place). If it comes out clean, you're ready to go. If not, depending on how you feel, you can either opt to douche or take a rain check.
If you decide to douche, less is more. When people douche with larger volumes of liquid and/or too many rinse cycles, they elicit more of the negative GI symptoms. Seek out a small reusable bulb and an isotonic and iso-osmolar liquid, which means it's compatible with your body and won't cause irritation. With the appropriate solution and methodology, whether you have IBS or not, you'll experience better bottoming and overall success.
A common anal sex misconception is that it's painful and bleeding can occur. While this may rarely happen, any persistent issues mean something's wrong. If this occurs, it's important that you seek a practitioner who understands the anal play intricacies and needs to ensure you get the appropriate care. Unfortunately, a lot of this is trial and error as someone tries to pair better eating habits, exercise, and minimize stressors to ensure we have a complete understanding of our bodies and how anal sex can interact with IBS.
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At my practice, we not only perform a detailed history and physical, but we also perform pelvic floor physical therapy and anal manometry testing. This unique test helps us understand the muscle and pelvic floor function and how they may be limited in clients who suffer from IBS. Physical therapy and even anal Botox can allow us to create a better approach to bottoming.
Having IBS can be a literal pain in the ass, especially when you like — or are curious to engage in — anal sex. But it's not all crappy news. It takes time to figure out what works and what doesn't, and it's important to only make small adjustments each time. If you implement too many changes all at once, you won't know what actually did the trick. Much like anal sex itself, getting your IBS under control takes patience and practice. And in the end, know that anal sex with IBS is possible. Sometimes it just takes a team to prove that "holistic" approach.
— Dr. Evan Goldstein is a nationally renowned anal surgeon and the Founder and CEO of Bespoke Surgical, the leading private practice specializing in an elite standard of sexual health and wellness care in New York City.