HUGO

Anal Care​

Our anus is an important part of our body and deserves our attention and care. Unfortunately, no one ever talks about it or teaches us how to care for it. Most of us are brought up to think of the anus as dirty and something that should be generally avoided and never be touched. Well, to hell with that! Your anus is magnificent. It has several important functions. It is also a very sensitive area and touching it can be intensely pleasurable. 

The anus does a number of things. First, of course, it allows the passage of digested food (otherwise known as poo) from your intestines. The elimination of this waste is obviously essential, so be kind to your anus as it carries out this function. Stay hydrated by drinking sufficient water, and ensure your diet includes an adequate amount of fiber. This will help avoid constipation. Hard stool and the straining required to push it out can hurt your anus. Your anus also allows the passage of gas. Bacteria that live in your large intestine digest and ferment some of the food we eat and produce gases including carbon dioxide, hydrogen, and methane. These gases are released through our anus when we fart. Your anus is generally very good at distinguishing gas from poo and letting you know when it is okay or not okay to relax your sphincter. Finally, for many of us, our anus functions as a source of sexual pleasure. The degree to which the anus fulfills this role varies from one person to another, but it is no less important compared to any other anal function. Touching, caressing, and licking the anus can be intensely pleasurable. And of course taking another man’s cock or a dildo into your anus is, for many men, deeply sexually satisfying.

Since it has so many essential functions, it important to take care of your anus. Keep it clean by washing it every day. Using a mild soap, take a moment in the shower to lather it up and wash all around and then rinse thoroughly. There is no need to rush; cleaning your anus is good. After the shower,you may want to moisturize around your anus. The area is skin like any other and can become dry and itchy. Using a regular body moisturizer can keep the skin supple and healthy. After a bowel movement avoid excessive vigorous wiping. This can chafe the skin around your anus causing abrasions that hurt. If you like that thorough clean feeling, consider using moist towelettes after a bowel movement. Be sure to use the ones marked “baby wipes” or “for personal hygiene”. Some hand-wipes contain alcohol or other ingredients that should not be used around your anus. One important warning: unlike toilet paper, towelettes do not break apart after flushing down the toilet and so can clog up sewer pipes. Keep a plastic bag or garbage can next to the toilet to dispose of towelettes after use. Lastly, touch your anus. You can easily do this while cleaning in the shower. Feel around for any lumps or areas of tenderness. If you find something new or that doesn’t feel right, see your doctor. Remember, your anus is important and we all have one. Take care of it, and enjoy it.

Douching

Douching is common and it is probably safe to say it is done by most guys who enjoying being a bottom. It is simply a way to rinse out the anus and rectum before sex.

The anus and rectum have a number of functions including the elimination of digested food (also known as poop), passage of gas (farting), and for many of us is a source of sexual pleasure. While all these functions are important, most of us prefer to separate them in time and place. That said, accidents will happen. Sometimes even after douching you may run into a little poop. When it happens don’t freak out or be embarrassed. Clean it up and move on. It happens to everyone from time to time.

Douching involves rinsing the anus and rectum with water. There are two types of douches. The most common consists of a rubber bulb and nozzle, which you can buy online or in most stores that sell toys. The bulb is made of rubber or silicone, and is squeezable. The nozzle is made of plastic, and is generally about 10 cm in length. The second type of douche is a shower douche. This consists of a nozzle and hose that you connect to the tap in your shower. A word of caution when using a shower douche – watch the water pressure; the idea is not to hose down your entire colon. If the water pressure is too high it can be painful and potentially cause harm. Always be sure to clean your douche after each use, rinse it thoroughly and let it dry before putting it away.

How to douche

Douching is really quite easy. Before you start make sure your douche is clean. If you are using a bulb, simply fill the bulb with mildly warm water and attach the nozzle. After applying some lube to the nozzle insert the nozzle into your anus and gently squeeze the bulb to push the water into your rectum. At this point do not let go of the bulb, keep the bulb collapsed and withdraw the nozzle from your anus. The water in your rectum will make you feel full and give you the urge to expel it. Sit on the toilet and let the water drain out. Douching may also stimulate you to move your bowels, so at first more than just water may come out. Once you are done, flush the toilet. You will likely want to douche again; most guys will douche a few times until the water coming back out is clean.

 

When douching, use water and only water. Do not use soap, detergents, oils, or any other products as these can irritate and damage the lining or your rectum. The temperature of the water should be just lukewarm, this is so important. Check the water temperature each time you fill the bulb. If you are using a shower douche, run the water until the water temperature is consistent. If the water is cold it will be shocking and very uncomfortable. If the water is hot it will be painful and damage your anus and rectum. You might enjoy a hot shower on the outside on your skin, but hot water on the inside is bad news. Nice, mildly warm water will feel comfortable.

 

Be sure to lube the nozzle each time before you insert it into your anus.

Sometimes you won’t necessarily expel all the water after douching, a little may stay inside. It is often a good idea to wait 30 minutes to an hour before having sex, just to give this extra water time to drain out.

Douching is safe. But again, use only water and nothing else to douche. Make sure the water is a comfortable mildly warm temperature and not cold or hot. If you are using a shower douche, watch the water pressure and don’t turn the tap on full blast. Remember douching involves rinsing out your rectum. Some people worry douching will wash out the good bacteria from their colon. When you douche, water does not flow that far in so there is no risk to the bacteria deep in your intestines. Lastly, how often can you douche? There is no clear answer to that, but it is probably not something that should be a daily routine. If you douche daily, your body could become dependent on it to help eliminate stool.

Hemorrhoids

Hemorrhoids are bulging, dilated veins in the lower rectum and around the anus. The exact cause of hemorrhoids is not completely understood, but clearly involves increased squeeze pressure at the anus. Diarrhea, as well as chronic constipation and straining in an effort to eliminate stool, are often associated with the development of hemorrhoids. The increased pressure at the anus may weaken the wall of a vein and cause it to bulge and form a hemorrhoid. Hemorrhoids inside the lower rectum are called internal hemorrhoids, while those that form outside around the anus are called external hemorrhoids.

External hemorrhoids around the outside of the anus usually appear as a lump and may feel uncomfortable; they can also be itchy. Internal hemorrhoids inside the lower rectum generally can’t be felt, but may protrude through the anus when straining to have a bowel movement. Because the walls of the vein forming a hemorrhoid are weakened, hemorrhoids may bleed. Bleeding hemorrhoids do not cause pain, but you may notice bright red blood on your stool or in the toilet bowl during a bowel movement. Sometimes the blood pooled inside a hemorrhoid can form a clot or thrombus; thrombosed hemorrhoids are painful.

Diagnosis of hemorrhoids is done by visual examination. External hemorrhoids are relatively easy to see and identify. Your doctor will also likely insert a lubed, gloved finger into your anus to feel for any lumps. If you have had any bleeding from your anus, your doctor will also likely insert an anoscope, a short plastic tube, into your anus to allow him or her to examine the inside for internal hemorrhoids.

Most often, hemorrhoids can be treated at home and will go away on their own, usually within about a week or two. Warm baths can help relax the anus and ease itching and discomfort. Over-the-counter hemorrhoid creams will also relieve pain and itching. If hemorrhoids persist or bleed, your doctor may recommend minor surgical procedures to remove the hemorrhoids. Rubber band ligation is a procedure where your doctor places a rubber band over the base of the hemorrhoid to cut off the blood supply. With the band in place, the hemorrhoid shrivels and falls off usually within a week. Severe hemorrhoids may require more extensive surgery called hemorrhoidectomy and requires an over night stay in the hospital.

Things you can do to prevent hemorrhoids include drinking plenty of water and eating a high fiber diet (fruit, vegetables and whole grains). This will help avoid constipation. Try not to strain and push when having a bowel movement, as this will increase pressure on your anus. Exercise also helps keep you regular.

Anal Fissure

An anal fissure is a tear or cut in the skin of the anus, usually just inside the anal canal, but they may also occur outside the anus next to the opening. Fissures are the most common cause of anal pain. These skin tears around the anus are most often the result of constipation and the passage of hard stool. Fissures can also result from diarrhea, vigorous wiping, and sometimes anal sex and dildos. The problem with fissures, like any tear in the skin, is that they are painful. The pain will make you squeeze your anus or may make the anal sphincter spasm on its own. The muscle spasm will cause increased pain and also decrease blood flow to the area preventing the fissure from healing. This then sets up a vicious cycle of pain, spasm, decreased blood flow, lack of healing, more pain, and so on.

Guys with an anal fissure will have sharp pain in and around their anus. The pain is constant and will be there at rest, but will get much worse with a bowel movement and passage of stool. The increased pain after a bowel movement can be intense and last for hours. Fissures can also bleed; you may notice blood on your stool or on the toilet paper after wiping.

Fissures are diagnosed by visual examination. If a fissure is suspected your doctor will likely ask you to lie on your stomach or on your side while he or she looks at your anus and feels for an area that may be the source of the pain.

Treating a fissure involves breaking the cycle of pain and spasm, and allowing the tear in the skin to heal. This is usually done with warm baths, creams to relieve pain and increase blood flow to the area, and by increasing the amount of fiber in your diet. Taking warm baths will keep the anus clean to allow healing, and help relax the sphincter and increase blood flow. It is best to do this two or three times a day, even for just 10-15 minutes. Your doctor may also prescribe a cream or ointment to relieve pain. In addition, your doctor will also likely prescribe a second ointment known as a topical vasodilator. This ointment, which should be applied as directed, will help relax the sphincter and increase blood flow to the area to promote healing. A commonly used vasodilator is nitroglycerin. This can, however, cause headaches and lightheadedness after applying it to the anus. While you are using nitroglycerine, you must not take Viagra, Cialis, or Levitra as there is a risk of serious drug interaction. Lastly, stool softeners or laxatives may be needed to prevent passing hard stool and re-injuring the fissure during healing. 

If warm baths and ointments don’t work or if you continue to get fissures repeatedly, your doctor may recommend surgery. Botox injections into the anus have also been used to relax the sphincter and help heal and prevent fissures.

One thing you can do to help prevent fissures is avoid constipation. Drink plenty of water and eat a high fiber diet including fruit, vegetables, and whole grains. Exercise also helps keep you regular. Take some time to care for your anus. Wash it every day and consider moisturizing to keep the skin around your anus supple and healthy.

Anal skin tags

Anal skin tags are excess growths of skin that hang off the skin around the anus. Other than being perhaps a nuisance, they are completely harmless. Anal skin tags are very common and can range in size from a few millimeters to more than a centimeter. There may be only one, but more often multiple skin tags will be present. If you have hemorrhoids around the anus you are more likely to develop skin tags, as when the hemorrhoid shrinks, a floppy little piece of overlying skin may be left behind. Many guys may feel skin tags as bumps around their anus and worry they have warts. Skin tags are not warts and they are not contagious.

Skin tags are soft, floppy pieces of skin that hang off the skin around the anus. They are completely harmless. However, large skin tags may catch on clothing and be uncomfortable. As they flop over, anal skin tags can also trap moisture or bits of stool between the tag and the anus and cause a fair bit of itching.

Anal skin tags are diagnosed by visual examination. Your doctor may ask you to lie down or bend over so he or she can look at your anus. Your doctor will feel around your anus for areas of tenderness, and whether the bumps are soft or firm. He or she will likely also insert a lubed, gloved finger into your anus to check if there are any lumps or bumps inside the anal canal as well. If you feel a lump or bump around your anus you should have it looked at to make sure it is nothing to worry about.

As mentioned, anal skin tags are harmless, but they can cause itching. Many guys who have anal skin tags are self-conscious about them and worry the tags make their anus less attractive. If they bother you, skin tags can be removed by a doctor. Small anal skin tags can be treated with liquid nitrogen just like warts. After freezing with liquid nitrogen, the skin tag will die, shrivel, and fall off. Larger anal skin tags may need to be removed with minor surgery. When this is done the doctor will clean around your anus with a disinfectant and then, using a needle, inject some local freezing around the base of the skin tag. The doctor will use a scalpel to cut away the skin tag and then close the small incision with a suture. You may need some stool softeners after the procedure, and it will be important to keep your anus clean and dry while the incision heals.

Anal skin tags can form on their own, but are often left behind when hemorrhoids and anal fissures heal. It is important to avoid constipation and straining to push out hard stool. Drink plenty of water and eat a high fiber diet including fruit, vegetables, and whole grains. Exercise also helps keep you regular. Take some time to care for your anus. Wash it every day and consider moisturizing to keep the skin around your anus supple and healthy.

Anal itching

Everyone can have an itch now and then, but when itching around the anus is persistent or occurs on a daily basis it is known as anal pruritis. Anal pruritis can be temporary and go away on its own, or can become a chronic condition. Many things can make your anus itchy. By far the most common cause of an itchy anus is feces left on the skin after a bowel movement. Feces can irritate the skin and even more so as it dries. Properly cleaning around your anus after a bowel movement is important. On the other hand, excessive and vigorous wiping can cause abrasions in the skin, which then become sore and itchy. So yes, it is important to strike that happy medium. Hemorrhoids can be itchy, as can anal skin tags. If you sweat a lot especially during exercise or while working out at the gym, moisture can accumulate in the crack between your buttocks and around the anus. This moisture can allow skin fungus to grow making the skin irritated, red, and itchy. This is essentially “jock itch” around your anus. The skin around your anus, like skin elsewhere on you body, can also be irritated by soaps and lotions. Use a mild soap to wash your anus and if you find a particular lotion irritates your skin, try a different product. If you use moist towelettes to clean around your anus make sure you use ones marked “baby wipes” or “for personal hygiene.” Avoid hand-wipes and other sanitizers as these may contain alcohol or other ingredients that can dry and irritate your anus. Anal itching can also be part of a general skin condition. Psoriasis and eczema can appear at the anus, just as it can elsewhere on the body. Finally, some infections can cause itching. Gonorrhea and Chlamydia in the anus and rectum can make your anus itchy. Pinworm will also cause anal itching, particularly at night.

The symptom of anal itching is precisely that, itching around the anus that is persistent or occurs on a daily basis. It can be quite irritating and at times embarrassing. Diagnosis focuses on the cause. Your doctor will likely ask you to lie down or bend over so he or she can look at your anus. Your doctor will feel around your anus for areas of irritation, abrasions, skin tags, or hemorrhoids. He or she will likely also insert a lubed, gloved finger into your anus to check if there are any lumps or bumps or areas of tenderness inside the anal canal. He or she may also insert an anoscope, a short plastic tube, into your anus to examine the inside.

Treatment of anal itching depends on what is causing it. Start with anal hygiene, keeping the area clean without excessive wiping. Sometimes a change in diet with increased fiber can improve the consistency of your stool and make cleaning a little easier. Consider also using moist towelettes to clean after a bowel movement. Make sure you use ones marked “baby wipes” or “for personal hygiene” and avoid hand-wipes and other sanitizers as these may contain alcohol. More frequent bathing or showering may help, but avoid harsh soaps that may dry the skin. After showering, dry your anus using a dabbing motion with a towel rather than rubbing. Creams containing zinc oxide may be helpful. Again, depending on the cause, other creams or ointments may be required; hemorrhoid cream for hemorrhoids, antifungal cream if there is a fungal skin infection, a short course of hydrocortisone cream for eczema, and so on.

analcancerscreening

Anal cancer

Anal cancer can happen when cells inside the anal canal become abnormal and begin to grow out of control, piling up on each other and forming a small tumor. Anal cancer is not the same as colon or rectal cancer. It is actually more like cervical cancer in women, as the majority of anal cancers are caused by the human papilloma virus, or HPV. There are over 100 types of the HPV virus, but certain ones, especially HPV-16, are linked to cancer. The most common way for the HPV virus to get into the anus is during sex, specifically when bottoming. If the virus is on a guy’s penis it will be delivered into the anus when you bottom, especially if he is not wearing a condom. Once inside, the virus infects the cells of the anal canal and can cause the cells to grow abnormally. Other factors, such as cigarette smoking, also affect the health of cells, and so can further promote the abnormal cell growth induced by the virus. Some types of anal cancer are unrelated to the HPV virus, but these cancers are less common.

Anal cancer has been increasing in the general population over the past 30 years, but is still relatively rare. Every year only about 2 in 100,000 people will be diagnosed with anal cancer. However, anal cancer happens more among us gay guys. Just like how the HPV virus can infect a woman’s cervix when she has sex, the virus can infect the cells of our anal canal when we bottom. As a result, every year about 30 in 100,000 gay guys will get anal cancer. Anything that affects the immune system, such having an organ transplant or HIV, increases the risk further. About 100 in 100,000 HIV+ gay guys are diagnosed with anal cancer each year.

Unfortunately anal cancer often has no symptoms until it is more advanced. The most common first sign is bleeding as the tumor begins to erode through the wall of the anal canal. Because even at this stage there is usually no pain, bleeding may be falsely attributed to hemorrhoids, delaying the diagnosis. You may be able to feel a lump or bump at the anus or just in side. Certainly not all lumps and bumps are cancer, but if you feel something you should have it looked at.

Anal cancer is diagnosed by biopsy. If you notice some bleeding ,or feel a bump around or just inside your anus, you should have it looked at by your doctor. Your doctor will examine your anal area and inserted a lubed, gloved finger into your anus to feel for lumps or bumps. If there is a concern he or she will likely refer you to a surgeon or someone with some expertise in the area. When you see the surgeon or specialist they will again examine your anus and look inside the anal canal using an anoscope, a short plastic tube to hold the anus open. If they see something abnormal they will take a biopsy, a small piece of the lesion, and send it to the laboratory for examination under the microscope. After the biopsy you may experience some minor bleeding, but the risks of biopsy are really very low.

Anal cancer is treatable, with best outcomes when it is caught early. If a biopsy confirms you have anal cancer your doctor will request a CAT scan of your chest, abdomen, and pelvis. The purpose of this is to find out if the cancer has spread. A combination of radiation therapy and chemotherapy is the preferred way to treat anal cancer as it has good success, avoids surgery, and preserves the anus. Your doctor will discuss the details of your therapy with you as it will vary depending on whether the cancer is only in the anus or has spread to other areas such as the lymph nodes. Sometimes surgery is still required. Again, your doctor will discuss that with you if and when it is necessary.

The best way to prevent anal cancer is to get vaccinated against the HPV virus. The vaccine will not prevent all anal cancers, but it will prevent the majority of them. Gardasil-9 protects you against 9 types of the HPV virus; HPV-6 and HPV-11 that cause plain ol’ genital warts, as well as 7 types of HPV that are linked to cancer including HPV-16. In Ontario Gardasil is now given for free to both boys and girls in grade 7 and is recommended for individuals under age 26. It is important to know though that the Canadian National Advisory Committee on Immunizations recommends Gardasil for all men who have sex with men regardless of age. Any guy who has sex with other guys, and is under 26 years of age, can get Gardasil for free from their local public health clinic. Guys 26 and older may have to pay for the vaccine, but if you have health benefits through work, check with your insurance company. Many companies cover the vaccine for individuals over 26. The vaccine consists of a first injection followed by two booster injections 2 and 6 months later. The total cost if you are paying out-of-pocket is about $540.

Other things you can do to help prevent anal cancer include using condoms during sex. Condoms can help reduce the chances of HPV getting into the anal canal. It is also important to touch and feel your anus. Take some time in the shower to feel for any lumps or bumps. If you feel something new, have your doctor take a look. Lastly, some centers may offer what is called high resolution anoscopy (HRA). During HRA, a doctor will insert a short plastic tube known as an anoscope into your anus and examine the anal canal with a colposcope, essentially a set of binoculars, which allows them to look at the walls of the anal canal under magnification. By doing this, the doctor may be able to identify areas of “dysplasia” or abnormal cell growth before they actually become cancer. If the doctor sees something they can biopsy the area, and if confirmed in the lab as significantly abnormal, the area can be treated during a simple office procedure. Unfortunately access to HRA is limited as it is available in only a few centers.