Prince Uranus
Dear Dr. Dick,
What's the difference between an anal fissure and a hemorrhoid? Lately I've had bleeding and a sharp pain when I go number 2, and sometimes after anal sex. I don't want to scare away a partner by leaving them with a bloody dick. Any advice is much appreciated. Thanks doc!
Prince Uranus
Dear Prince,
Aw, shit! Sounds like your delicate flower got a little too much wear-and-tear. Ouch! I suggest two things: seeing a medical provider so you know what's up, and holding off on being bottom until you get some relief.
Thanks for asking about fissures vs. hemorrhoids! Here's the difference:
ANAL FISSURES
An anal fissure is a small tear in the skin that lines your hole. A fissure can cause a severe stabbing pain when you go number 2. You might also notice some bright red blood on the toilet paper when you wipe, or on the surface of your poop. The pain can last from a couple minutes to several hours--which makes anal sex or a lap dance an uncomfortable prospect.
WHAT CAUSES AN ANAL FISSURE?
An anal fissure is most often caused by passing a hard, dry stool. It can also be caused by anal sex and fingering, persistent diarrhea, straining when you poop, constipation, and putting objects in the butt. Less often, certain sexually transmitted infections, particularly herpes, can cause anal pain that can be confused with the pain from anal fissures. Syphilis can cause sores on the butt, though they usually don't hurt. Rarely, fissures can result from more serious autoimmune diseases. In general, if you have something that you think is a fissure, you should have a medical provider take a look.
An anal fissure can be hard to heal because the wrenching pain can cause the anal sphincter muscle to spasm. The spasm reduces the amount of blood flow to the fissure, which slows down healing of the wound. The next time you poop, the pain-spasm cycle continues, and the fissure just can't heal. Sometimes an anal fissure will result in a skin tag outside or just inside the anus.
TREATMENT
Most anal fissures can be treated without surgery. Often times, your medical provider will prescribe a fiber supplement or high-fiber diet to make your poop bulkier; this will allow the anus to gently expand and stretch. Also, it can help to soak your butt in warm water after a bowel movement.
You might also get a prescription for a cream to insert into the anus to help with the healing process. Keep the applicator to yourself and wash your hands before and after using the cream.
The problem can pop up again easily, and it's important to keep eating a high-fiber diet, and practice good bowel habits (avoid straining or sitting on the toilet for long periods of time, etc). Visit a medical provider if you continue to have problems with constipation or bowel movements.
If these treatments do not work, a surgery might be necessary to remove the fissure. These are usually done in an outpatient setting, and result in quick relief.
HEMORRHOIDS
There are two kinds of people in the world: those who have hemorrhoids, and those who will get them. In fact, more than ½ the world's population will get hemorrhoids, usually after the magic age of 30.
Hemorrhoids are enlarged, swollen blood vessels in the anus and lower rectum. They can be external or internal.
External (outside) hemorrhoids pop up near the anus and are covered by thin, sensitive skin. These usually do not hurt, but if a blood clot develops in the hemorrhoid, it leads to a painful, hard lump. The hemorrhoid might also bleed if it ruptures, which could happen with anal sex or straining.
Internal (inside) hemorrhoids develop under the lining of the anus. These can cause bleeding (usually without pain) and can also protrude (stick out of the anal opening) during a bowel movement. If the hemorrhoid protrudes from the anal opening and can't be pushed back inside, severe pain can occur.
SYMPTOMS
• Bleeding when you poop
• Itching in the anal area
• Pain in the affected area
• Sensitive lumps in the affected area
• Protrusion of the hemorrhoid during bowel movements (hemorrhoid sticks out of the anus)
WHAT CAUSES A HEMORRHOID?
A hemorrhoid is caused when the tissues that support the blood vessels get stretched. When the vessels stretch and expand, their walls become thin and bleed. The blood vessels will then protrude (stick out) if the stretching and pressure continue. Straining during bowel movements, constipation, diarrhea, and spending a long time on the toilet are the major causes of hemorrhoids.
TREATMENT
• Hemorrhoids can usually get better when you eat a high-fiber diet. Drinking plenty of water each day can also help reduce your chance of having hard, dry, bowel movements.
• Try not to strain when you poop. Straining puts extra pressure on the hemorrhoid!
• Some people find relief from Sitz baths---sitting in plain, warm water for 10 minutes each day.
Severe hemorrhoids may need to be removed by a medical provider, which can usually be done in an outpatient setting.
SAFER SEX
Since fissures and hemorrhoids can cause bleeding, you might be more susceptible to getting or spreading an infection like HIV. Here are some tips:
• Are you or your partner(s) POZ? Talk to each other about taking HIV medications. U.S. National HIV treatment guidelines now recommend that everyone with HIV take antiretroviral therapy (medicines that fight HIV). Those medications will help you and/or your partner stay healthy. They can also help protect a person who is POZ from spreading HIV. We don't know exactly how effective HIV meds are in protecting men who have sex with men. Still, the meds probably help a lot and it would be best if you and/or your partner were on meds and had an undetectable viral load (a blood test showing you have no HIV in your blood).
• Use water-based lube with condoms to prevent tearing your delicate flower.
• Use condoms for anal, vaginal, and oral sex, and use a dam for rimming.
• If you are HIV-negative, think about getting on PrEP (Pre-Exposure Prophylaxis). Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill.
• Test every 3 months for HIV and STIs like chlamydia, gonorrhea, syphilis, and herpes. If you test positive for an STI, connect with a medical provider right away for treatment.
• PEP (Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If a person feels that they might have been exposed to HIV (like through a condom break or needle stick) go to the emergency room at Harborview within 24 hours of the exposure. PEP works best when started immediately, and will not be prescribed after 72 hours.
• If you're using crystal, and worried about remembering to use a condom, try an insertive condom. You can put one in up to 8 hours before sex!
Be well,
Dr. Dick