FOR YEARS, I'VE known there’s something wrong with my asshole. Nearly every time I wiped with regular toilet paper—no matter how soft—there was blood. And when I wiped after bottoming? It was a goddamn bloodbath.
Being a sex columnist, I knew this wasn’t normal, but I wasn’t sure what I was doing wrong. I was using a ton of lube, breathing, going slowly—all the things you’re supposed to do when having anal sex. Still, my anus was left looking like Carrie after prom night.
I saw multiple doctors about it. They looked at my anus for all of fifteen seconds and told me I had an anal fissure (i.e., a small tear in the anal tissue). They then would prescribe me some prescription ointment, often hydrocortisone cream. “Apply for a week and don’t have anal sex,” they said. “You should be all cleared up and feeling better after a week.”
The creams did help a little bit, but the moment I stopped them, I’d be back to square one. Luckily, bidets helped. No longer was I a bloody mess, but the one time I’d poop without a bidet, there would be blood, like clockwork. (This made any form of vacation a pain in the ass, literally.)
Eventually, I just got used to it—figured this was my burden to bear—until I read Butt Seriously: The Definitive Guide to Anal Health, Pleasure, and Everything In Between, by Dr. Evan Goldstein.
I learned there was so damn much going on with my asshole. So, I scheduled an appointment with the Butt Whisperer, himself, Dr. Goldstein. After running anal manometry tests (more on this in a moment) to measure the strength and pressure of my anal muscles, he went eye to eye with my hole, examining the skin.
Here’s what I learned—and what I think everyone should know—about buttholes.
1. There are three types of booty holes—knowing what type you are will determine your relationship to bottoming.
Dr. Goldstein’s assistant ran anal manometry tests whereby he inserted a (very small and painless) tube in my anus. His assistant tested the amount of anal pressure I had at rest and when I squeezed. He also tested my capability to “push out” the mechanism that’s needed when expelling your bowels in the bathroom.
Butt Seriously: The Definitive Guide to Anal Health, Pleasure, and Everything In Between
The anal manometry test revealed I have a very tight asshole while resting. “There are three types of assholes,” Dr. Goldstein said, when explaining my results. Roughly 40 percent fall into the category of having a “looser” anus. “These people don’t have any problem bottoming during anal sex.” Then roughly 50% fall into the category of “normal.” These people often have slight trouble with anal sex, but they can learn to bottom with proper education. Then there are 10% of folks with simply too tight of an anus. I fell into that category.
Luckily anal Botox can help relax the sphincter muscles, which would put me into the appropriate bottoming range. It’ll also make it easier to poop, with less straining, which will decrease the likelihood of getting fissures or hemorrhoids.
I’ve only bottomed once since getting anal Botox, but I will tell you it was a lot easier to take a penis, and I didn’t bleed after!
2. Your skin and muscles need to work together.
Botox helped to relax my sphincter muscles, but muscles are just half of the equation. The other half is skin. After examination (spreading my cheeks and looking at my anus), Goldstein revealed that I have a chronic anal fissure with excess scar tissue that’s causing pain (and for me to involuntarily squeeze when it’s touched). I will actually require surgery to remove the scar tissue.
“All too often, doctors only address muscles or skin,” Goldstein explained. For example, they’ll see a fissure and prescribe cream, but if you have a super tight asshole, falling into that 10% of folks, you’re likely to keep getting fissures because the root of the problem is muscular.
Conversely, a proctologist may do anal botox to help with tightness yet not treat the actual fissure (the skin issue).
So anal Botox, for me, is a sort of stop-gap measure. It’ll help with pain during anal sex and make it easier for me to poop, but I also need to get the scar tissue removed. Otherwise, I’m going to keep running into issues with pain and blood. My body will keep involuntarily squeezing when the fissure is touched.
3. You’re probably pooping wrong.
“No one ever teaches us the right way to shit,” Goldstein says. “There’s truth to the adage, shit or get off the pot.” If you can’t poop within 30 seconds, you should get up and try again later. “Drink some water, brush your teeth, start your day,” he says. “When you feel the urge again, go and sit.”
You should not be straining. When you strain, that’s when you get into trouble, getting hemorrhoids and fissures. You also are more likely to have a poopy hole when you strain, which then requires a lot more wiping. Excessive wiping and friction will cause your anal lining to tear.
4. You’re likely wiping wrong.
You’re actually supposed to wipe standing up! “Shitting is actually pretty traumatic on the body,” Goldstein explains. “The body is really smart, and it sends blood to act like airbags to protect the anus.” When you wipe while sitting, this can lead to potential problems with hemorrhoids and bleeding. “But when you stand up, the mechanism finishes, and blood flows away, so you don’t have any complications.”
Of course, you don’t feel as “clean” when you wipe standing up, which is why Goldstein highly recommends bidets. “Or you can wipe once while sitting down to get the bulk of the poop, but then stand up.”
5. You should never use wet wipes.
Especially if you have a hairy behind, you may favor wet wipes. Otherwise, it can feel like you’re just smearing poop back and forth. But wet wipes aren’t just terrible for the environment; they’re also bad for your butt health. Dr. Goldstein notes that he sees a lot of herpes and warts from HPV because of wet wipes.
“Wet wipes change the microbiome of your ass,” he says. “Remember, our ass is dirty, but it in a good way.” All booties have good and bad bacteria. Wet wipes alter the bacteria. “And there is an immune reaction because I see fungal bacteria and viral infections from wet wipes, and the second people stop using wet wipes, they go away.”
If you're looking to learn more about your anus, check out: Butt Seriously: The Definitive Guide to Anal Health, Pleasure, and Everything In Between.
Butt Seriously: The Definitive Guide to Anal Health, Pleasure, and Everything In Between
