Ask the Doctors: Anal Fissures

I’ve recently been diagnosed with an anal fissure. I am a heterosexual male but I’ve enjoyed a women taking me with a strap on. Could this have caused it? What about future anal?
–Back Door Blues

Anal fissures are annoying and sometimes quite painful, and some sources of information about them mention anal sex as a possible cause. But while I can’t completely rule out your strap-on experience as a cause of this wince-inducing condition, I can certainly add more possibilities as to its cause than that. And I’d be glad to make some suggestions for future anal exploration that will help prevent a return visit from the fissure.

The closest comparable experience to a fissure — one most of us have had, at least if we’ve lived in a cold climate — is the split that can form where your lips come together. This is often the result of chapped lips or a cold sore. They’re somewhat painful, especially if you open your mouth up wide. When a fissure happens anally, on the other hand, it may be irritated almost all the time; your cheeks are rubbing together with movement and when you’re seated, and then of course there’s the pain and repeated re-irritation that happens each time you defecate. Simply put, a fissure is a tear in the outer layer of skin on (or inside of) the anus, and it may bleed, itch, sting, or cause substantial pain. A person with an anal fissure will generally find it too painful to have anal sex. You’ll certainly want to wait til it clears up to get back in the saddle.

How to do that? One answer is to look at a fissure’s common causes. Bowel problems often cause them; both constipation and diarrhea can be culprits. Diet often plays a key role in bowel issues, so make sure yours is healthy: plenty of fiber, in particular. Diets high in processed grains, dairy, and meat (and low in veggies, legumes, and whole grains) can be particularly problematic. Food sensitivities play a role in some people’s bowel problems; in fact, this might point to the possibility of a potentially serious condition like celiac disease (gluten intolerance). And you should pay attention to possibly-irritating substances like coffee, alcohol, acidic food (like tomatoes), and hot spices. (Crohn’s disease and other inflammatory bowel conditions can be implicated too — they may all need to be addressed by dietary changes.) It may be that your diet and your bowel are fine, but this is such a common source of fissures that it’s worth your consideration. Particularly in the case of constipation, a doctor is likely to prescribe a fiber supplement like psyllium husk or a stool softener; too-hard stool will have an ongoing irritating effect on fissures as well as on hemorrhoids.

If you pay attention to what you eat, you may be able to reverse bowel problems yourself. It’s worth doing that in part because you’ll likely be generally healthier with a better diet. Increase your water intake if it is low, too.

Insufficient blood flow can also be a culprit, and many of us who lead largely sedentary, office-bound lives would do well to find exercise methods that help reverse this; yoga, swimming, having sex, and dancing could all be good choices to get more pelvic movement into your life. There’s also the role of Kegel (a.k.a. PC, or pubococcygeal) exercises, which support pelvic blood flow and strengthen the musculature of the pelvic floor, including those surrounding the anus. Plus they make your orgasms stronger! Learn about doing these exercises here. Pregnancy and childbirth can be a fissures risk factor for women, and Kegels are often recommended to pregnant women.

The sources that mention anal sex should really spell out the real, specific risks. If you’re entered too quickly by a too-large object you might risk some kind of injury, including a fissure; this, of course, is not the textbook definition of “anal sex,” especially around here at Good Vibes. People who engage in slow penetration with enough warm-up and plenty of lube are probably going to be able to avoid fissures and other anal irritation.

Folks who go too fast, use a hard and inflexible toy or other object, don’t lube up enough, and don’t warm up from a narrower to a larger diameter — they might be in line for microtrauma because they’ve been too rough, too fast. Here again blood flow is a significant variable, and blood flow is enhanced by arousal. Other genital play, anal massage and touch, external play before insertion happens — all these help prevent the conditions that would otherwise risk a fissure or other damage.

I also want to clarify that when I caution against going fast, I’m not suggesting that, once turned on and comfortably entered by a person or toy, you can’t engage in fast anal intercourse. I’m really recommending going slowly in the process of arousal and insertion. The often-very-tight anal sphincter needs to be able to relax in order to let anything come in. A too-tight anus is also an impediment to healing a fissure; a less-invasive treatment that may sometimes help, and bring comfort, is the sitz bath: a warm bath taken a few times a day.

Docs will recommend a number of treatments for fissures, though if you can keep your anus clean, avoid bowel irregularities, avoid further irritation, and make sure your circulation is OK, your fissure will heal on its own and you won’t have to try surgery, Botox injections, or nitroglycerine — all remedies that either address a tight sphincter or the blood flow that feeds it. There’s another technique recommended by my colleague Dr. Robert Lawrence, whose anal expertise is significant: He suggests that you keep latex or vinyl gloves in the bathroom and that before a bowel movement, you glove up, lube up, and gently insert a finger by pushing against the anus’s uninjured side, so you’re not pushing in against the painful tear; then carefully covering up the fissure with your gloved finger and moving your bowel material over the glove so that it does not get repeatedly irritated while it’s trying to heal. Remember to dispose of the glove properly — not in the toilet where it will clog, please.

Some people quail at the idea of doing this, but really, here’s the (ahem) bottom line: Don’t you want your ass to stop hurting?

Good luck with getting rid of your pesky fissure as soon as possible, and don’t let your doctor do any procedure without discussing less-invasive ways of dealing with it, and also without telling the physician that you would like the treatment to allow you continued enjoyment of anal play. Plenty of doctors need to be reminded that even their heterosexual male patients might be fans of back-door delight.


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Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at carolqueen.com.

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