Conversations about anal health are often uncomfortable and embarrassing.  Many do not know where to turn for this information and might be reluctant to bring it up with their healthcare providers.  Here are some tips to help your anal health.

First – see the anatomy and function – Diagram A

The anus is the exit and entry for the rectum (which is the last section of the large intestine – see diagram).  The anus can sense hot and cold, wet and dry, light touch, pain, distention (swelling), and pleasure. The anus has strong muscles – called sphincters. There are two anal sphincters – one on the outside and one on the inside.  Their job is to allow entry and exit and to protect the rectum.

Exit:  The sphincters relax to allow elimination of feces. This relaxation occurs when internal pressure is exerted, such as when a person is squeezing for a bowel movement.

Entry:  The sphincters can also relax with sexual arousal and during orgasm no matter the type of sexual activity.  For those who enjoy anal-receptive sex, this relaxation helps to allow entry. It is important that anal reception be properly lubricated and that the anus is relaxed and “ready” for sex.

Simple and Straightforward Tips for Anal Health 

1. Become familiar with your anus – use a mirror to check your anus and surrounding skin on a regular basis (at least once a week).  If you see redness, sores, unusual bumps, or rashes – seek medical attention.
2. If you have pain or itching – seek medical attention.
3. Avoid constipation, which causes a difficult bowel movement (BM) of hard dry feces. For most people by drinking lots of non-alcoholic fluids, such as water, juice, soda, tea/coffee and by eating a high-fiber diet, including fresh fruits and vegetables and whole grains (see: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=p00363.
4. If constipated, do not avoid a BM – this makes the feces dryer and harder – which will aggravate the problem.  It might be uncomfortable to have a BM, but it could get worse if avoiding it.  You could insert a glycerin suppository into the anus – past the sphincters (see Diagram B).  This will stimulate the anal sphincters to relax and will also lubricate, to help evacuate the hard dry feces.  These suppositories are available without prescription, over-the-counter, and they can be purchased at drug/grocery stores. Glycerin is a lubricant, which is gentler than laxatives (which stimulate the intestinal muscular movement and are not always needed).  Glycerin suppositories are not expensive, especially at discount stores.
5. If the anus is irritated by a BM, the friction along with wiping, cleanse gently with mild soap and water – rinse and dry thoroughly.  After cleansing, you could apply A & D cream (creams are water-based; ointments are oil-based and are too dense and heavy).  A & D cream is an over-the-counter product that is inexpensive, especially at discount stores.
6. Avoid harsh soaps (heavily perfumed or heavy-duty hand or disinfecting soaps).  Avoid scented towelettes.  Do not use alcohol, hydrogen peroxide, iodine, other disinfectants, or witch hazel – these are damaging to the anal and surrounding skin tissue.  Avoid hydrocortisone products, unless advised by a health care provider.  Do not insert powder, soap, or towelettes into the anus, since these would cause irritation and even injury. Some people like to use powder; if so, use cornstarch-based powder instead, and apply only to skin. Avoid talcum powder as it can cause irritation. 
7. Anal-receptive sex:
   1. If the anus is irritated during anal-receptive sex, follow the same suggestions as noted in #5 above.  One way to avoid irritation during/after sex is to use plenty of water-soluble lubricant before sex. Silicone-based lubricants are recommended to avoid irritating the rectum.  Also, a glycerin suppository could be for additional lubrication (see Diagram B).
   2. Relaxation of the anal sphincters is also critical.  Sexual arousal during foreplay is important to help the anus to relax.  Bearing down on the anus during insertion of penis/toy helps to relax the sphincters too.  A glycerin suppository can also be used instead, or with lubricating gel, to adequately lubricate the anus. Glycerin and water-soluble lubricant are necessary to prevent damage to latex condoms.
   3. Oil-based products cause latex to tear/rupture; they are also too thick/heavy for the anus and especially for the rectum.
8. If you do experience pain in the anus during sex (or BMs) – it could be a sign of a problem such as hemorrhoids or fissures.
   1. Hemorrhoids are common and medical treatments are typically adequate for treatment, although sometimes surgery is indicated.  Over-the-counter hemorrhoid treatments are usually adequate for care (avoid hydrocortisone, as noted in #6 above).  
   2. Fissures – sometimes the anus can have tears in them caused by friction or stretching during anal sex (or BMs).  These are called fissures, which can be quite painful. 
   3. Slight Bleeding can occur with hemorrhoids or fissures.  Usually, this is only a small amount on toilet paper when wiping or a few drops in the toilet or in the underwear. If bleeding is more than what would saturate the crotch area of the underwear, a healthcare provider should be consulted.
9. If you do have anal-receptive sex, talk with your healthcare provider about:
   1. Healthy anal habits.
   2. Having anal and rectal exams on a routine basis – to check for problems like hemorrhoids, fissures, or signs of STIs (as above), such as herpes or genital warts, as well as anal cancer.
   3. Getting tested for the sexually transmitted infections (STIs):  syphilis, gonorrhea, and chlamydia (including testing of the rectum).
   4. Getting tested for other STIs including HIV and Hepatitis C. 
10. Get STI vaccines, including:
    1. Hepatitis A.
    2. Hepatitis B.
    3. HPV (human papilloma virus) – for females aged 9-26 and for males aged 13-21. There are some exceptions – check with a healthcare provider.  HPV is the main cause of cervical cancer in women and anal cancer in both men and women (especially if they are living with HIV).
11. Barriers are recommended for anal-receptive sex for protection from infections in the anus/rectum and the inserting penis.
    1. A male condom can be very effective – worn on the erect (hard) inserting  penis (See:  https://www.cdc.gov/condomeffectiveness/male-condom-use.html)
    2. A female condom (FC2TM is the brand available in USA) can be used inside the rectum.  (See: http://www.aidsmap.com/Female-condoms-for-anal-sex/page/1322575/)
    3. Do not use both condoms at the same time – friction of the two can cause breakage of the condoms.

Inserting a Rectal Suppository – Diagram B

Place the lubricated suppository with the narrowed end up – into the anus. You will need to push it up enough to get above both anal sphincters to reach the rectum (as shown in diagram).  You can use a glove or finger cot (as in diagram) to avoid getting feces on your finger.

Resources
https://www.cdc.gov/std/
https://www.cdc.gov/vaccines/hcp/acip-recs/
https://www.cdc.gov/lgbthealth/
https://www.nih.gov/
https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/definition-facts
https://www.cancer.gov/types/anal/patient/anal-treatment-pdq