Coping with hemorrhoids

Dear Dr. Ren,

I am a gay man in my mid-40s with an embarrassing problem. I have hemorrhoids. This is uncomfortable enough on its own, but when I meet a new man, well, you can imagine. What can I do?

Blushing and Bleeding

Dear Blushing and Bleeding,

Yours is a more common problem than you think.

About half of the population has hemorrhoids by age 50, though usually these come and go, oftentimes without our even noticing.

It is important that you get a proper diagnosis of what exactly is going on with your bum, as hemorrhoids are only one of several disquieting conditions. Remember, bleeding may also be a symptom of fissures (little tears) or other digestive diseases, including colorectal cancer. See your doctor for a proper diagnosis.

S/he will examine your anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam. You may require an exam with an anoscope, a hollow, lighted tube used for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum. It is not as horrible as it sounds and sometimes detects polyps and other possible problems.

Hemorrhoids, also called piles, are enlarged varicose veins in the anus and rectum. They can occur internally, externally or in combination. Sometimes the word “hemorrhoid” refers not to a swollen vein but to the downward displacement of the lining of the anal canal. Try pushing it back inside. When hemorrhoids are left hanging out, they are prime candidates to develop clots —not a good thing.

Once you’ve determined what’s going on with your bottom, what are you to do?

Initially, relieve the symptoms. Try tub or sitz baths several times a day in plain, warm water for about 10 minutes. This simple regimen can be surprisingly effective. You can also try using a hemorrhoidal cream or suppositories.

If none of these bring you relief, a number of surgical options are available. (Get ready to wince, but none of these treatments are as bad as living with chronic piles).

Treatment for internal hemorrhoids includes rubber banding, stapling, injection of sclerosant (a material that blocks the vein), cryosurgery, laser, or electro-coagulation techniques. Surgical removal may be required for large, permanently prolapsed external hemorrhoids or strangulated hemorrhoids.

Once you’ve got your piles under control, preventing their recurrence requires relieving the pressure and straining of constipation. Try increasing fibre and fluids in your diet, which will make softer, bulkier stools. You may find a stool softener or a fibre supplement such as psyllium (Metamucil) or methylcellulose (Citrucel) to be helpful.

Also, remove reading material from the loo —just poop and leave.

Okay, now that we’ve got the educational portion of the column out of the way, let’s get on with the juicy bits. You want to know how to handle the issue of anal sex when your ass is out of commission.

Although you can have anal sex when you have hemorrhoids, it’s better to wait until they’ve healed. Friction and pressure from penetration can cause further irritation, discomfort, and pain. Not fun.

Also, hemorrhoids that bleed may place you at increased risk for HIV infection, since the virus can be transmitted more easily through an open “wound.”

This is, besides the discomfort of squeezing itchy little balloons between your butt cheeks, a good motivation for you to get them dealt with and maintain a piles-free ass zone.

Even when you think you are hemorrhoid-free, always get your top to wear a condom or use a Reality condom yourself when you are having anal sex. You may unknowingly have piles internally that put you at risk. Always use lots of water-based lube designed for anal sex.

For more information on good keister nudging, pick up a copy of Anal Pleasure and Health by Jack Morin, PhD and, for the girls, The Ultimate Guide to Anal Sex for Women by Tristan Taormino.

As to how you can have sex even with piles, try directing the sexual activity in another direction. There are lots of other behaviours you can enjoy without bottoming to anal sex. Be creative. Direct his attention elsewhere.

However, if that’s clearly what’s on the menu for the evening, then you’ll have to be truthful and say that your bum is off limits for the time being because you’re sore. Try delivering the line with a wink and a smile. That may be enough.

Depending on your rapport with your new partner, you may want to tell him you are dealing with a case of piles and you’ll get back to him as soon as you have them cleared up. Awkward? Yes, but only mildly so considering most of us have to accommodate our bodies’ idiosyncrasies at one time or another.

With half the population experiencing bum jewels, chances are your new lover will understand. No? Then you can do better in choosing your lovers!

See your doctor for a diagnosis, get the butt flaps dealt with and change your diet so they stay away. Remember safe sex and don’t forget patience and humour!

Join Dr Pega Ren for An Evening of Sex Talk for Older Queers, at Little Sister’s on Aug 19 at 7 pm.