It’s not hemorrhoids, it’s an anal fissure (and you can treat it with Botox)
If you’re having persistent pain and bleeding from your butt for more than a few days, it’s time to see someone who can help.
That’s the message that Carolyn Million, MD, a colorectal surgeon and specialist in all things anal, wants to tell people who use their butt for sex–and everyone.
Dr. Million, a Queer ally who holds a practice in Oakland, California, sees clients from all over the Bay Area who come with questions about things that feel off when they bottom. She diagnoses and treats warts, HPV, digestive issues, skin tags, and more. Oftentimes, she’s diagnosing and treating anal fissures.
“Anal fissures are really undertreated,” she said. “A lot of times, they don’t get properly identified. People think they have hemorrhoids, or something else. And then the person just feels kind of consigned to continue living with it because there hasn’t been a proper evaluation.”
Anal fissures are tears or cuts that can occur in the thin lining of the anus. They can be caused by passing hard stools when pooping, by straining too hard when pooping, by having stools that are too loose (overly acidic stool can burn the canal), by getting pounded hard during anal sex, or having a really large bowel movement. They can be very painful and can bleed a lot. Some fissures can heal right away, but some can become chronic, especially if there’s ongoing abrasion to the area.
“You can develop pain and bleeding for months, even years,” said Dr. Million. “And over time, you can develop extra scar tissue, because as the body’s trying to heal those fissures, it’s creating scar tissues both inside your anal canal and outside your anal canal. The longer you take to treat it, the more likely it is that you’ll end up with an unsightly skin tag.”
The good news is that anal fissures are treatable and preventable.
In terms of prevention, Dr. Million always provides guidance to patients on normalizing stools. “They should be soft and formed,” she said. Douching correctly and using lots of lube during sex can also help with prevention.
If a fissure does not heal on its own, you will need medication or another treatment. Topical medication, applied to the affected area, heals about two-thirds of fissures in Dr. Million’s estimation.
Other larger or more persistent fissures may require Botox treatment or surgery.
Botox interferes with the communication between neurons and muscle cells–relaxing muscles when they don’t “get the message” to tighten, explained Dr. Million. As a consequence of the muscle not getting tight, more blood flows to the area with the fissure–allowing it to heal better.
Dr. Million offers Botox for anal fissure treatment at her practice.
“If you’ve had Botox for your face, it’s sort of similar,” she said. “It’s outpatient, and it’s relatively fast. The most common comment people make is, ‘Well, that didn’t hurt as badly as I thought it was.’ It lasts about three months, and usually by that time the fissure does heal.”
