Sexual health

Q&A: What causes bleeding & pain from your butt?

Pierre-Cédric Crouch, PhD, ANP-BC answers our burning questions about butt pain. Here’s what to do if you notice pain, swelling or blood.

Maybe you’ve had this happen before: You wipe your butt and notice red streaks on the toilet paper. Or you wipe up after bottoming and you see blood on the towel. What’s going on?

Bleeding and pain can be symptoms of something minor like hemorrhoids to something more serious like lymphogranuloma venereum (LGV). To learn more about what to do if you experience bleeding from your butt, I asked San Francisco AIDS Foundation director of nursing Pierre-Cédric Crouch, PhD, ANP-BC, ACRN some “burning” questions I had.

Q: Thanks for answering my questions, Pierre! What are some reasons a person might bleed from their butt?

Pierre: You can bleed for a lot of different reasons. It could be something as simple as hemorrhoids or an anal fissure (get the details on anal fissures). But other things can make you bleed too: genital warts, ulcers, herpes, even having a painful bowel movement. You can also get bloody discharge from lymphogranuloma venereum (LGV).

Q: I’ve never heard of LGV before. Tell me more!

Pierre: LGV is a sexually transmitted bacterial infection that is caused by a type of chlamydia bacteria. It’s more common in men than women, and people who are living with HIV seem to be more likely to get it. When you get tested for chlamydia, your test would be positive if you have LGV but your provider would have to order a special test to see if it’s LGV. You don’t need to test specifically for LGV if you aren’t having any symptoms.

Because the infection affects the lymphatic system, it can cause swelling and redness in the groin area and drainage through the skin from the lymph nodes in the groin. It can also affect the lymph nodes around your butt if you have anal sex, and you might experience bloody discharge from your butt.

Q: Yikes! Sounds awful. Can LGV be treated?

Pierre: Absolutely. We treat LGV with antibiotics. If you have symptoms, the treatment lasts for three weeks (which is longer than we treat other types of chlamydia).

Q: You mentioned hemorrhoids potentially causing bleeding. Besides looking unpleasant, are hemorrhoids a health concern?

Pierre: Hemorrhoids are swollen veins that happen inside the rectum or on the anus. Straining when you poop can cause them, as can anal sex. Sometimes they are not serious and go away on their own. But sometimes they don’t go away—in those cases, you can get them treated.

I know some healthcare providers take the position that if your butt functions, it’s fine. They think ‘who cares what your butt looks like if you’re able to use it?’ But that view doesn’t support the health and happiness of people who bottom. Having a pretty butt is important!

Q: I love hearing about pretty butts! But for now, let’s move on to other possible causes of pain and bleeding. What about anal sex? Can people experience pain and bleeding from anal sex?

Pierre: Yes—anal sex can be another cause of pain and bleeding. No matter what you do if you bottom, if your partner is really rough, it’s going to hurt. Or if you haven’t bottomed in a long time, and you don’t take enough time to loosen yourself up, you can tear or strain a muscle. And that can cause bleeding.

Q: When should people seek help for pain or bleeding?

Pierre: If you have painful rectal bleeding, talk to your healthcare provider! I think people may delay seeking care because they are embarrassed or don’t want to talk about their butt. You have to remember that healthcare providers are used to hearing about this kind of stuff. Nothing is going to shock us. We’re here to help you feel and be healthy.

Douchie's Guide to Butt Health

Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves. Get info about everything from douching to fissures with this series on all things anal. Visit

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Douchie brings butt health & happiness out of the closet so you can care for your butt in the way it deserves.