LEARN ABOUT ANAL INCONTINENCE FROM THE EXPERTS AT BESPOKE SURGICAL
What Is Anal Incontinence?
While some may think this is something to laugh at, we can assure you that it is a medical condition and it does happen to the best of us. No matter how scientifically we define “anal incontinence”, the fact still remains that in layman’s terms, it’s you losing control of your bowels.
However, within the gay community, specifically, anal incontinence (or “fecal incontinence”) is often confused with “looseness”. One may experience “looseness” without experiencing anal incontinence; however, the other is not true. Are you simply unable to keep in a fart or do you have fecal matter running down your leg? Or maybe it’s a combo of both? How about just diminished sexual pleasures to both you and your partner(s)? It all stems from the loss of some or all muscular function that maintains normal coaptation and bowel function.
If you take a step back and think about how this can affect someone’s life, you can see that the overall situation can be detrimental to not only one’s daily living, but also one’s sex life and relationships. Further down on this page, we will dive deeper into how one gets to this point. However, the most common question we get asked is: can anal engagement cause incontinence? Keep reading.
Causes of Anal Incontinence
From the definition stated above, this can occur from, but is not limited to, anal trauma, neurological dysfunction, surgical procedures (inappropriate fissure and/or fistula surgery), anal cancers, and, of course, sexual behaviors. All of these injuries, however you think about it, can paralyze or diminish the function to one or all anorectal muscles. Depending on the severity of the injury determines the severity of the symptoms developed.
Does Anal Sex Cause Incontinence?
This is a complicated answer. If one regularly engages with large cocks, large toys, and/or fists, these can either cause tearing with trauma or gradually stretch the muscles beyond their capacity, leading to some elements of what has been mentioned so far. That said, it’s key to help make sure people are experienced when engaging and educated to not only know their limits, but also to offset those dilation days with contraction days. It’s about building and rebuilding that muscle! If we approach this early on, we can minimize any potential complications, specifically if we go past that normal capacity.
What Are the Symptoms of Anal Incontinence?
The varying degrees of incontinence can cause a myriad changes in the region—from a small amount of mucus or wetness in the area to some bowel leakage to no control of defecation at all. And obviously there is everything that’s in between. Now, on a sexual front, people can develop “looseness” that has varying severity of potential incontinence issues. When people throw around the term “looseness”, it also seems to correlate with one’s own or one’s partner’s sexual pleasures—and clearly not in a good way.
How Is Anal Incontinence Diagnosed?
Diagnostic parameters are done more by discussing a thorough history and taking a physical examination. Through this and an appropriate description or daily charting, one can be pretty accurate in the diagnosis. From there, anal manometry (testing the muscular function), defecography (analyzing the actual defecation process), and an appropriate anoscopic and either a sigmoidoscopy or full colonoscopy is warranted. All of these combined will provide us with the appropriate algorithms for management.
What Is the Treatment for Anal Incontinence?
Here at Bespoke Surgical, Dr. Goldstein mostly deals with mild incontinence issues from either prior surgeries and/or the sequelae from anal trauma or intercourse. All other larger scale incontinence gets referred out to specialists of that specific pathology. Let’s take the sexual ramifications first. The key for Dr. Goldstein is to maximize medical management before we even think of surgical treatment. Does the client have any function remaining in the muscles?
If so, can we work through physical therapy and stimulation to attempt improvement of both muscular and neurological control? We love the use of butt plugs. Take the smallest size and every other day place that in and then contract, holding it for 5 seconds at a time. Doing this 15-20 times during the session, the incremental exercise, and also adding pelvic floor work, like kettle bells and/or squats, should help get one to a better place.
If this fails, then one may need a more surgical approach. Sometimes it’s just one isolated region that isn’t coapting well, possibly from prior surgery. Fillers now are available and can be great to attempt to close that gap. We advise temporary ones, since if it over-corrects, we can amend its placement. Also, nowadays, they truly build native tissue in the region and the hope is that, over time, its use and injection will not be warranted. As a side note: they do make permanent fillers for more severe cases.
Surgical correction for looseness or mild incontinence may be just as simple as removing a hemorrhoid and/or skin tag. During this procedure, tightening can be done to the muscle in question to truly aid in the increased elasticity. Dr. Goldstein does this surgery frequently and it truly enhances not only just the daily function, but also the sexual pleasures had by all. Doing this, plus working with pelvic floor therapy, allows for persistent tightening during the longevity of the bottom. Sometimes, we stage this procedure (or have to stage due to location of surgical correction), taking care of one side at a time. This allows one to see and confirm the improvement with also less recovery post-procedure.
There are a myriad of other treatments available, out of the scope of our work here at Bespoke Surgical, but more from stimulators being placed and/or complete surgical corrections that would be of benefit depending on one’s true diagnosis. Of course, we would and could aid in that referral, if needed.
Surgical anal reconstruction recovery consists of three to five days of initial acute pain, followed by one to two weeks of more isolated pain during bowel movements. On and off bleeding, accompanied with some mucus discharge, is of course normal and improves with time. Most are back at the gym within three to five days and about a week for topping. Clients see us at one and two month intervals.
During that time, in-office tweaking is done with the scarring to allow for full and complete healing. On the second postoperative visit, a full internal examination is done to confirm improvement, which allows one to start using butt plugs and seeing a physical therapist to maximize our healing. Toy work begins at two months and full bottoming around three months.
Prevention of Anal Incontinence (How to Minimize Risks)
The key to prevention is education on the correct way to engage. Now with that, we have needs and desires. Sometimes those take us beyond the actual muscle capacity of our sphincters, leading to the aforementioned issues. Clearly, Dr. Goldstein doesn’t want someone to avoid engaging however they want to. Rather, it’s about not only understanding the science behind penetration (of any kind), but also implementing safer practices. Just like at the gym, one has days of contraction and then others of relaxation. The same should be done anally.
Using a butt plug, let’s start with adequate contraction around these toys, holding that contraction for an extended period of time. Adding this and pelvic floor kegel exercises, along with PT pelvic floor therapist sessions, should create the balance needed on a sexual front. Also, squats and lower leg/pelvic work at the gym can assist. Don’t forget to also squeeze with your partner(s) inside you—this feels great for all and helps keep everything aligned.
Bottoming is hard work and having the full package—literally—on successful engagements is imperative to prevent that looseness we all dread. Having a better understanding of all of the above, should offset these potential complications from how we engage. Please, by all means, engage how you want, but surround yourself with not only experienced partners, but also providers who can create successful outcomes.
Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, NYC’s leading sexual health private practice. He received his osteopathic doctorate from the University of Medicine and Dentistry School in 2002 and completed his residency in General Surgery at Maimonides Medical Center. In 2020, he was named one of NYC’s top LGBTQ+ business leaders by Crain’s New York and he is involved with GLSEN, ACRIA, HRC, and Callen-Lorde’s Howard J. Brown Society. All of these experiences and affiliations have shaped his whole-life approach towards the practice of private surgical care and sexual wellness.