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Crohn's Disease Forum » Support Forum » Gay, Lesbian, Bisexual & Transgender » Rectal disease options and cleanliness


05-27-2014, 09:07 AM   #1
LewisS
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Rectal disease options and cleanliness

Not sure if this topic has ever come up . If your back passage and the surrounding area is affected by your condition in some way or another whether that be hemorrhoids, skin tags, fissures etc. would your GI consider having that repaired through surgery or would they just recommend its left alone? I'm not even sure what the deal is down there, I just know it's not 'normal'.

Also, a question for gay men, straight men, any men! Do you shave or tidy up that area before an examination or colonoscopy?

Lewis
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Last edited by LewisS; 05-27-2014 at 09:35 AM.
05-27-2014, 10:34 PM   #2
nogutsnoglory
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I think your GI and colorectal surgeon will often to try preserve any intestines and organs with treatment being the first approach, followed by bowel saving surgery. They could recommend a patient ignore symptoms if they are not dangerous or terribly distressing. This is where it becomes more critical to voice concern that you are in too much discomfort from the problem or to be open about your sexuality if the problem inhibits normal functioning.

There are a number of treatments and surgeries that can be done for aggressive hemmirhoids, fissures, abscess, fistula and other rectal complications. I believe there may even be full reconstructive surgery but I dont know about that.

Is there a particular area of concern you have? We could look into the different options you may have.

As for cleanliness before a procedure, I do try to be extra good with my handheld to be neat and polite if they are looking or working up there. I don't shave it because I don't think they care what it looks like, they see them all day long and I figure they just appreciate the cleanliness and that's all. I would like to keep the area neater for a partner but I don't even know how one grooms that area by themselves nor the risks of a razor cutting delicate tissue.
05-28-2014, 06:49 AM   #3
LewisS
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When it comes to that area, I think I have all of the above. It's progressively got worse. It started with one fissure which led to a skin tag and that process just repeated itself. In the early stages I used to bleed a lot, enough to turn the water in the toilet bowl red and enough to soak the tissue paper. I think that could have been due to a ruptured internal hemorrhoid, I'm not sure.

Now I have mainly (pretty much only) diarrhea I don't tend to bleed anymore. If I do, it's just a bit on the tissue paper or mixed in with the BM. The hemorrhoid tends to flare up when I have a lot of D and gets really sore.

Apologies for the details. It's not pleasant I know. Not sure if I'd dare to mention my sexuality to a doctor...
05-28-2014, 01:52 PM   #4
durwardian
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Not sure if this topic has ever come up . If your back passage and the surrounding area is affected by your condition in some way or another whether that be hemorrhoids, skin tags, fissures etc. would your GI consider having that repaired through surgery or would they just recommend its left alone? I'm not even sure what the deal is down there, I just know it's not 'normal'.

Also, a question for gay men, straight men, any men! Do you shave or tidy up that area before an examination or colonoscopy?

Lewis
Yes to trimming up, easier for the doc to see what's going on. Shaving with a razor is not a good idea.

As far as fixing things, health insurance is a pain. So if you have money, they can fix or repair all kinds of stuff. If you don't, you suffer.
06-01-2014, 05:38 PM   #5
nogutsnoglory
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Lewis have you tried sitz bath with Epsom salt and hemorrhoid or calmoseptine cream to ease the rawness and pain?

Sort of on par with this discussion but do you guys think a gastroenterologist is more likely to be accepting or understanding of anal sex or less so?

It could go either way, they deal with this all day and the icky factor is out of the picture or they view the whole thing as gross and couldn't imagine why someone would want to engage in anal sex. Certainly anal sex is not a gay or straight behavior because it's done by people of all orientations but more so among gay men. I'm always wondering how a GI would reply if I had questions on anal health for sex purposes.
06-01-2014, 08:00 PM   #6
LewisS
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Lewis have you tried sitz bath with Epsom salt and hemorrhoid or calmoseptine cream to ease the rawness and pain?

Sort of on par with this discussion but do you guys think a gastroenterologist is more likely to be accepting or understanding of anal sex or less so?

It could go either way, they deal with this all day and the icky factor is out of the picture or they view the whole thing as gross and couldn't imagine why someone would want to engage in anal sex. Certainly anal sex is not a gay or straight behavior because it's done by people of all orientations but more so among gay men. I'm always wondering how a GI would reply if I had questions on anal health for sex purposes.
I've used the creams, which work, but it's basically everything that's left over that bothers me. I think due to recurrent fissures there's just a ton of damage.

I just wouldn't like to be the one to find out if my GI was open-minded on that or not. Imagine how awkward that would be if he wasn't! I'm thinking maybe since people with IBD need regular colonoscopies, surely they would want to make that as comfortable as possible for me. I think if my BMs were solid, they'd struggle to pass, so how would he/she get a camera up there without damaging it further. I haven't a clue what I'm talking about, but surely just because it's not a visible area to most, that wouldn't prevent them from wanting to repair it. I mean, I know it's there and that's the hard part, I kinda feel broken? I'm not even saying I'd like anal sex, but I'd like the option to try it...

What bothers me most is that all doctors should be understanding of all kinds of human beings, it's what's they're taught - well, should be.
08-19-2014, 03:26 PM   #7
LewisS
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Now I know what's going on I thought I should update this thread a little. I have crohns and it's in the lower end of the small bowel and affects the rectum and anus. I'll be having an MRI specifically in that area to see what's going on.

He asked what surgery I'd had done on my anus and I said none...so he thinks I've perhaps had a fistula that's healed itself. The scar is really large, but looks so neat as if it had been stitched. I heard him refer to it as colonic disease and said to one of his juniors I was more prone to something in the anus region. Not sure if he was talking about cancer...I'll ask when I have my next check up.

Apologies for any typos, autocorrect hates me tonight. Bowel was vowel and thinks was things.
08-19-2014, 03:52 PM   #8
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Hey Lewis I came across your posts the other day and been following your story, sounds like you've been through a lot, I got diagnosed with crohns in april a week before my birthday but apparently ive been showing symptoms of it for around a year which explains why I went down to 6.3 stone, but at least you've finally got a diagnosis and hope you start to feel better
08-19-2014, 03:59 PM   #9
LewisS
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Wow, 6 stone 3! Your BMI must've been really low. I'm glad to have a diagnosis now and I already feel better for it. How's your treatment going?
08-19-2014, 04:06 PM   #10
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yeah I weighed around 10 stone in July last year but I wanted to lose weight and when I wanted to stop losing it it just kept coming off and that's when I realised something was wrong but yeah since I started treatment in April I've put just over a stone on so I'm 7.7 now, I just need to put on around another stone and I will be happy but at least its coming back slowly but surely. For my treatment I'm on 6 tablets a day of Asacol 800mg and it seems to be going well and I had a check up last Wednesday, my inflammation markers have gone down by half so its looking good at the moment
08-20-2014, 06:14 AM   #11
Ice
Hi Lewis, I'm not a man - well, not in body anyways, but I have dealt with my bouts of fissures as well in this last year.

In my case, when I had my first fissure that I knew of (after a day of really bad D multiple times, I suddenly felt a bit of razor sharp pricking feeling and then there was blood), my physician (normal one) was who I first reported it to (since I didn't have a gastro specialist at the time) who confirmed it and told me that if I took care of myself and my fissure properly, it would go away on its own.

It's true; it DID go away on its own and for myself, but because of my bouts of D (at the start of my episodes) which sometimes ends in C, the fissure can get re-torn and so I've developed a bit of scarring myself but no skin tags.

At this rate, the fissure might become an almost 'permanent' fixture if only because we can't seem to control the bouts of D that are always a part of my episodes and the more 'bad' episodes of D are what seem to bother my fissure the most and I was told it's because of the acidity levels which weakens the skin where I had the fissure and makes it prone/easier to re-tearing.

It bothers me a bit but not a whole lot in the grand scheme of things, and despite the recurrences, my doctor remains hopeful that we can manage it surgery-free and he's been my doctor for at least 10 years now.

Thing is, I haven't been to a gastro doctor so their opinion might be different - especially when considering something like Crohn's with the complication of fissures - but you should always have the chance and choice to think about your options first before a doctor will perform any kind of surgery besides that which is imminently lifesaving.

When I asked if 'sex back there is out of the question', he said that it's still possible once it's healed (unhealed = more risk for infection) but to take it easy, go slow (gentle gentle stretching over time may be needed so as to not over-stretch or strain where the fissure was/is), and to use lots of lubrication.

That said, when the time comes and you want to explore that part of your sexuality and you are able to safely/healthily, there is something called anal (or rectal) dilation that you might consider investigating into.

Basically, it is the process of using specially shaped and sized implements of gradually increasing size to help stretch the anus and the related muscles and the dilation/stretch process can be a very gentle one and in some cases of fissures, even a therapeutic one.

Despite how kinky it might sound, the goal in the case of fissures isn't to over-stretch or 'go extreme' with it; rather, to help relax the muscles more and to possibly help soften up and break down the scar tissue and allow for more stretching. If someone has C issues and they get fissures, for example, gentle dilation may help their bodies relax more for their BMs and take the stretching easier.

Additionally, for men and women alike, anal dilators have been suggested as a prelude to the anal sex itself - to help ease one into it and get used to the feelings and stretching, etc.

But since Crohn's is involved in addition to the fissure, if at all possible, I would like to get a sex-positive gastro specialist to weigh in because Crohn's may add in other considerations.

All that said, I wish you the best and please take care; I'm glad you have your dX (though not glad that you feel so poorly at times) because knowledge is power.

I'm sorry if I rambled and I'm sorry if I ended up missing a part of your question or concern.
08-20-2014, 11:26 AM   #12
LewisS
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Hey Ice. Your rambling provided me with a lot of information! I wish I was brave enough to bring sex/sexuality up with my GI. Not sure he'd be as open about it...

My main issue is really the appearance of it, it's not very sexually...appealing? I mean I'm sure it would be possible for me to have sex, but cosmetically I'm not happy with how it looks. The crohn's has really damaged that part of my body, which sucks, but it's something I have to live with. Hopefully I meet somebody who is understanding or has crohn's themselves!

It sucks because I do feel very sexually restricted and I think if I were to meet somebody it would be very difficult for me to even approach sex.
08-20-2014, 02:02 PM   #13
mish2575
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When it comes to that area, I think I have all of the above. It's progressively got worse. It started with one fissure which led to a skin tag and that process just repeated itself. In the early stages I used to bleed a lot, enough to turn the water in the toilet bowl red and enough to soak the tissue paper. I think that could have been due to a ruptured internal hemorrhoid, I'm not sure.

Now I have mainly (pretty much only) diarrhea I don't tend to bleed anymore. If I do, it's just a bit on the tissue paper or mixed in with the BM. The hemorrhoid tends to flare up when I have a lot of D and gets really sore.

Apologies for the details. It's not pleasant I know. Not sure if I'd dare to mention my sexuality to a doctor...
I am right behind you in this (LOL - behind). I am dealing with a very sore anus and a skin tag. I don't have fissures (that I know of) but do have fistulas.

I am prone to hidradenitis (boils) in that area so I cannot shave. I use an electric trimmer to get as much as I can before an appt. (I'm a mostly straight female) My husband isn't going back there again, possibly ever, so my tidying up at this point is just for the doctor.

I keep telling myself it could be worse. . .




P.S. I hope you don't mind me responding. . . I found this post in "new posts"
08-20-2014, 02:05 PM   #14
mish2575
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Lewis have you tried sitz bath with Epsom salt and hemorrhoid or calmoseptine cream to ease the rawness and pain?

Sort of on par with this discussion but do you guys think a gastroenterologist is more likely to be accepting or understanding of anal sex or less so?

It could go either way, they deal with this all day and the icky factor is out of the picture or they view the whole thing as gross and couldn't imagine why someone would want to engage in anal sex. Certainly anal sex is not a gay or straight behavior because it's done by people of all orientations but more so among gay men. I'm always wondering how a GI would reply if I had questions on anal health for sex purposes.
I've mentioned it as a woman. I have almost no modesty about issues when I see doctors. I just wish I could get past my modesty in a public restroom. LOL
08-20-2014, 02:09 PM   #15
LewisS
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Hahaha of course I don't mind. The 'my husband isn't going back there' really gave me the giggles. Oh how lovely this disease is...
08-20-2014, 02:14 PM   #16
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Lewis,
I don't know if this helps but you cannot be the first gay man your doctor has seen. Many women, including me and Ice, have asked about anal sex.

Also, think of a gynecologist. . . to them I would think there is nothing sexual about a vagina but to us women there is.


I do understand how you feel. I am a straight woman with a 15 year partner. Luckily we have done it all before I developed Crohns but at this point my issues prevent us from having vaginal or anal intercourse. And I cant shave AT ALL so I also feel gross, even with a trimmer.

Hang in there. The mental part, embarrassment will go away with experience and age.
BUT, maybe you can find your answers here.
08-20-2014, 04:24 PM   #17
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My main issue is really the appearance of it, it's not very sexually...appealing? I mean I'm sure it would be possible for me to have sex, but cosmetically I'm not happy with how it looks. The crohn's has really damaged that part of my body, which sucks, but it's something I have to live with. Hopefully I meet somebody who is understanding or has crohn's themselves!
Not a guy but ugh i know this feeling. I had two hemorrhoids back in November and have been left with two ugly skin tags. I would love to get rid of them but from what I've read the recovery is very painful and they're not keen to remove them from people with Crohn's. Haven't dared asked my consultant about it though haha.
08-21-2014, 03:47 AM   #18
LewisS
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I'm probably going to ask if anything can be done to repair that area due to personal embarrassment and not feeling 'normal' and if he questions it or turns weird, I'll just shut my mouth and never mention if again!
08-21-2014, 05:14 AM   #19
Ice
Hey again Lewis!

Yes, unless something is contraindicating it, it's entirely possible to get skin tags removed and hemorrhoids banded/removed/taken care of and even scar tissue possibly taken care of.

I've heard of people whose doctors just ended up 'taking care of them' anyways without being asked to and I've heard of people asking their doctors to do so; it really all depends and when adding something like Crohn's into the mix, it might just depend on the doctor's opinion and why they have the opinion that they do.

Edit: I know some doctors think that 'cleaning the area up' is healthier and helps prevent future infection, but if you're having a flare in that region and it makes the area really sensitive (maybe thins the tissue there a bit and maybe makes it more prone to infection/trauma?), a doctor might want to wait until things settle or are settled more to do so?

One way to approach the issue without directly mentioning sexuality is to perhaps simply do what you just said and say that they bother you and give you discomfort (it sounds like they would even if sexuality wasn't in the picture; I know my fissure makes me literally feel uncomfortable when it's flaring/when it's aggravated!) and ask if they can be taken care of.

All the best!
08-23-2014, 09:06 AM   #20
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Before I had my ileostomy, I had repeated rectal prolapses that were surgically repaired. It wasn't for cosmetic reasons - they made it very hard for me to have a bowel movement, and of course all the diarrhoea made the rectal problems worse. I also had a lot of tears in the skin.

The problem I had was that the surgeries were only ever a temporary fix - I was prone to prolapses, and of course the skin quickly tears again also, if the causes of the problem aren't fixed. One of the many benefits of having the ileostomy is that I don't have any of these things to worry about any more. That was very much addressing the causes of the problem - although perhaps not something to be entered into lightly!

I was very fanatical about keeping the area clean. I'd shower following every bowel movement. I never had any skin irritation or infections, so I believe my attention to hygiene was not wasted! Definitely pay attention to cleanliness - though I'm sure you are already.

You might well find that haemorrhoids and skin tags come back again, so having surgery might result in you going through a lot of trouble only to have the problem reoccur. I do know that haemorrhoids can be removed with fairly minor procedures like banding, not requiring general anaesthesia. The best thing is to address the cause(s) of the problems - basically anything to reduce the amount of strain the area is exposed to, so anything that reduces diarrhoea, or reduces constipation if that's an issue for you - but I'm well aware that's probably easier said than done.

I'm not sure whether surgeons would consider operating for purely cosmetic reasons. I'd assume that very much comes down to the individual surgeon. And then they'd have to take into account issues such as risk of reoccurence, the effect it's having on your emotional state, and risk of complications such as infection.

I can't advise on the sexual issues, as I'm a straight female, but I do recognise that that deciding whether to discuss your sexuality with a doctor must bring up a whole load of worries. Many rectal problems can be assessed by a doctor without needing to go into details of sexual orientation or activity, but I think I'd give you the same advice I'd give to anyone - find a doctor you trust. Most people will feel some embarrassment having a rectal examination, or even just discussing it, regardless of sexuality. I have always felt comfortable with my colorectal surgeon. He never makes me feel embarrassed, and he's examined me many, many times! (Not anymore; now he examines my stoma instead!) So if you can, find a surgeon you get a good feeling about, and, if you can, talk to him/her for a while first about your problems in more general terms, before deciding what further information you feel ok about sharing.

I would recommend seeing a colorectal surgeon rather than a gastroenterologist, unless you already have a gastroenterologist who you want to stick with - or see both; I actually see my colorectal surgeon and two different gastros. at the moment! You're in the UK, so you should be entitled to see a consultant for each problem you have. I don't think your GP should object if you ask for a referral to a colorectal specialist, to address the specifically rectal problems, even if you are already seeing a gastroenterologist for the more general management of your Crohn's. On the NHS, you are also always entitled to a second opinion, so don't feel like you have to go with the first consultant you see. You don't need to have a major reason for objecting to a consultant, you can just tell your GP that you'd like to get another perspective, or simply say that you didn't feel comfortable with the first consultant you saw (if that does turn out to be the case).

Having an understanding GP is always a useful thing too, of course, as they're the first person you have to explain your problems to in order for the referral to a consultant to be made in the first place. You could perhaps even ask your GP to put the basic, medically relevant points of your concerns about sexuality in the referral letter, if that sounds like an easier way of doing things?

Last edited by UnXmas; 08-23-2014 at 09:29 AM.
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