Aside

The Healthy Bear Talks About Anal Douching

Hey there Guys,

For many gay men anal sex is an important part of our sex life. In the 2010 Gay Community Periodic Survey just under 88% of males stated they had had anal sex in the past year. As part of preparation for anal sex many men may choose douching as a way to reduce the risk of “accidents” in the bedroom. Today I wanted to talk about the pros and cons of douching and to also discuss ways to reduce harm if you choose to douche.

So what exactly is douching?

Douching is the process of passing a fluid into the lower colon and rectum, the lower part of the gut that is responsible for collecting faeces, to allow for cleaning and removal of any residual, ahem, matter.

This can be done in a few different ways including special bulbs that hold water right up to intricate systems that connect to the plumbing usually in the shower.

By far the most common fluid used is water however some people may add salt, soaps or other agents to the mix to increase the sense of cleansing.

Are there any risks with douching?

To cut to the chase yes. To quote the excellent resource “The Bottom Line” from The Terrence Higgins Trust:

  • Douching washes away much of the protective mucous lining of your arse, leaving you more open to infections.
  • It can irritate your arse lining making infections easier to enter through the inflamed skin. Sticking a nozzle up your arse could cause tiny cuts.
  • Avoid a douche just before sex as after douching you can still ‘leak’ water for a while.
  • Overuse of enemas/douches can interfere with the normal workings of your bowel, with some people’s bowels needing laxatives to function.
  • Enemas can ‘overload’ the heart so avoid them if you have an irregular heart beat or other heart problems.

The main concerns with douching are that adding water into the arse can damage the delicate lining of the bowel. This can increase the chance of sexual infections, of most concern HIV. Passing the tube into the ass can also cut and scratch so it’s important to make sure plenty of lube is used and that the attachment you place inside you is nice and smooth.

Once you get past about 5cm inside the ass there are no pain receptors like in the skin so it’s possible to bump and even tear the lining of the colon and not notice it. If you develop sudden bleeding, unusual sensations or dull achy pain it’s important to seek medical help immediately.

The lining of the ass is designed to absorb water so adding a moderate volume of water into the arse can lead to an unexpected increase in blood volume. If you suffer with heart, kidney or other significant medical conditions it’s best not to douche as these fluctuations can cause big problems.

Because the lining of the ass is very delicate it’s important not to use any additives to the water used in the douche as they increase irritation. An interesting study from the International Rectal Micobicide Advocates is showing a promising new iso-osmolar (a fluid with similar properties to cells and blood) douche that does not damage the arse lining. This may also be able to be used as a way to introduce medicines into the rectum that may kill HIV if it comes in contact.

By far the most important tool for reducing potential sexual infections if you do chose to douche is to have sex using condoms. Not only do they protect against infections but can also be much easier to clean up if there are any accidents.

Are there any alternatives to douching?

For most of the time the lower part of the arse is empty. Faeces only moves down into the rectum when you are ready to empty your bowels. By going to the bathroom before you plan to have sex you can greatly reduce the risk of mess during sex.

Other tips include having plenty of good quality fiber in your diet. Fibrous veges like broccoli, carrots and fruit are not able to be absorbed by the gut. These fibers help keep the faeces well formed making emptying your bowels easier and more complete. Keeping your water levels up will also help make emptying your bowels much easier and cleaner.

Each time you eat a special reflex called the “gastrocolic reflex”. This is why many people report needing to go to the bathroom after eating. Basically what happens is that as the stomach fills a message is sent to the bowels to “empty out” to allow space for the food from the emptying stomach. Not eating for 2-3 hours before you plan on anal sex can be a great way to reduce the risk of “accidents” mid passion.

I know of a few gay men who use medications like GastroStop™ or immodium to reduce stomach emptying however this is not recommended as it really can play havock with the natural rhythm of your gut.

What is the best way to douche?

If you considering douching it’s important to chose the safest tools to reduce risk of harm to the lining of your arse.

Looking at the nozzle, be sure it’s smooth with no sharp edges that could scratch or cut. One good option is some of the rubber choices that are firm yet soft enough to bend a little when you insert them inside your arse.

I don’t recommend using the systems that plumb into the mains water if you are new to this practice. High pressures can cause significant damage to the bowel. Good options include the bulb like douches that can be found at chemists as well as adult stores.

If you are looking for a shower attachment style douche that is a safer choice check out the Streem Master shower system. Based on gravity it is convenient and reduces the risk of high pressure accidents significantly.

For clean-up tips check out this great resource from Pride Alive on how to keep your butt clean both before and after sex.

The bottom line is that like all things, moderation is the key. Occasional douching done carefully is unlikely to cause major damage. Due to the risk of irritation of the lining of the gut it’s important to always practice safe sex to reduce the risk of spread of sexual infections.

If at any time you notice discomfort, bleeding or discharge from the arse, fevers or changes in your normal bowel habits be sure to seek medical attention immediately.

Please feel free to share your thoughts or questions in the comment boxes below.

Yours in good health.

Dr George

Jim says:

Thanks for your page and the link to the Xtube video on the subject. This is such a difficult subject to get information from doctors on . . . they seem embarrassed to give a simple rectal exam sometimes, so I don’t feel comfortable broaching this subject. I’ve been essentially self taught on anal cleansing since I was a teenager (I’m in my fifties now). Watching the video I was surprised how many times he flushed out and how long he held it. Doesn’t the colon absorb water? I always thought it was important not to hold for any length of time, basically flush and release. If I’m preparing to bottom I’ll usually do it max three times or until the water is clear. It’s not foolproof but most of the time it works. Also, I’ve been having some issues with severe cramping, unrelated to enemas or douching. I’m trying to set up an appt with a gastroenterologist (no insurance makes that challenging), but I’ve found a regimen of a Miralax style laxative really helps to keep things soft and moving, and has eliminated the cramps so far. The only problem is I never seem to be able to completely void, so I use my shower shot for a quick (and small volume) flush afterward. It seems to work great and gets what’s left, but I’m wondering if I’m asking for trouble doing this daily?

Michael says:

Thanks so much for the information! Learned a lot, not just what to do but what NOT to do. I think this explains some of the discomfort I feel sometimes after douching and why no matter how much I do it just NOT being able to get clean! The water going into the colon is not good, just clean the rectum if you’ve already had a bowel movement earlier.

Roger that. :-)

Josh says:

I hope I’m not too late and that these questions are still being answered. I feel like this could be a little TMI of a question also, but, do you have any tips for getting everything out/making sure you’re empty down there? I force myself to go to the bathroom an hour or two before I plan on having sex, and a lot of the time I feel like I just push and push and I’m never clean/empty. It sucks because my boyfriend comes over and I constantly have to deny him because of my lack of being able to make sure I’m clean and get everything out, which is really messing up my confidence in my relationship. This is also a relatively new problem, too, because I used to live with my ex and would go through this process every night before bed and rarely had this issue. Should I be taking laxatives, or is there a step that I’m missing? Or should I not be trying to push everything out; does that create a problem that wouldn’t even be there in the first place?

Your advice would be greatly appreciated.

nick says:

thank you for this article, i really appreciated the link to pridealive’s resource. it’s surprisingly hard to find good information on bottoming, either bottoms are magical and prep, what prep? or, you had better purge everything from your intestines at all costs.
i’m nineteen and haven’t bottomed before, and my boyfriend has but it didn’t go well. i’m really glad we decided to try and get some reasonable information first and i’m glad i came across this. :)

Sean Bliss says:

Thank you…this explains some of the discomfort experienced and that I’m performing it wrong

Dee Screet says:

YUKKY!!! Poo-Poo!!

Peter says:

I’m at the other end of the overuse causing loss of function part of your article. Though it’s not quite as simple as that.

I’ve had a mains pressure system for about a decade, though I didn’t use it especially often. Then a year and a half ago I had a hospital stay that turned out to be Cauda Equina Syndrome (Large Paracentral DIsc Protrusion with Left Lateral Stenosis at L4/L5). They operated on my spine (Laminectomy and Discectomy) and sent me home with handfuls of laxatives (movicol, coloxyl with senna, and microlax), told me to buy more laxatives over the counter, and eventually got around to teaching me how to self-catheterise (minor oversight on the part of the health system – but that’s not important just now).

I quickly figured out that if I wanted to earn an income I could not get by with loss of bowel control due to spinal/neurological deficit, combined with over the counter laxatives. That combination of full flow and no ability to control what comes out would have been smelly and humiliating several times a week (it was an almost daily occurrence while in hospital) and would have probably permanently damaged my mental health. The hospital set me up to fail. Given all the cutbacks lately to Disability Pensions I’d probably not even qualify for one, so I’d get to spend the following few years in total penury on Sickness Allowance, probably never leaving home.

I refused to let that be my fate. I threw out the laxatives and reattached the shower enema the day I got home after my month in hospital. Now I don’t have accidents at work or elsewhere because there’s nothing left to have an accident with.

Now after a year and a half of irrigating my rectum and descending colon every 2-3 days, and self-catheterising, I’m starting to regain the ability to urinate (with a long way to go before that’s fully under control), but I don’t feel much closer to regaining the ability to control my bowels. I’m probably now addicted to enemas. I can’t go on holidays longer than 3 days without making seriously weird travel plans (though I did just buy a travel version of the shower shot from Manhaus on my last trip to Melbourne).

While this is probably TMI for your readers, I thought I’d spill my guts (no pun intended) to point out that if I were straight I’d have been completely screwed by the health system’s lack of good advice or reservations about enemas. I might have had a better chance at bowel health, but it wouldn’t have mattered, because I’d have turned into a total shut-in (or committed suicide) from the humiliation of not being able to control what is on its way down and out.

Despite the advice of people like yourself (and others) I am now promoting shower shots to other Cauda Equina Syndrome patients on the CESSG yahoo group, admittedly with reservations, to help give people in my position a chance to regain some social and economic capacity. A few have tried it and decided it’s not for them. Others have appreciated the advice and are doing it too.

If an interested doctor or medical researcher wants to help, they can figure out and promote ways of regrowing gut flora, and countering the other ill effects of shower enemas, which could then also be of benefit to gay men who overuse enemas by choice, rather than issuing blanket statements to avoid enemas.

Peter thanks for your detailed reply.

I treat a number of spinal injured patients and indeed enema’s are the main stay for them as they are not able to sense or control the lower section of the abdominal wall or bowel.

This post was really aimed at the average person who has questions about douching for anal sex. Spinal injuries are a totally different kettle of fish.

Certainly there are simple ways to replenish bowel flora including eating yoghurt and taking probiotics however if the bowel is deep cleansed frequently it will simply wash the good bacteria away as well.

I think the best solution is for balance and to consider how much of the bowel needs to be clear of faeces, just the lower part for anal sex, or does there need to be deeper cleansing?

Jonas says:

I have a question that somewhat goes along with the answer you provided above. I have been considering using an anal douche because I have been experiencing health issues for several years now and doctors I have spoken to about this don’t seem to be very helpful. I hope you can help me.

First, thank you George Forgan-Smith for this excellent article, it was just what I was looking for. I have a question that I hope you can answer. I have both internal and external hemorrhoids, which I have had for a very long time now (6 years or so) that bleed intermittently. I know that part of my issue is that I need to be eating a higher fiber diet with more fruits and vegetables, but I think there are other factors that there isn’t much I can do about. I have had two intestinal surgeries many years ago, and ever since then, I have had more difficulty with bowel movements, which I think greatly contributes to developing the hemorrhoids.

I have been looking into different ways to help reduce the flair-ups of the hemorrhoids and reduce the frequency of the bleeding, etc. Increasing my fiber intake has helped, but I have researched other ways to help, one of which is the occasional douche or enema. I have read many articles from allegedly reputable sites about how enemas can greatly help your health, but I wasn’t convinced it was the miracle cure it was being presented so I did some more digging, which lead me to your article. I was wondering however, despite your warnings about douching, if an occasional douche might help me a little bit and provide me some relief from the pain, discomfort, and occasional bleeding from my hemorrhoids? What are your thoughts?

Bahahaha love LOVE the use of the water jet photo!

Great article – good for the “always douche” guys to know it could be counter productive

Marcus Bovey says:

Ive seen pics of art FROM douching…..

Is that a picture of the fountain in Canberra?

Mark says:

So I wonder. How much water can you really get into your ass? And will it stop somewhere?When I’m flushing my ass I put a hose in and turn on really low pressure and I’ll have it in there for like half an hour, till my stomach starts bloathing out. Then I go to the toilet and press it all out. It really feels great afterwards. How much water can I get up there?And can it get al the way up to my stomach and cause damage?I never put pressure on and when I feel some pain I stop immediately
-Thanks

Mark half an hour sounds like a very long time. If your stomach is bloating out I think you are putting way to much water in.
The idea is to just cleans the lower part of the colon and that normally only needs 100-200ml of water.
Check out the video, it’s a very good guide and as he mentions if you keep on passing more and more faeces the water is probably spilling over the bend that connects the lower part of the colon to the ascending part.

Ace says:

So, I’ve had digestive issues for as long as I can remember. I’ve been diagnosed with IBS years ago, and I’ve kind of got my stomach under control for the most part. However, a few years ago I started to have to (sorry for being so descriptive) dig out feces with my finger because it like gets stuck. Yet when I get it out, it’s really soft. Another things is, I use wet wipes instead of toilet paper because I think it makes me cleaner, so instead of putting my finger up my butt and pulling out the feces, I would use the wipe to act like a barrier so I didn’t get anything under my fingernail (I don’t have rubber gloves or anything like that handy) so basically I’m putting the wipe in my anus. I’ve had to do this for years because the feces would get stuck. I had a colonoscopy because I got so frustrated with all the problems I have, and they said they couldn’t see anything wrong, so I figured they couldn’t see any damage caused by putting wipes up there. But, could it be causing damage or making the problem of feces getting stuck worse? I try not to do it if I don’t really have to, but quite often if I don’t it won’t come out no matter what I do. I’ve also noticed that a lot of mucus comes out too. Could this be because of the wipes as well? I’ve never known where to go to get any answers about this. Thanks for your help.

Hey there Andy,
At the anus there are a number of curves and turns and I wonder if you have a “slightly more curvy” ass. The best port of call is to see either your family doctor or a gay friendly gatroenterologist to check and make sure there are not any pouches or infections in the last section of your colon.
Do you have a family doctor you are happy with?

Dr George

Ace says:

Whoops, sorry it took me so long to reply. Did you know my name was Andy from my email address or did it connect with my facebook? I don’t really want this to be on my facebook lol. Anywho, no, I hate my doctor. Actually, it’s not even a doctor. It’s a physicians assistant and there’s one doctor for multiple offices and he never shows up (I’ve never ever seen him) and the PA’s just put everything in his name. How that is even legal, I don’t know. I could go on and on and on about how terrible they are, but unfortunately I have no choice but to go to them because they’re the only one that takes my terrible insurance within about an hour of where I live (and I don’t drive so I’d have to take multiple busses to get anywhere else, which is really not fun). I was really hoping that when I had the colonoscopy (which wasn’t so bad, but the prep for it was hands down the worst experience of my life) they would tell me if they noticed anything different or wrong, but the only thing they said was was that they couldn’t get into the upper part because of something like the hole was too small or something. I’m not a doctor and I don’t remember his exact words. I do remember that he said this particular thing happens in about 3 out of 100 people when I asked him why it happened/why he couldn’t do it. I thought to myself “Of course I have to be one of those three out of 100 people because that’s just who I am” lol.

Clair Bush says:

My first colonoscopy (back in the early 1970s) was done without anesthesia, and hurt so much that I finally passed out from the pain. If there are no pain receptors inside the ass beyond the first 5 cm, what was hurting, and why are colonoscopies now done under considerable anesthesia, if not general?

Hey Clair,
Indeed the lining of the bowel does not have pain receptors like in the skin. The bowel is not sensitive to touch or sharp pain. It is *very* sensitive to stretch though. This is why constipation and the un-coordinated movement of an upset stomach can be so painful.
I am shocked to hear that you had to endure a colonscopy with no anaesthetic! The pain you would have experienced is from the gas introduced stretching the bowel as well as the bumping and stretching of the bowels as the camera is passed.
Have a great weekend Clair

byftpup (byron) says:

Thanks for the info, I keep wandering about douching… If I should be doing it or not.. There are so very many different views it’s always hard to work out. The info is rarely unbiased.. Pro or Anti.. You provide info in a manner that leaves the decision to the reader, and I appreciate that!