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 ErgoFlow 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