Bottoming and IBD

  • Bottoming or anal sex (the fancy medical term is receptive anal intercourse/RAI) is an important part of many people’s enjoyment (not everyone’s preference, but if you like it, you like it, and IBD shouldn’t make you stop!)

  • Making sure your experiences bottoming are pleasurable and safe having IBD are important.

  • I use bottoming/anoreceptive intercourse/receptive anal intercourse (RAI)/anal/anal sex all interchangeably on this website - you may use different words, just apply whatever you use to the topic!

  • More about bottoming after specific things like fissures, hemorrhoids, and more can be found on this page. Information about PrEP, PEP, DoxyPEP and more can be found on this page. Information about stomas/setons/other surgery can be found here.

  • Important: Being gay, bottoming, or any permutation of the sorts does not cause IBD (and isn’t “2 times more likely to give you IBD”). That’s not how that works and that paper was Not It.

Not Very Brief Overview of Bottoming/Receptive Anal Intercourse and IBD

  • Prep for bottoming often involves using things like loperamide (Immodium), enemas, eating a high fiber diet which can be a big no-no in IBD (every person is different!), so be sure to double-check with a trusted care team member if taking things like Immodium and other prep tools such as anal douches is safe for you.

  • You don't have to say "I'm asking about bottoming" you can ask "Is it safe for me to take Imodium"? (because honestly, so many people with IBD have wondered if they can)

  • Using Fleet enemas/douching too much can irritate your inner rectal mucosa, making it more friable or delicate- too much of anything can be a bad thing, so be careful not to do too much (everything in moderation!)

  • Saline (Fleet, etc) is the ideal enema to use - your body, and butt, have a very delicate balance of electrolytes that can get out of balance if you use the wrong equipment. Think about colonoscopy prep - it’s a bunch of electrolyte water!

  • Please don't use anything from under or above the kitchen sink like bleach, rubbing alcohol, olive oil to douche. 

  • That would hurt your butt quite a lot - plus olive oil will make you really slippery and oily/greasy and I don't think that would be great - if you need help buying lube there are places that give it away for free  like sexual health clinics, and worst comes to worst,  submit here  and I will venmo you before you have to use bleach or some good olive oil (save that for cooking something good)

  • If you notice pain, bleeding, or unusual soreness/weeping when prepping or bottoming (engaging in anoreceptive intercourse) pause what you are doing - you may need to recollect, try a gentler approach, or have a check-in with your physician.

  • If there is significant inflammation in your anorectal area, anoreceptive intercourse increases the risk for trauma to the area and can increase pain.
  • IBD is often associated with being on immunosuppressive medication (biologics, etc). so.....

  • Protection is important if with a new partner(s) as well as being proactive about testing for STIs.

  • If applicable, you may consider talking to your doctor about starting PrEP, having a prescription for DoxyPEP, etc.

  • Many people with IBD already take Doxy for things like EIM skin disorders and it's immunomodulatory effects (Rosacea, etc) so the benefits of being on post-exposure prophylaxis for STIs using a pretty common antibiotic may outweigh the potential costs (antibiotic use) if that is your situation.

    • If you begin to notice blood or experience pain - it may be time to take a break from bottoming/anoreceptive intercourse

    • Douching too frequently and using products with excessive additives in areas of pre-existing inflammation can lead to bleeding and irritation

    • Akyl/Amyl nitrite/poppers act as a vasodilator and can have harmful side effects, such as methemoglobenemia, and can lower your blood pressure * a lot* and cause a rapid spike in heart rate. Be very careful when using and make sure someone is with you. Please be safe!

    • Lubricant (lube) is your friend! I cannot emphasize this enough. Spit is NOT a good lube - use water based or silicone based (unless using a silicone based toy - silcone + silicone = degrade) See this page for more info on lube, condoms and what to mix/not to mix.

    • ALWAYS use a flared base for anything going in behind - this applies for everyone, not just if you have IBD! No matter how much you think or are confident that it won't get pulled up in there or stuck, there is always a chance you are proven wrong. There are STRONG muscles in the anus!

    • Foreplay is important! Being turned on will help you/your butt and anal muscles relax.

    • Foreplay also triggers physiological and physical responses (releasing oxytocin, serotonin, etc that lower cortisol) that make the sexual activity enjoyable and possible!

  • This applies for everyone - not just IBD-ers - sex shouldn't hurt and you shouldn't bleed!

  • If you are you just coming out of a flare, try other positions or ways of being intimate while your bottom or rectum is healing - save those bottoms! (not to exclude tops or anything, love y'all too)

  • If your Crohn’s or Ulcerative Colitis is in remission, anal sex should be fine - especially using lube and being smart about safe sex. Just remember to listen to your body, stop if anything feels weird or hurts weirdly, and communicate.

  • You won’t have an enjoyable time if you are suffering through or in pain- but there is one piece of advice for bottoming/anal sex that is most important of all - I cannot stress enough ,

    LISTEN to your body and COMMUNICATE with your partner!

    Never let anyone make you feel less than as a partner because of your IBD. You deserve to be respected and cherished as you are. This disease is tough, but you are tougher.

A basic diagram of colorectal anatomy that you might find in a textbook from the 80s or on your doctor’s office walls.

Having a Pleasurable Bottoming Experience

With IBD

Fiber: Decreases your need to douche, BUT in IBD, fiber can be a touchy subject. It may help to ask your doctor about increasing fiber in your diet (you don’t have to say it’s for the purposes of anal sex.)

  •  Companies market fiber supplements to bottoms - DON’T FALL FOR IT! They are soooo overpriced, and the same thing as any fiber supplement you get at the pharmacy. Just get a psyllium husk supplement and don’t buy something that is marked up 500%.

  • Rectal Douching: There are no increases in STI transmission associated with douching. Isotonic saline does not damage the epithelium. Fleet enemas are HYPERtonic/Hyperosmolar and can lead to epithelium damage after too much use.

  • Lubricant: Silicone lubricant is ideal ONLY if not using a silicone based toy. If you think you’ve got enough lube, use some more. Iso-osmolar lubricants (typically silicone based) might be preferred for bottoming as hyperosmolar lubricants (typically water based) can cause epithelial damage and increase risk of bleeding and infection if used too frequently.

  • HOWEVER, when using silicone lubricant with silicone objects (for example, a dildo), be careful, as combining silicone + silicone will lead to material breaking down.

  • Poppers: Don’t combine these with PDE5 inhibitors (medication for erectile dysfunction and pulmonary hypertension including Cialis and Viagra). Poppers should be used with a lot of caution as they can cause significant cardiac events, and if you are on certain meds to manage IBD side effects or other conditions, you may need to check that.

  • Here is the interaction checker for medications that interact with poppers:

  • Foreplay: Getting aroused/turned on will not only relax you, but make the muscles around your butt relax and blood flow increase (all the happy chemicals do that) It never hurts to throw in some foreplay to loosen things up!

  • You don’t need a partner for this, either - fingers are a good place to start, because you can start with a pinky and work your way up, or you can use sex toys like vibrators, dildos, anal/rectal dilators,etc  https://www.drugs.com/drug-interact

    Consent: Open communication, respect, and honesty all are super important to having a pleasurable experience. Consent is sexy!

  • Communication: Having a pleasurable time bottoming (and being a top!) should involve open communication, regardless if you have IBD. Communicating what feels good, what doesn’t, what you are comfortable with, what you aren’t, etc, is essential to having the most pleasure.

    Safe Sex: Condoms and dental dams if you are with a new partner and good hygiene ALWAYS! Brush your teeth and wash your booty!

If It Hurts:

Recurrent or persistent pain that occurs before, during or after bottoming/anal

When/How Does Painful Bottoming Happen?

  • Painful bottoming/anal sex typically occurs at the anus during initial entry or during entry and/or thrusting

  • Internal anal sphincter hypertonicity and sphincter spasms can result in difficulty with anal entry/penetration and painful anal sex

  • Sharp pain might additionally be experienced during entry/penetration or thrusting if a penetrating object pushes on the rectosigmoid junction causing mesenteric stretching (refer to the diagram- the rectosigmoid junction is roughly 6 to 9 inches (15-17 cm) up from the anus (your butthole)

  • Some people really enjoy this area and it can feel really good! (colloquially known as the “second hole”/"second ring" etc.)
  • If that is your thing/you enjoy that or it feels good to you, ensuring you are maximally prepared and relaxed is a good idea. 
  • Follow the tips above and work with your partner(s)  to make sure you are ready, and don't be afraid to try things out yourself beforehand to "test the waters" - i.e,  self play with a dildo at home, fingers, etc.

  • If you have active inflammation in this area (rectosigmoid junction/second hole) things may not feel as good and the tissue may be more prone to friability/easier to damage/bleed

  • If this is the case, take everything slow and be smart about what you do. Trust your intuition/gut feeling (even if your guts are a little diseased)

Anatomical, Physiological and Psychosocial Factors That Can Contribute to Painful Bottoming:

  • Inadequate anorectum lubrication (aka - not enough lube) (be generous with that lube)

  • The anorectal angle (the angle of a line from the anal canal tangent to the posterior rectal wall, the angle increases after evacuation (fancy word for pooping, important in anal continence and how your sphincter functions)

  • Anal sphincter tightness

  • Size of the penetrating object (whether that’s a dildo, toy, penis, finger, etc) - if it is too big (length wise or width/girth wise) you may be a bit uncomfortable. I promise your partner will understand if you need to slow down because size is an issue.

  • Lack of relaxation and foreplay - it’s so important for not only loosening things up but dilating the blood vessels and everything down there

  • Proctitis (inflammation of the rectum) may be associated with rectal pain, tenesmus and bleeding.

  • For us with IBD engaging in RAI/bottoming, increased bleeding from proctitis might not be life-threating, but could create anxiety for yourself (and partner(s) if present) from concern as well as confusion regarding the underlying source of the bleeding.

  • For individuals with prostates affected by IBD with rectal involvement, local inflammation can cause persistent prostatic inflammation (inflamed prostate area), likely affecting bottomming/RAI.

Psychosocial/ Mental and Social Health Things That Can Make Bottoming Unpleasant

  • All of these things can increase sympathetic nervous system activity that then leads to increased anal sphincter hypertonicity (AKA when you get nervous and wound up, your butthole gets too wound up  and tight too).

  • Trauma history (unfortunately, prevalent in people from sexual and gender minority communities)

  • Internalized homophobia

  • Fear of STI transmission (including HIV)

  • Fear and/or phobia of engaging in a stigmatized act (related to internalized homophobia)

  • Defecation concerns, including defecation during RAI, are associated with anodyspareunia (painful bottoming due to butt spasms)

  • This is all the more reason why it’s important to stay in tune with your mental wellbeing and mental health, and check in with a therapist/psychologist/psychiatrist/mental health professional of whatever flavor to make sure everything is good.
Detailed anatomy of the anus and rectum - the anorectal junction (“second hole” is circled) If your IBD is active in this area, you may not have as much pleasure here.

IBD Systemic Inflammation and Bottoming

  • Widespread/systemic inflammation in IBD can also make bottoming not the best.

  • Systemic inflammation from IBD can cause side effects with negative impacts on things in the bedroom, including:

  • Fatigue

  • Fecal incontinence

  • Bloody diarrhea

  • Abdominal pain and malnutrition

  • All of which can contribute to less fun in the bedroom.

  • The fear of having diarrhea can also contributing to issues with intimacy, so make sure this is something you talk to your doctor about if it’s an issue important to you, and communicate to your partner as a concern (but NOTHING to be insecure or worried about - everybody poops!)

  • Although RAI/bottoming might initially be painful, over time, the pain generally diminishes and pleasure increases - practice and getting more comfortable with bottoming can make things go easier. This goes for everyone - IBD or not.

And most importantly, don’t let the haters (or very misinformed people) get you down! You can, in fact, bottom with IBD (and honestly, it’s like a built in advantage because it sometimes makes it a little easier, especially when prepping - when life gives you lemons ya know)