Why do I get haemorrhoids every time I bottom? Dr Ranj Singh advises on anal sex

The questions I get asked most frequently about anal sex aren’t about pleasure, positions or preparation; it’s about what happens afterwards. 

It was no surprise then, when one of the team at Attitude Towers questioned why they develop haemorrhoids (piles) after bottoming, even when they’re using plenty of lube. It’s a frustrating problem, and one that can make people anxious about sex. 

The first thing to know is that not every sore, swollen or bleeding bum is actually a haemorrhoid. There are several conditions that can cause similar symptoms. Anal fissures (small tears in the lining of the anus), irritation from friction, infections and even simple swelling of the tissues after sex can all be mistaken for haemorrhoids. That said, haemorrhoids are common, and anal sex can sometimes make them worse. 

What are haemorrhoids?

Haemorrhoids are enlarged blood vessels in and around the anus. We all have these vascular cushions naturally – they help us maintain continence. Problems arise when they become swollen, inflamed or enlarged. Symptoms can include itching, discomfort, lumps around the anus and bright-red bleeding, particularly after opening your bowels. 

So, why might bottoming trigger them? Partly, it’s down to pressure. Anal penetration stretches the tissues around the anus and can temporarily increase pressure within those blood vessels. If you already have a tendency towards haemorrhoids, sex may simply aggravate an existing problem rather than cause a new one. 

How to stop it from hurting

It’s also worth remembering that lube, while incredibly important, isn’t magic. Successful bottoming isn’t just about reducing friction. It’s also about relaxation, communication, preparation and allowing your body time to adapt. The muscles around the anus are designed to stay closed most of the time. If you’re tense, anxious or rushing things, those tissues are more likely to become irritated. 

And let’s talk about pain. There’s a persistent myth that bottoming is supposed to hurt. It really isn’t. Stretching sensations may be normal during initial penetration, but significant pain is a sign that something needs to change. More relaxation, more lubrication, more communication, more time – all of these. 

One of the most overlooked aspects of anal health is actually bowel health. Constipation, straining on the toilet, spending 20 minutes scrolling through social media while sitting on the loo, dehydration and a low-fibre diet are all major contributors to haemorrhoids. In many cases, sex simply draws attention to a problem that was already brewing. This is why prevention starts long before the bedroom. 

How to treat haemorrhoids

The good news is that genuine haemorrhoids are often very treatable. Many improve with simple measures such as increasing fibre intake, drinking more water, avoiding straining and using over-the-counter treatments. Warm baths can also help relieve discomfort. 

For more persistent cases, treatments such as rubber-band ligation (placing a tiny band around the haemorrhoid, cutting off its blood supply so it gradually shrinks), or sclerotherapy (injecting the haemorrhoid to make it shrink) can be highly effective. Larger haemorrhoids may occasionally require surgery, but that’s usually reserved for cases that haven’t responded to simpler approaches. 

Of course, not all bleeding after anal sex is caused by haemorrhoids. Small fissures can cause surprisingly dramatic bleeding and are often associated with a sharp, tearing pain. Certain sexually transmitted infections, including gonorrhoea, chlamydia, herpes and syphilis, can affect the rectum and cause bleeding, pain or discharge. More rarely, inflammatory bowel disease, polyps and bowel cancer can also show up with rectal bleeding. 

Treat your bottom with care

That’s why you should never assume that bleeding is “just piles”, especially if it’s recurrent, worsening or accompanied by other symptoms such as changes in bowel habits, abdominal pain or unexplained weight loss. 

The (excuse the pun) bottom line? Your sex life should be pleasurable, comfortable and enjoyable. If you’re consistently experiencing bleeding, pain or swelling, find out why. The answer might be changing technique or improving bowel habits. Or you might have a condition that needs treatment. Either way, your bum deserves just as much care and attention as every other part of your body.   

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This is a feature appearing in issue 371 of Attitude magazine, on sale in print and digital now. Order Attitude magazine issue 371 in print now, or in digital on the links below on Apple News+ and the Attitude app.