How to Live with Ulcerative Colitis and Still Have a Sex Life

Many a stigma limits people from exploring all avenues of their sexual desires. And in a culture that treats bowel functions as taboo, that can be especially true for people living with digestive conditions. For those with inflammatory bowel diseases like ulcerative colitis (UC), which includes symptoms like diarrhea, rectal bleeding, abdominal pain, frequent bowel movements and urgency, this fear fuels a common misconception: that receptive anal sex is forever off the menu.Benching backdoor action may sound like little more than a minor coital inconvenience. But actually, “this belief can feel devastating for people who experience ass play as central to their erotic identity,” says mental health expert and sex therapist Jesse Kahn, LCSW, CST, director of The Gender & Sexuality Therapy Center in New York City. Those people include queer men, people with vaginal scarring or chronic pelvic pain who rely on anal play for pleasure, and individuals taking medications like SSRIs that dull other types of touch.But the belief that anal play is always off-limits for those living with UC is largely a myth, according to gastroenterologist Carlton Thomas, MD, who gives professional and personal safety tips about pooping and anal play through his TikTok and Instagram. “If your ulcerative colitis symptoms are under control and you’re not experiencing bleeding or diarrhea, then penetration is absolutely fine,” he says.While he doesn’t advise bottoming—being the receiver of anal penetration—during active flares, “plenty of people with inflammatory bowel disease participate in receptive anal sex, and even intense forms of anal play like fisting, when they’re in remission,” he says.The potential risk of receiving anal with a UC flarePractically speaking, the symptoms associated with UC “can make it hard to feel sexy, so most people aren’t thinking about anal sex during flares,” says Evan Goldstein, DO, a doctor in New York City who specializes in anal care, the founder of Bespoke Surgical, and the author of Butt Seriously. But even if someone were inclined to push through, penetration during a flare is likely to be painful at best and dangerous at worst.During flares, the tissue lining the digestive tract becomes tender and more prone to irritation or tearing, says Dr. Thomas. Worse, because the rectal lining may already be compromised, anal penetration can lead to tears, abscess formations, and other complications along the anal canal, he says. Especially in the absence of barriers, there’s also an increased risk of contracting sexually transmitted infections like chlamydia, gonorrhea, syphilis, herpes, or HIV, he adds.There’s emerging evidence that inflammatory bowel disease flares can disrupt the gut and anal microbiomes—the community of microbes that supports anal and digestive health, notes Dr. Goldstein. When that microbial balance is thrown off, the protective lining of the lower digestive tract can become more vulnerable to irritation, infection, and slower healing. For people with UC, whose tissue is already inflamed, that means friction from penetration can be more likely to aggravate symptoms, he says.What’s more, the common pre-anal practice of douching—rinsing your rear with water or a cleansing solution before sex—can compound the problem, Dr. Goldstein says. Tap water or harsh cleansing solutions can strip away protective mucus and further disrupt the microbiome, potentially worsening irritation in an already inflamed rectum, he says.Unfortunately, the pressure to douche thoroughly can feel especially intense for people with UC, since symptoms like anal bleeding, mucus, and unpredictable bowel movements can make people worry about mess during sex, says Dr. Goldstein. But aggressive or frequent douching can further irritate already sensitive tissue, potentially prolonging flaring or triggering additional symptoms, he says.When anal penetration is back on the tableModern medicine has transformed life with UC, according to Dr. Thomas. Today, many people manage UC effectively with anti-inflammatory, steroidal, immunosuppressant, or biologic therapies that help control inflammation in the colon and rectum.When combined with lifestyle interventions—stress management, dietary adjustments, and adequate sleep—many patients can enter week-, month-, and even year-long bouts when inflammation is in check and symptoms are at bay, he says. “During these stretches of remission, receptive anal penetration is absolutely fine,” he says. More than fine, it can be safe and very pleasurable.Dr. Thomas generally recommends waiting at least a few weeks after symptoms have resolved before attempting penetration. Internal inflammation and irritation can persist for some time even after outward symptoms have disappeared, so this rest allows them to subside fully.If you’re unsure whether your body is ready, Thomas suggests starting with a simple self-check. Apply a generous amount of lubricant to your finger or a slim dildo and gently test penetration yourself. (FYI: The shape of anal beads, prostate massager, and butt plug is less optimal for this kind of test). If you experience any discomfort or pain, or there’s any blood on the object upon removal, that’s a sign that your body needs more time to heal.How to have pleasurable anal intercourse with UCThe key to pleasurable anal if you have UC is finding a treatment regime that helps you enter remission—then sticking with it. “Clear, proactive communication with your partner beforehand about what feels good, what’s off-limits, and how you’ll express a need to stop or slow down is also essential, because ulcerative colitis can involve fluctuating symptoms, and anal sex requires attunement even without a chronic condition,” says Kahn.Beyond that, however, most butt-play rituals follow the same basic principles, whether you have inflammatory bowel disease or not.One of the most important is choosing a penetrative tool that’s appropriately sized for your experience level, says anal sex educator Alex Hall, founder of The Bottom’s Digest, a one-of-a-kind resource for anal-friendly recipes and lifestyle tips. If you’re new to anal play—or returning after time off due to a flare—that may mean starting with a slim, anal-safe dildo or vibrator before graduating to a partner’s anatomy.Once play begins, lube and patience are key. “Every booty has two muscles working together: the external and internal anal sphincters,” explains Hall. The external sphincter is a voluntary muscle you can consciously tighten or relax. (Go ahead and squeeze your butthole as you would to hold in a fart right now—that’s your external sphincter in action). The internal sphincter, by contrast, is controlled automatically by the nervous system and usually needs time and relaxation before it comfortably allows penetration, he says.To help these muscles relax, Hall recommends the “butt clock” technique, developed by Dr. Thomas. After applying plenty of lubricant, gently insert the tip of a finger and press toward the front of the body—roughly the 12 o’clock position—for 30 seconds while taking slow, deep breaths, Hall explains.“The magic happens on your exhales, so make them long,” he says. After 30 seconds, move to 3:00, then 6:00, then 9:00. Keep moving around the “clock” until your finger slides comfortably into the rectum, and you feel zero pain.”Once the muscles relax and penetration feels comfortable, you can gradually experiment with deeper insertion. But keep checking in with your body as things progress. If, at any point, you feel discomfort during anal play, press pause, suggests Hall. Pain is your body’s way of telling you your anal sphincters aren’t yet adequately relaxed—or that there is still some lingering irritation or inflammation from a recent flare.Remember: Anal pleasure doesn’t start and stop with penetrationAnal penetration can be incredibly pleasurable, but remember: that’s only one of many ways to experience anal pleasure. “There are a million things you can do other than anal intercourse,” says Dr. Thomas.External stimulation around the anus, oral-anal contact, shallow touch near the opening, kneading of the glute muscles, and vibrators designed for external play can all be pleasurable options—especially for those of you with UC who need to avoid anal intercourse during flares, and while your bodies are fully healing.