Does anal sex cause incontinence?

The following question came by way of a Gchat message from an acquaintance:

I have a question from a conversation I had with a bunch of gay men. There were six of us, and a friend said that he had a doctor who'd warned him that continued anal sex (as the bottom) over time could permanently "wear out" his sphincter and create all sorts of incontinence problems for him as he grew older. Half of us thought it was crazed right-wing propaganda (I was in that camp). The others had heard similar things!

I CANNOT BELIEVE I'M TYPING THIS INTO A GCHAT MESSAGE. There haven’t been any large-scale, long-term incontinence studies done on gay men who bottom. (It’s hard enough to get funding for studies generally relating to sex, let alone gay sex -- so just imagine the challenge of adding in that favorite topic of toddlers everywhere: poop.) I can tell you, however, that the consensus among sex educators is that anal sex does not carry a high risk of fecal incontinence. In other words: Your friend’s docto...

That isn’t to say that such problems never result from anal sex: It certainly can if severe damage is done to the internal sphincter. That can happen “if someone doesn't use enough lube or doesn't warm up enough to relax the muscles,” says Charlie Glickman, Good Vibrations' education program manager. Other liabilities are numbing creams, alcohol and drugs, he says, “since they can make you not feel as much, even though damage is still occurring.” The takeaway: “If you're more or less sober, adequately lubed, and never going wider than your body can comfortably accommodate, you can bottom regularly for years and not have any damage.” Glickman adds, “Muscles don't wear out because you use them. If stretching muscles necessarily caused them to tear, long-term yoga practitioners would be in trouble. Just like any other muscle, relaxing and stretching the anus doesn't cause damage if you listen to your body and don't force it.”

Similarly, in “The Ultimate Guide to Anal Sex for Men,” Bill Brent writes, “Stretching the sphincter and rectal tissue safely over time tends to strengthen rather than loosen the muscles associated with anal sex, as people who practice fisting and using large toys can attest." That’s a gem of counterintuitive wisdom to share with your friends over Sunday brunch -- just maybe wait until the second round of mimosas.

So, whence did this myth arise? There have been two studies to report a marginal risk of incontinence from repeated anal sex -- but one included passing gas in its definition of incontinence, and the other used subjects who had experienced serious anal trauma (either through assault or unsafe sex of the sort that Glickman mentioned earlier). More reliably, a 1997 study found no higher incidence of fecal incontinence in gay men who bottom and nonreceptive hetero dudes (a control group -- what a concept!). Of course, there are also plenty of examples of homophobic right-wing propaganda on the topic (see here) that are not even remotely based in medical fact. It’s hard to say which is to blame for that doctor’s misinformation, but, regardless, it might be time for your friend to find a new one.

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