Re: Bleeding During Anal Sex
Denna Repaci
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The objectives of this study were to evaluate the frequency and determinants of rectal bleeding and the association between rectal bleeding and risk of human immunodeficiency virus (HIV) infection among homosexual/ bisexual men in Mexico City. Men who requested anonymous HIV testing at a public clinic in Mexico City and who reported engaging in any homosexual behavior were eligible to participate in this study. Trained staff collected information on demographic factors, sexual behavior, psychological states, and HIV serostatus from all consenting, eligible clients. Logistic regression modeling was used to investigate the independent effect of risk factors among 2,758 men who were tested between June 1991 and December 1992. Bleeding during anal intercourse was a common occurrence: More than one third of the men in the study reported some bleeding, and 8% reported bleeding in half or more of their intercourse episodes. The prevalence of HIV infection among bleeders was 42% as compared with 28% in nonbleeders (p < 0.0001), and the adjusted odds ratio was 1.8 (95% confidence interval (CI) 1.1-2.8) for men who bled in more than half of their anal intercourse episodes relative to nonbleeders. There was a trend of increasing HIV seroprevalence with increasing frequency of rectal bleeding (p = 0.001). Nine percent of all HIV infections and 42% of infections among frequent bleeders were attributable to rectal bleeding. Men who reported both rectal bleeding and anal warts were 3.5 (95% CI 2.1-5.8) times more likely to be HIV-infected in multivariate analysis than men reporting neither rectal bleeding nor anal warts. Determinants of rectal bleeding included older age, more education, more receptive anal intercourse than insertive intercourse, receptive digital-anal contact, anal warts, and genital ulcers. Among men reporting sex with men in Mexico City, rectal bleeding is common. It is an independent risk factor for HIV infection, and warrants attention in acquired immunodeficiency syndrome prevention efforts. Rectal bleeding that results from rupture of anal warts may be an especially effective portal of HIV transmission.
PIP: During June 1991 to December 1992, 68.8% of all men who gave informed consent for HIV testing at a public health clinic in Mexico City and for participation in this study had ever had sexual intercourse with men. The final sample size was 2758 men. The study examined the reported frequency of rectal bleeding, the determinants of rectal bleeding, and the interactions between rectal bleeding and other risk factors with HIV infection among homosexual/bisexual men. It also aimed to determine whether rectal bleeding is an independent risk factor for HIV transmission. 32.8% had HIV infection. 39% reported some rectal bleeding during anal intercourse. 8% experienced rectal bleeding during at least 50% of intercourse episodes. Overall, bleeders were more likely to be HIV infected than nonbleeders (42% vs. 28%; p 0.0001; adjusted odds ratio [AOR] = 1.8 for men who bled in more than 50% of anal intercourse episodes; AOR = 1.3 for men who sometimes bled). The odds ratios increased as the frequency of reported rectal bleeding increased (p = 0.001). Condom use during receptive anal intercourse did not affect the association between rectal bleeding and HIV infection. 9% of all HIV infections were attributable to rectal bleeding. 42% of HIV infections among bleeders were attributable to rectal bleeding. In the multivariate analysis, men with both rectal bleeding and anal warts were more likely to have HIV infection than men who had neither (67.9% vs. 27.2%; AOR = 3.5). Significant predictors of rectal bleeding were older age (i.e., =or 30) (AOR = 1.5), more education (AOR = 1.4-1.5), more receptive anal intercourse than insertive intercourse (AOR = 5.3-16.1), receptive digital-anal contact (AOR = 1.6), anal warts (AOR = 1.9), and genital ulcers (AOR = 2). These findings show that rectal bleeding is an independent risk factor for HIV infection. Rupture of anal warts is an especially effective portal of HIV transmission.
Dr. Janet Brito is a nationally certified Latinx sex therapist, supervisor, speaker, trainer, and author. Dr. Brito is the founder and owner of the Hawaii Center for Sexual and Relationship Health, a group practice that specializes in relationship and sex therapy, out of control sexual behavior, and gender and sexually diverse populations, and The Sexual Health School, an online training program for healthcare professionals seeking human sexuality training.
Louise Morales-Brown is a social researcher within the civil service, collecting evidence of social issues to inform and evaluate policy decisions. She has an undergraduate degree in applied psychology and criminology from the University of Brighton, in the U.K. She is currently undertaking her Ph.D. part-time at Lancaster University, where she is researching into patient experiences of diabetes distress.
Bleeding after anal sex can also occur as a result of an infection. Similar to other forms of sex, anal sex can lead to sexually transmitted infections (STIs), such as chlamydia and gonorrhea of the rectum, which can cause bleeding.
One of the first things that a person should do after having anal sex is to wash the area well with warm, soapy water. If bleeding has occurred, a person should clean the area with their finger, removing any dried blood or lubricant.
Another aim of treatment should be to keep the digestive tract functioning well. A person should eat plenty of fiber and drink enough water to keep their bowel movements coming. Preventing constipation can help stop anal fissures from worsening.
Dr. Deborah Weatherspoon is a former university nursing educator and has authored multiple publications. She has also presented at national and international levels about medical and leadership issues.
A sitz bath is a therapeutic warm water bath that immerses just the buttocks and hips. It can provide comfort and relief from hemorrhoids, anal herpes, proctitis, fissures, and more. The addition of salt helps relieve pain.
If using a suppository, stand with one foot on a chair or shower side. Relax your back and buttocks. Insert the suppository into the rectum. Gently but firmly push the medicine or capsule past the anal sphincter.
While the rectum or anus is healing, consider using a stool softener to make bowel movements easier to pass. This will relieve pressure on the delicate tissues and reduce the chances of additional bleeding.
They may also order a sigmoidoscopy or anoscopy. These tests use lighted tubes with a camera to see inside the rectum and lower GI tract. Conditions like hemorrhoids, fissures, or a perforation will be visible.
Rectal bleeding, or hematochezia, is a frequently encountered problem in the outpatient setting. It can herald a pathology in the proximal lower gastrointestinal tract, but it can also be from diseases specific to the rectal region, such as hemorrhoids, fissures, proctitis, and anorectal malignancy. This activity reviews the evaluation and treatment of rectal bleeding and highlights the role of the interprofessional team in the care of patients with this condition.
Objectives:
- Identify the etiology of rectal bleeding.Review the appropriate evaluation of rectal bleeding.Outline the management options available for rectal bleeding.Summarize interprofessional team strategies for improving care coordination and communication to advance the care of rectal bleeding and improve outcomes.
Rectal bleeding, or hematochezia, is a frequently encountered problem in the outpatient setting. It can herald a pathology in the proximal lower gastrointestinal tract, but it can also be from diseases specific to the rectal region, such as hemorrhoids, fissures, proctitis, and anorectal malignancy. Unfortunately, it has been reported that less than half the patients with rectal bleeding will ever seek medical help for their symptoms.[1][2]
Rectal bleeding presents as frank red blood exiting from the anus. The presentation may range from mild to severe, depending on the etiology of the bleeding. Mild cases may appear as red blood streaking the patient's stool or toilet paper after wiping, and severe cases may present as a large volume, brisk bleed. The following review will discuss rectal bleeding with more focus on hemorrhoids as it is the most common cause of rectal bleeding in the middle-aged and elderly populations.
Gastrointestinal bleeding is divided into the upper and lower gastrointestinal tract (GIT) bleeding based on whether the bleeding originates from above or below the ligament of Treitz (suspensory ligament of the duodenum). Rectal bleeding is mainly caused by pathology from the lower GI tract, which includes the small intestine beyond the duodenum, the colon, rectum, or anal canal.
Upper GIT bleeding: Upper GI bleeding can present with black tarry stools. As the blood passes through the GIT, gastric and duodenal secretions convert hemoglobin into acid hematin giving the stool its dark reddish-brown color. Hematochezia may result from upper GI bleeding if the bleeding is of large enough volume that the gastric and intestinal secretions are not sufficient to convert hemoglobin into acid hematin. Blood also acts as a cathartic, decreasing intestinal transit time and providing less time for the enzyme reaction to take place. If a patient is experiencing hematemesis associated with hematochezia, this would further suggest that the source of the bleed is coming from the upper GI tract, especially if these symptoms are associated with hemodynamic instability or shock. Examples of upper GI bleedings that may cause hematochezia include a Mallory Weiss tear, bleeding esophageal varices, or a perforated gastroduodenal artery. It's worth mentioning that in patients with insufficient secretion of gastric HCl, as in achlorhydria, an upper GI bleed may present with hematochezia as well. General causes of bleeding: When evaluating an individual for GI bleeding, it is also important to consider other underlying factors that may be contributing to the acute presentation. This includes bleeding diatheses such as vitamin K deficiency, hemophilia, thrombocytopenia, or anti-coagulant toxicity.
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