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Inflammatory Bowel Disease, Colorectal Surgery, And Gay Kink

A slight break from your regular scheduled programming to bring you something that hopefully won’t affect you, but if it does, you’ll find a woeful lack of information about. But first: I am not a medical doctor, however I have lived with Crohn’s Disease for the best part of 25 years – obviously my experiences are n=1 and therefore may differ from yours, but I hope my perspective is helpful.

Introduction
Diseases of the bowel are unpleasant and difficult to talk about at the best of times, let alone when combined with living as an active gay man. Most medical professionals (at least in my more recent experiences) have been understanding and accommodating but it often feels like having to come out all over again: “this is my husband” when sat in a consultation room or ward together, for example [1]. Bowel diseases can lead to lethargy, complex diets, and urgent trips to the toilet, all of which can really interfere with an active social life. In the same way, being “ano-receptive” in the dry medical terminology (you enjoy getting fucked in the ass) can be a bit of a non-starter – bowel disease also evolves over time and I’ve personally found the shift from being a bottom to a top mentally difficult to adjust to.

Inflammatory Bowel Disease
IBD affects somewhere around 0.5% of the population in Westernised countries. There was a marked increase in the diseases in the 1990s, however this has stabilised in recent years. There are various forms of IBD but the most common are Crohn’s Disease and Ulcerative Colitis. Crohn’s can affect the gut from top to tail and is characterised by small patches of active disease (inflammation) interspersed with healthy bowel. Ulcerative Colitis (UC) predominantly affects the colon and anus, with disease affecting all parts of the bowel. Symptoms of IBD include diarrhoea, bleeding, cramping pain and fatigue. Medical treatment of IBD includes steroids (and sadly not the muscle-building kind), immuno-modulatory drugs, and newer “biologics” like Humira.
So far, nothing a quick google search wouldn’t tell you, but what about the impact on your sex life? Well, obviously being continuously tired or needing to dash to the toilet with little notice can rather affect ass play or a heavy bondage scene. Most IBD sufferers will be aware of their own symptoms and can usually predict whether today is going to be a good day for adventurous situations or not, but explaining this to someone you’ve arranged a meet with can be more tricky. So, tops, if someone tells you they have IBD, don’t automatically assume they’re a flake if they pull out at the last minute.
More practically, receptive anal sex (getting fucked) can be uncomfortable if you have IBD. Whilst social pressure can be strong, listen to your own body and what you can and can’t do. It’s worth discussing with your doctor, although they’re likely to be risk adverse. Obviously, if you have inflammation and ulceration in your ass, this is going to make getting fucked painful. There is some evidence to suggest that Crohn’s Disease sufferers have a less elastic bowel wall which can make things uncomfortable. Active inflammation can also make the bowel wall more permeable to infection so it’s important to practice safe sex [2].

Colorectal Surgery
Around 80% of IBD sufferers will require surgery at some point in their lives, of varying degrees. Some will require a permanent stoma formation where the bowel is diverted into an external bag. For many IBD sufferers this can give them their life back, but it’s worth considering its impact on your sex life – doctors may well you “it will have no impact” without realising this may not necessarily be true for a gay fetishist. What will be the impact on you wearing tight latex, or getting fucked (some stoma formations result in you losing your anus)? I can’t give you a great answer here, but these are things to ask and discuss with your partners and doctors.
Fissures and fistulas can affect the whole population (prevalence is about 0.01%), but having IBD greatly increases the chances of one. A fissure is a tear in the lining of the anus which causes pain and bleeding when using the toilet, or obviously, when indulging in ass play. There are various medical and surgical treatments for fissures, but it’s probably best not to have anal sex until you’re healed.
A fistula is a tunnel from the inside of the anus. This can become infected which leads to an abscess, an intensely painful experience. Fistulae rarely resolve themselves and surgery is generally required, which can involve “laying open” of the tract, itself a not overly comfortable healing process. Depending on where the fistula was, this could involve cutting through sphincter muscle and may lead to some loss of continence [3]. 
My personal experience suggests that ass play is going to be off limits if you have any kind of fissure or fistula surgery, and you have complications such as IBD. 

Conclusions
Many doctors will not automatically provide help and information to gay men about sex and relationships that are impacted by IBD and colorectal surgery. You, as a patient, will need to come out all over again, but in my experience, once you’ve done this, you’re likely to receive a sympathetic and understanding response.
Colorectal surgery can have serious impacts on life as a gay man. As well as time for physical healing, addressing mental health challenges and giving time for relationships to adjust is important.
Members of the gay fetish scene should be aware of IBD and how this can affect societal pressures.

References

  1. https://www.magonlinelibrary.com/doi/abs/10.12968/gasn.2014.12.6.19
  2. https://academic.oup.com/ibdjournal/article-abstract/23/8/1285/4560709?redirectedFrom=fulltext
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5231615/


If you have any comments or experiences to add (either as a patient or healthcare provider) please add them below or email me via loki at this domain.