Bleeding after anal sex typically isn't cause for concern.
Many people experience light spotting from time to time due to the delicate nature of the tissues involved.
If you're experiencing heavier bleeding, though, it could be a sign of an underlying condition or injury that should be addressed.
You should see a doctor or other healthcare provider if you notice more than a couple of drops of light pink blood, or if you experience discomfort that lasts for more than two days.
Here's how to identify the cause, tips for relief, how to reduce your risk for future bleeding, and more.
Bleeding after anal sex is often the result of too much friction, rough behavior, or cuts from fingernails.
Most common causes
- Anal tears (fissures). The delicate tissue inside the rectal canal and around the anus can tear during penetration. The tears are typically caused by friction, but fingernails can also be responsible. Pain, especially with bowel movements, often accompanies bleeding from fissures.
- Dilated veins (internal or external hemorrhoids). These swollen blood vessels may be undetectable until they burst during anal sex. The pressure and friction from fingers, a sex toy, or penis may tear open these veins. Hemorrhoids can also cause pain or discomfort during sex.
- Anal warts (condylomata). Anal warts, which are caused by a sexually transmitted infection (STI), are small and appear inside and around the anus. They typically cause no pain or discomfort, though they may itch. They may also bleed if rubbed during anal sex.
- Acute or chronic constipation. A backup of bowel movements can put a strain on the muscles of the rectum. When you push to pass stool, you can develop hemorrhoids or tears. This may lead to pain and bleeding after anal penetration.
- Overusing enemas. Enemas pass fluid into the rectum and large intestine in order to relieve constipation or deliver medication to your lower gastrointestinal (GI) tract. They're safe to use on occasion, but frequent use can irritate the tissue. This may make fissures or tears more likely during anal sex.
Less common causes
- Anal herpes. These sores or blisters around the anus are caused by the herpes simplex virus, a type of STI. Anal herpes are red bumps or white blisters, and they may bleed when irritated. They also cause pain and itching.
- Lymphogranuloma venereum. This STI causes a chronic infection of the lymphatic system and inflammation of the tissues lining the rectum, also known as proctitis. It may also lead to swelling in the genital tissues. During anal sex, the swelling and inflammation may make bleeding more likely.
Rare causes
Though very rare, it is possible to perforate, or tear, the colon during anal sex. Minor bleeding, however, won't be the only symptom. You may also experience extreme pain, swelling in the lower abdomen, fever, and nausea. If you have these symptoms, seek immediate medical attention.
If you're experiencing minor bleeding after anal sex, you can take steps to stop it and help your rectum and anus recover. Just remember the acronym WASH.
Sit in a warm bath (W)
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.
You can use a regular bathtub or purchase a special sitz bath washbasin. Many fit onto a toilet.
Fill the bath with warm water, and sprinkle Epsom salt into the water. Let it dissolve. Rest in the water for 10 to 20 minutes.
Repeat daily until your symptoms are gone.
Apply an analgesic agent (A)
Mild pain may accompany minor rectal bleeding. You can purchase over-the-counter (OTC) creams, ointments, or suppositories that are designed to temporarily numb the anal area and reduce pain.
Apply a small dab of the medicine to your finger. Gently rub the ointment or cream over the anal opening.
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.
You shouldn't use an OTC medicine for more than three days in a row. If you're still experiencing pain after three days, see a doctor or other healthcare provider.
Take a stool softener (S)
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.
Stool softeners are available as OTC oral pills or rectal suppositories. Some of these medications work by drawing water into the bowels. This makes the stool softer and easier to pass.
Be sure to drink plenty of water if you're taking stool softeners.
Eat high-fiber foods (H)
Constipation often leads to hard stool that's difficult to pass. This can irritate tissues and increase the chances of bleeding after anal sex.
Eating a high-fiber diet, however, can relieve constipation and keep the bowels moving regularly.
Fiber-rich foods include fresh fruits, vegetables, and whole grains. These foods add bulk to your bowel movements, which will make them easier to pass.
Minor bleeding typically isn't cause for concern. Spotting should end in a day or two.
See a doctor if the bleeding lasts for more than two days or becomes heavy.
Seek immediate medical attention if you experience heavy bleeding or severe pain right after anal sex. Severe pain and heavy bleeding are typically caused by an underlying injury or condition.
To understand what's causing the bleeding, your provider may perform a physical exam. This includes looking at the anus and opening of the rectum.
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.
You may be less likely to experience spotting or more severe bleeding if you:
- Start slowly. After healing, don't return with the gusto you had before. Go slow. Start with the tongue or fingers. During penetration, stop and take a measure of how you or your partner feel. Full penetration with a penis or toy doesn't have to be an immediate goal.
- Use lube — and lots of it. Unlike the vagina, the anus and rectum aren't self-lubricating. If you don't use lube, friction will happen. That can lead to tearing and bleeding. Apply lube generously to the fingers, penis, or toy. Keep reapplying if friction returns.
- Consider an anal dilator or butt plug. These devices are designed to help your anal sphincter and rectal muscles adjust to penetration. The key is to use them in increasing increments so your muscles have time to adjust. This will cut down on the chances of a tear. Talk with your doctor about the best way to use these.
- Trim fingernails. Sharp, long, or pointy nails don't belong in the anus or rectum. Ask your partner to cut, clean, and trim their nails if they plan to use their fingers during foreplay or sex.
- Use a soft, flexible dildo. Rigid sex toys can cause painful tears. Look for one that's made of a softer material, such as silicone. It will bend and flex with the body's natural curves.
- Try a facedown position. Plant your face into a pillow and stick your hips into the air. This position may relieve anal pressure and make penetration easier. With decreased pressure, you're less likely to experience any tears or cuts that might cause bleeding.
In addition to rectal bleeding, anal sex presents a few other complications, including the risk for STIs.
You should always wear condoms during any type of sexual encounter to prevent the exchange of STIs. Lubricated condoms will cut down on friction.
If you're wearing a condom, water-based lubes are recommended. Oil-based lubes can break down latex condoms, which could result in a tear.
As with any sexual activity, you can contract and share STIs during anal sex. It's important to get regular STI tests — at least once a year, if not more. This way, you can treat any infections early and prevent complications.
Though you may be alarmed to see a bit of blood after anal sex, it's not unusual.
Friction from anal penetration can cause tiny tears in the tissue or blood vessels inside your rectum. The bleeding should stop in a day or two.
If it doesn't, make an appointment to see a doctor. Your provider can help make sure the bleeding isn't more serious, and you can have peace of mind about future play.