Anal Pleasure and Health: A Guide for Men, Women and Couples (41 page)

I'm not at all suggesting that IBS is "all-in-the-head"-quite the contrary. IBS is a powerful example of how emotions and body constantly interact, sometimes with devastating results. In my own practice, I've worked with dozens of clients with IBS who were surprised to discovered that they had accumulated a tremendous amount of unacknowledged anger and/or fear in their digestive systems and that, in turn, their distressing symptoms made them feel even more upset. I'm pleased to report that many of these clients found considerable relief when they became conscious of and expressed their most difficult emotions. Daily use of virtually any relaxation technique can be highly beneficial, as is the seven-step selfhealing program that I'll describe shortly.

FECAL INCONTINENCE. Fecal incontinence refers to unintended releases of rectal contents, which can result in unwanted passage of solid or liquid stools. Some experts include involuntary passage of gas in the definition, but this makes no sense, at least in cases when only gas is passed. Unwanted farting is the result of producing too much gas-some of which is an inevitable byproduct of digestion-not the inability to contain it. During episodes of rectal incontinence, soiled underwear is common and popularly called "pooping one's pants."

Involuntary releases of solid feces are extremely rare, significantly less than I% report doing this. Involuntary releases of diarrhea, however, are understandably much more common, especially among the elderly. Those who suffer from IBS and tend toward diarrhea, also report losing control at times. The problem here is mostly the diarrhea itself, not the inability of the anus to control it.

I'm bringing up this problem here because, over the years, I've heard so many clients express concern that becoming sufficiently relaxed to enjoy receiving an object or penis, especially doing this regularly, will lead to incontinence down the road. There is no indication that even frequent anal intercourse leads to incontinence. To confirm my observations, I asked several physicians with large gay practices if they had ever seen a case like this. They had not, except in a few instances where there was clear damage to the anal sphincters, general problems with the motor functioning of the pelvis, or spinal cord injury. Some of these doctors expressed surprise that they hadn't even seen more incontinence problems among regular practitioners of fisting (handballing). Actually this was quite rare as well, unless there was obvious damage to the anus or rectum.

Exercising the anal and pelvic muscles helps prevent the development of incontinence. Unexercised anal and pelvic muscles tend to become flabby over time and, therefore, can't do their job properly. I suspect that part of the reason why the elderly often lose bowel control is a result of muscular deterioration from lack of exercise. Not surprisingly, exercising these muscles improves their tone and elasticity, both of which are necessary ingredients for healthy bowel functioning. In addition, paying attention to one's diet, especially getting enough fiber, tends to counteract diarrhea, except when it is a symptom of an intestinal infection, food poisoning, or the flu.

CHRONIC PELVIC PAIN SYNDROMES. There is a growing recognition in modern medicine that coincides with my own observations over the years. Not only is chronic anal and pelvic tension implicated in the common problems I've just described, but a vicious cycle-tension
pain
anxiety b more tension b more pain-often makes the muscular contractions and spasms increasingly worse. As a result, many people develop a wide range of symptoms that have baffled physicians for a very long time.

For example, the vast majority of cases of prostatitis (inflammation of a man's prostate gland) are not caused by bacteria. This is easy to determine with lab tests. Similarly, many men have intermittent or constant pain or discomfort in the genital area, perhaps the penis, scrotum, testicles, or perineum (the sensitive area between the genitals and the anus, with or without lower back or thigh pain). There may be burning during urination, even erection or ejaculation problems.

More often than not, doctors are unable to indentify any specific cause for these problems, and have traditionally used a variety of Latin terms that sound impressive but, in the end, are pretty much meaningless. For the suffering patient, a growing sense of anxiety or helpless depression can develop, a natural reaction to chronic pain, especially when there seems to be no identifiable reason for it.

Many women experience similar chronic or recurring symptoms. Pain or discomfort may be felt anywhere or all over the vulva (external genitals, including inner and outer lips). Vaginal pain may be so severe that intercourse is impossible to enjoy (dyspareunia), often leading to a complete loss of sexual desire. Sometimes pain is felt just above the pubic bone around the bladder area or the outer or inner parts of the clitoris. As with men, urination can be accompanied by burning sensations. Anal and/or rectal pain is another common symptom, even when no obvious cause (such as a hemorrhoid or fissure) can be found. Pain may also involve the back, buttocks, or thighs.

In 1995, the National Institutes of Health (NIH) acknowledged that the grab-bag of names given to these problems (especially chronic nonbacterial prostatitis in men) didn't really shed any useful light on them. They adopted a new name: Chronic Pelvic Pain Syndromes. When someone has these sorts of aches and pains, all known causes must, of course, be ruled out because, as we have seen, many infections and specific diseases cause similar symptoms.

When pain persists even after an anal or pelvic disease is treated, or if no indication of a specific disease can be found, medical experts have been focusing more and more attention on the incredible range of manifestations of intense, chronic tension of the pelvic floor muscles (see Figure 2 on pages 38-39 to refresh your memory about these muscles). The tension can become so profound that certain "trigger points"-specific areas of one or more muscle groups-set off a cascade of spasms, with increasingly greater ease. Over time, a trigger point can evolve into a "hair-trigger point."

You probably recall that the muscles of the pelvic floor are interconnected. Therefore, tension rarely "stays put" in one muscle, but tends to spread to the others. Since one of the main functions of the pelvic floor is to support and anchor the organs of the pelvis, it's easy to picture how muscle cramping can cause discomfort in one or more organs. In addition, pelvic floor muscles are connected to the bones of the pelvis and the lower back. When they're constantly constricted, they put a tremendous strain and the skeletal system and, therefore, pain can radiate far beyond the pelvic region. Finally, supertight muscles cut off blood flow the region and also compress nerves, including the sciatic nerve that runs through the pelvis and down the legs. No wonder the symptoms are so incredibly varied.

The Department of Urology at Stanford University, using a multidisciplinary approach, has made major strides in understanding and treating chronic pelvic pain. They teach their patients how to cultivate a deep awareness of the pelvic muscles by paying attention without self-judgment, "going with" pain or discomfort instead of fighting it. They call this counter-intuitive response to pain "paradoxical relaxation," because trying to relax hurting muscles actually keeps them tense.

Fundamentally, they apply mindful self-exploration to the problemessentially the same approach I've laid out in this book. They also advocate self-touch, but in an extremely focused, frequent, and dedicated way. Patients are taught how to find and massage their own trigger points to gradually calm their reactivity. Specially trained physical therapists use their skills to help patients identify and learn about their trigger points. Another crucial component is learning to accept and release the anxiety and other emotional distress that has understandably built up around the problem, and ends up perpetuating it.

Their approach is called the Stanford Protocol, and they claim significant symptom reduction for 70% of men with "prostatitis" who didn't respond to other treatments. They're also seeing unmistakable benefits for the array of other symptoms of chronic pelvic pain. Other medical centers are developing similar methods to better understand and treat these problems emanating from the complex pelvic floor.

Most readers of this book are likely to be dealing with some degree of pelvic tension. If you've discovered that you anal-pelvic muscles are chronic tension zones, you're more likely to have some symptoms as a result. It all depends on how much tension you've accumulated and long it's been going on. Relatively few readers will have the level of severe contractions and spasms required to produce the debilitating symptoms I've described in this section. But if you're having some of these symptoms, and your doctor has
ruled out other known causes, I strongly recommend that you look into this promising approach.*

GUIDELINES FOR SELFHEALING

AT THE VERY FIRST sign of anal irritation or symptoms-or starting now if you already have them-I suggest that you dedicate yourself to a simple, seven-step program to help mobilize your body's innate capacity for healing. If you've tried the exercises suggested throughout this book, you're already familiar with the awareness and relaxation-based approach that I advocate. The only difference here is that you'll be applying these methods, at least initially, to the singular goal of promoting anal wellness. Once your anus and rectum are feeling much better, your discoveries will have prepared you for whatever forms of anal enjoyment might interest you, if any. People who have appreciated anal pleasures in the past may be eager to start enjoying them again, but this isn't always the case. Especially if an anal problem has caused you a lot of pain and emotional trauma, it may take quite a while before you're ready to fully enjoy your anus again. Be patient with yourself.

This program works best with health problems caused or seriously aggravated by chronic muscle tension. Included in this category are most, if not all, of the health concerns I've just described, especially hemorrhoids, fissures, constipation, Irritable Bowel Syndrome (IBS), and the Pelvic Pain Syndromes as well.

Keep in mind that this approach won't help you directly with an STD or any other condition caused by an infectious pathogen. But there are many potential indirect benefits even for STDs. For one thing, reducing overall stress and tension-a key goal of the program-can strengthen your immune system. This is especially clear in the case of herpes, since outbreaks are often caused or aggravated by stress. Once an STD is healed-or you've done all you can to adapt to it-deep relaxation can improve your quality of life and help counteract the fear, confusion, and shame that so often accompanies an STD.

If you don't notice improvement in your symptoms within a few weeks, or whenever you're in significant pain, it's wise to consult a sensitive physician. But be sure to continue with the selfhealing program, and tell him or her about your activities. If you decide that a medical procedure is necessary, your ongoing commitment to selfhealing will speed your recovery.

• Step 1: Examine your anus visually with a mirror (see Chapter 4) and, unless it's too tender to touch, gently explore your anal opening with your fingers. Doing so will give you invaluable information about what's really going on back there. Repeat the visual self-exams periodically and note any visual changes (most likely they'll be quite obvious). Find the most comfortable way to stroke your anus while breathing deeply at least once, preferably twice, per day.

• Step 2: Suspend all anal sex play until the problem is resolved or sufficiently understood for you to make informed decisions about which activities, if any, are consistent with healing. External anal touch-tenderly provided by yourself or a sensitive partner-can be soothing and helps promote relaxation. Gently inserting a finger into your anus may also help you relax, as long as there's absolutely no pain involved. You might leave your finger inside for a few moments as you breath. Withdraw your finger very slowly. Use a water-soluble lubricant for easy cleanup.

• Step 3: Take frequent warm baths-two or three times per day is ideal-especially after bowel movements. Warm water contributes to relaxation, increases blood flow and removes irritants from the area. If comfortable, do some of your gentle stroking and breathing while in the tub. During deep breathing and warm baths, visualize your anal muscles relaxing, and the pain and irritation receding. Picture in your mind the anal tissues becoming warm and healthy (see Chapter 6).

• Step 4: Pay special attention to your diet. First of all, stay away from items that might irritate your GI tract, such as spicy foods, nuts, and other items that may not digest completely and thus leave rough edges. It's also smart to take a break from alcohol (which irritates the digestive system) and caffeine (which can exacerbate constipation or diarrhea). At the very least, keep consumption to a minimum.

At the same time, actively develop a high-fiber, low-fat diet. The best sources of fiber are fresh fruits and vegetables, whole
grains, and legumes (unless they give you gas). Chances are you can also benefit from fiber supplements such as psyllium (Metamucil°)-especially
easy to take in capsule form-or oat bran. And don't forget to drink plenty of water. Eight to 10 glasses per day are recommended, but do the best you can. Fluids are as important as fiber (they work wonders together) for optimal stool consistency and bowel function.