Anal sex may be linked to an increased risk of incontinence, particularly among men who have sex with men, a U.S. study suggests.
Researchers analyzed national health survey data from 6,150 adults and found 37 percent of women and about 5 percent of men reported trying anal intercourse at least once.
When they did, the women were 50 percent more likely than their peers to report having fecal incontinence at least once a month, while the men’s odds of incontinence were almost tripled.
“While this study does not give us data on the frequency of anal sex and the impact on fecal incontinence, we did see a relationship between the practice of anal sex and fecal incontinence, more so among men than women,” said lead author Dr. Alayne Markland of the University of Alabama at Birmingham.
“We just don’t know if someone who has anal sex one or two times is at the same increased risk for fecal incontinence compared to someone who has anal sex regularly,” Markland added by email.
Even though anal intercourse is common among both heterosexual and homosexual couples, little is known about how this practice might impact bowel function, Markland and colleagues note in the American Journal of Gastroenterology.
To assess how these two things might be related, the researchers reviewed responses to the National Health and Nutrition Examination Surveys completed in 2009 and 2010 from adults 20 years and older.
The survey posed different questions to women and men, which might account for at least some of the differences in outcomes by gender in the study.
For women, the survey asked, “Have you ever had anal sex?” But for men, the survey asked, “Have you ever had any kind of sex with a man, including oral or anal?”
To determine fecal incontinence, researchers reviewed responses to survey questions about leakage of mucus, liquid or stool occurring at least monthly.
Most adults who experience fecal incontinence have only occasional bouts of diarrhea. The condition can be chronic, however, and can be caused by muscle and nerve damage around the rectum, constipation, certain diseases and surgical procedures and by childbirth.
Overall, 8.3 percent of women and 5.6 percent of men in the study had fecal incontinence. About 10 percent of women who had anal sex also had incontinence, compared with 7.4 percent of women who didn’t report this type of intercourse in the survey.
Almost 12 percent of men who had anal sex had incontinence, compared with about 5 percent of men who didn’t.
The results don’t prove anal sex causes incontinence, the authors note. They also lacked data on the frequency of anal sex, which might influence the results. Even so, the findings suggest that doctors may want to discuss the possibility of a connection with patients, the authors conclude.
“These findings will likely become an important part of the patient education counseling physicians provide to their patients,” said William Whitehead, director of the Center for Functional GI and Motility Disorders at the University of North Carolina at Chapel Hill.
“While it is tempting to think that only the rare patient who is a gay male would benefit from such counseling, this study makes it clear that anal intercourse is a common practice that is not limited to gay men,” Whitehead, who wasn’t involved in the study, added by email.
More research is needed to understand how anal sex might lead to incontinence, though it’s possible that the practice contributes to decreased anal sphincter tone that leads to stool leakage in some people, Whitehead said.
“However, common sense suggests that people who engage in anal intercourse should be advised against introducing rigid or large objects into the rectum as this increases the risk of trauma,” he said. “They should also be encouraged to treat pain or bleeding as a warning to stop and seek medical evaluation.”
