When bleeding after anal sex is normal, and when it’s not

Anal sex can be an exciting source of pleasure that may be enjoyed in a number of ways, such as fingering, rimming, and using sex toys, as well as penetration with a penis. However, there’s nothing quite like a bit of post-anal bleeding to dampen the mood.

Though no form of anal bleeding should really be considered normal, and it is certainly not something you should expect after anal sex, it can happen and it is not uncommon. Serious injuries from anal sex are rare, however, any bleeding from the back passage afterwards may seem alarming, whether it’s your first time or you enjoy anal sex regularly.

If you have any worries or concerns regarding anal bleeding, you can always run them by your doctor. That being said, not all bleeding after anal sex situations may necessarily require you to see your doctor right away

Small tears (anal fissures)

A small amount of one-off spotting after anal sex — i.e. a couple of drops/streaks of blood on toilet paper — is not uncommon, and any mild bleeding or discomfort should settle within a couple of days. The most common cause of this is small tears in the anus, which are known as anal fissures. Anal fissures can occur when the thin and delicate tissues of the anus tear under pressure. Though fissures are most commonly caused by constipation, they may occasionally happen due to anal sex.

Unlike the vagina, the anus is not self-lubricating and therefore small tears may occur due to friction from penetrative anal sex

Unlike the vagina, the anus is not self-lubricating and therefore small tears may occur due to friction from penetrative anal sex, or potentially due to having sharp nails when fingering. Anal fissures can also be painful — causing discomfort and stinging as well as a bit of spotting when you go to the toilet.¹ However, small tears usually heal on their own, and your symptoms should improve within one to two days.

Irritation of internal haemorrhoids

Another common cause of mild spotting after anal sex may be due to the irritation of internal haemorrhoids. Haemorrhoids (or piles) occur when the blood vessels found in and around the anus become swollen, likely due to increased pressure to the rectum through issues like constipation. They may therefore be exacerbated by penetrative anal sex, leading to some bleeding after. This may also cause a bit of spotting when you go to the toilet, however your symptoms should settle within a couple of days.

STIs

As with any other type of sex, there is the risk of getting an STI when you have anal sex, which can also sometimes play a role in anal bleeding. Common STIs such as chlamydia and gonorrhoea may cause swelling of the anus and can also be associated with increased pain during anal sex, bleeding after anal sex, and discharge from the back passage.² Anal warts caused by HPV and herpes ulcers may also cause some bleeding when irritated during anal sex.

If you have symptoms or are concerned you may have an STI, you should check in with your doctor or local sexual health services. In any case, it’s always advisable to get regular STI check-ups.

When to see a doctor

Mild spotting after anal sex is usually not much cause for concern, and if you are experiencing this, it is advisable to avoid further anal sex for at least a few days while you wait for things to heal. You can also help your body by eating a high fibre diet, to keep your bowel movements regular and avoid constipation.³

However, if you find that your bleeding or pain symptoms do not settle within a couple of days, or worsen, you should see your doctor, who may want to rule out more intense anal injury or underlying conditions. For example, though anal fissures and haemorrhoids often resolve on their own, they can sometimes recur and cause more chronic bleeding and pain that may need further investigation and possible treatment.

Your doctor will take a history and perform a routine examination, and can advise you on symptom relief and potential treatments if required

You should also check in with your doctor sooner if you have any of the following:

• A large amount of bleeding after anal sex
• Recurring episodes of spotting after anal sex
• Pain during anal sex
• Severe pain or discomfort after anal sex
• Anal swelling or discharge

Your doctor will take a history and perform a routine examination, and can advise you on symptom relief and potential treatments if required. Occasionally, they may want to carry out further investigations to help guide their diagnosis and treatment, or rule out other, less common causes of anal bleeding.

Tips for staying safe

Anal sex and anal play can be a fun and exciting way to discover your own pleasure, and whether it’s self-pleasure or with a partner, there are things you can do to help you have a safer experience. Though your body may need some time to acclimatise to anal play, no sex should ever be painful!

The important thing is to start slowly, maybe introducing a finger (though keep your nails trimmed) or a smaller sex toy, before moving on to deeper penetration — only if and when you feel ready. With anal sex, your greatest companion is lube, and lots of it. Water-based or silicone-based are usually best and can be used with condoms, however, remember to avoid using silicone-based lubes with silicone sex toys as this may erode the surface of the toy over time.

Safer sex practices, such as using condoms or oral dams, and regular STI checks can also help keep your sex life infection-free. As well, keeping your diet high in fibre will help keep your bowel movements regular and lower your risk of getting anal fissures or haemorrhoids. The most important thing when having sex is that you feel confident and secure. However, if you have any concerns, healthcare professionals are always here to help you along the way.

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Page last updated January 2024
Next update due 2027