Yes, gay men get hemorrhoids, and for the same reasons everyone else does. Hemorrhoids develop when the veins around the anus or inside the rectum become swollen and inflamed, typically from straining during bowel movements, sitting for long periods, or not eating enough fiber. Being gay doesn’t make you more or less likely to develop them. That said, receptive anal sex can irritate existing hemorrhoids and is worth understanding if you’re dealing with symptoms.
What Actually Causes Hemorrhoids
Hemorrhoids form when pressure builds in the veins of the lower rectum. The most common culprits are straining on the toilet, chronic constipation or diarrhea, sitting for extended periods, low-fiber diets, and obesity. They can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). About half of all adults experience hemorrhoid symptoms by age 50, regardless of sexual orientation.
Receptive anal sex is not a primary cause of hemorrhoids. Research from the National Library of Medicine notes that men who have sex with men, including those who have receptive anal sex, develop anal conditions like hemorrhoids that are “unrelated to sexual practice.” The root causes are the same everyday factors: diet, hydration, bathroom habits, and time spent sitting.
How Anal Sex Affects Existing Hemorrhoids
If you already have hemorrhoids, anal sex can make them worse. The friction and pressure from penetration can aggravate swelling, increase pain, and cause bleeding. In more severe cases, it can tear the anal lining, creating fissures on top of the hemorrhoid symptoms you’re already managing. Some people notice bleeding during sex from an irritated hemorrhoid or a fissure that keeps reopening.
This doesn’t mean anal sex is off the table permanently. It does mean that during a flare-up, giving things time to calm down will prevent the cycle of irritation, swelling, and re-injury. If you’re using topical hemorrhoid treatments like creams containing hydrocortisone or lidocaine, keep in mind that these aren’t designed to double as lubricants and should be part of your symptom management routine, not your sexual preparation.
Telling Hemorrhoids Apart From Other Conditions
One reason this question matters is that several conditions can look or feel similar around the anus, and sexually active men may worry about what’s actually going on. Hemorrhoids, anal fissures, and certain infections can all cause pain, bleeding, or lumps, but they behave differently.
- Internal hemorrhoids usually cause painless bright red bleeding, visible as streaks on toilet paper or dripping into the bowl after a bowel movement. You may not feel them at all unless they prolapse (push through the opening).
- External hemorrhoids feel like a lump near the anus and can be painful, itchy, or swollen. They sometimes produce a mucus discharge.
- Anal fissures cause sharp pain during and after bowel movements, often followed by a throbbing sensation that can last hours. They also bleed, but the pain pattern is distinct.
- STI-related symptoms like those from herpes or HPV look different on examination. Herpes causes clusters of small blisters or ulcers. HPV causes warts with a rough, raised texture. Neither behaves like a hemorrhoid on close inspection.
If you’re unsure what you’re dealing with, a quick exam is usually enough for a diagnosis. Doctors typically take a history and visually examine the area, sometimes using a short tube called an anoscope to see inside the anal canal.
Preventing Flare-Ups
The single most effective thing you can do is eat more fiber. The NIDDK recommends 14 grams of fiber per 1,000 calories you eat, which works out to about 28 grams per day on a standard 2,000-calorie diet. High-fiber foods like beans, whole grains, fruits, and vegetables make stools softer and easier to pass, which reduces the straining that causes hemorrhoids in the first place. Drinking enough water throughout the day helps the fiber do its job.
For managing active symptoms, warm sitz baths (sitting in a few inches of warm water for about 20 minutes) after bowel movements and two to three additional times per day can relieve pain and relax the muscles around the anus. Over-the-counter creams and suppositories containing ingredients like lidocaine provide temporary relief from pain and itching. Steroid-based options work well short-term but aren’t meant for extended use because the active ingredients can be absorbed into the body over time.
Practical Tips for Anal Sex With Hemorrhoids
If your hemorrhoids are mild and not actively flaring, anal sex is generally possible with some precautions. Go slow, use plenty of lubricant, and communicate openly with your partner about any pain or discomfort. Pain is a signal to stop or adjust, not push through. Forcing things when hemorrhoids are irritated virtually guarantees a worse flare-up afterward.
During an active flare, it’s worth waiting. The swollen tissue is more fragile, more prone to bleeding, and more likely to develop fissures from the added friction. There’s no hard rule on exactly how many days to wait, but letting symptoms fully resolve before resuming gives the tissue time to heal and reduces the chance of a repeat cycle.
When Hemorrhoids Need Medical Treatment
Most hemorrhoids respond to fiber, hydration, and topical treatments within a week or two. When they don’t, or when they keep coming back, there are office-based procedures that can resolve them. Rubber band ligation, where a small band is placed around the base of an internal hemorrhoid to cut off its blood supply, is a common first-line option for moderate hemorrhoids. Other approaches include injecting a solution to shrink the tissue (sclerotherapy) or using infrared light to reduce blood flow.
Surgical removal is typically reserved for the most severe cases, particularly large hemorrhoids that protrude and can’t be pushed back in. If you’ve had a surgical procedure like stapled hemorrhoidopexy, the recovery timeline matters. The healing process takes several months, and anal intercourse during that period carries real risks, including injury from residual surgical staples. These staples can remain visible on imaging for 12 months or longer after the procedure, so your surgeon’s guidance on when to resume activity is worth following closely.
Persistent bleeding, pain that doesn’t improve with home care, or any lump that changes in size or character warrants a visit to get things checked. Most of the time it’s straightforward hemorrhoids, but ruling out other causes is quick and gives you a clear path forward.