How to heal anal fissures and hemorrhoids? Try bottoming, experts say

Why does bottoming help?

Since hemorrhoids are “just swollen veins caused by a concentration of elevated pressures,” Goldstein says bottoming can be used in a similar way to anal Botox, where “slow, well-lubricated penetration can redistribute pressure away from the hemorrhoid, which is why some people describe real relief.”

According to Goldstein, anal fissures can also be helped by bottoming because it stretches and relaxes the area and “creates controlled friction against the tear and scar,” which “strengthens the overlying tissue” so that you can get back to having sex pain-free.

“Think of it like developing a callus that becomes protective,” Goldstein says. “The key is to make sure your fissure is as optimized as possible or in the cycle of it not being irritated. By testing the waters with the small glass dilator and then progressing from there, you can see if this is a viable option to improve your quality of life.”

Fong sees bottoming as less helpful for hemorrhoids, but “anecdotally and physiologically,” she’s seen it help correct anal fissures and prevent future ones. “Possibly for chronic anal fissures because the underlying physiology is that there is a hypertonic anal sphincter — literal 'tight ass’ — and obviously, bottoming will stretch the skin and muscles that eventually help improve blood flow that heals the fissure, similar to anal dilators or Botox injection,” she explains. “But I would not do it with an acute fissure (it would hurt and not heal), and hemorrhoids is usually the opposite issue, too much loose mucosa.”

And the science backs them up. While there haven’t been any studies on bottoming as a treatment, there have been studies exploring dilator use for anal fissures. According to a 2023 study by the Journal of the Anus, Rectum and Colon, controlled anal dilatation is “the preferred procedure for patients with chronic anal fissures who do not respond to conservative treatments.”

Who is a good candidate?

“Someone who does not have active hemorrhoids or fissures, without recent anorectal surgery” is the best candidate for trying bottoming as a treatment method, says Fong, who also recommends you "start small and go slow.”

The best time to start this unique and potentially pleasurable treatment is when your anal fissures and/or hemorrhoids are calm and not in an active flare-up, Goldstein says.

“Before anyone starts this conversation, my first question is always: Are you in an active flare right now, or are things relatively settled? That answer sends you down a completely different path,” he says. “Calm, manageable, comfortable for the moment – that's a good candidate to give this all a good college try.”

Most people assume that fissures and hemorrhoids “have to shut your sex life down indefinitely,” but that couldn’t be further from the truth. “With the right prep – dilation, gentle douching (our Future Method Anal Douche Kit makes this simple without further irritation), extended foreplay, silicone lube, honest check-ins with your body – a lot of people can navigate flare-ups and keep a good sex life,” Goldstein says.

How can you try this method?

Before you get started, you should check in with your health care provider to make sure your hemorrhoids or fissures aren’t so severe that you’ll end up doing more harm than good by giving bottoming a try. Then, you’ll need to start slowly and go solo at first before bringing in someone to top you. Fong says “the smallest dilators are pencil thin, but I'd say start with something index finger size.”

Goldstein recommends starting with a glass dilation kit, which will start small and get progressively larger and can have a pleasant cooling effect. “Pay attention in real time: Does it feel like relief, or does it feel sharp and tight? If it's relief, you can extend that same slow approach to a partner, with extended foreplay and warm-up, not straight to penetration (though this should really always be the case),” he says. “If at any point you hit sharp pain, more than trace bleeding, or a constant full-pressure feeling — stop, rest, and use aftercare like suppositories, topical creams, or Epsom salt baths before trying again.”

And don’t forget the lube: “Increased friction means increased aggravation of the skin and muscle,” Goldstein says. “Lube and foreplay help relax everything and reduce elevated pressures.”

You also need to communicate openly with your partner so that you don't get hurt in the process. “Their job is to be patient and keep listening and watching your verbal and facial cues,” he says. “Checking in, not rushing to penetration, and stopping the second you signal pain, not just discomfort. So many tops just want to shove it in or be more too aggressive. This is not the timing. The goal is to get to whatever sex you want. But we need to be strategic. Slow and steady wins this race.”

Does penis size matter?

Ah, the age-old question: does penis size matter? When is comes to sex, the size of your penis doesn’t really matter because with technique, sex positions, and toys, anyone can be a dynamo in bed. But when it comes to using bottoming to treat painful health issues, you need to start small and not be a size queen.

“I would make sure you have progressed on the anal dilators to an appropriate size that mimics your partner’s length,” Goldstein explains. “Some people even add dildos to set the same stage. Make sure you bring the dilators or toys into your first true penile play, either before or during as foreplay. Set the stage for success. If there are any deviations, then pull away – literally. We do not want anymore trauma in the anal space, as it also then starts to fuck with you mentally, and not in a good way.”

Sources cited:

Dr. Evan Goldstein is a leading anal health expert in the United States and founder of Future Method.

Dr. Carmen Fong is a colorectal surgeon and the chief medical officer at Bummed.