My husband and I both enjoy sex a bit on the wild side.

Patient

Q: My husband and I both enjoy sex a bit on the wild side. After a few tequilas in Mexico, things got a little wilder than usual. We had anal sex at my request (I don't want anyone to think it wasn't consensual). Something happened and a lot of blood came out of my anus... a lot of blood. After 2 tampons and some time- it stopped bleeding and I passed some small clots in the morning..
At the moment my bottom is sore just on the inside- but only about a pain level 2. It's been 3 days and I just had a slightly uncomfortable bowel movement with dark stool and some blood.
The 2 things I'm worried about are
1. I lost what seemed like a lot of blood.
2. I'm not dizzy but I'm tired and light headed.
At one point, years ago, a doctor found an internal hemorrhoid and it's never bothered me so I didn't do anything about it. I am a small woman who is chronically constipated.
I don't have a fever. I don't have bleeding when I'm not using the bathroom. I'm eating a lot of food with iron.
I really don't want to go to my doctor about this for obvious reasons. I prefer to wait it out if there's no major risks. I'd like advice on this.
Also, if I do go, should I see a specialist or my family doctor? (I like my family doc, but I think I'd be too shy to go back to her after this!) Do I have to tell them how it happened or can I say I was having a bowel movement when it happened? Thanks!

Symptoms:  Anal bleeding followed by dizziness.
Doctor

A:   Hello,
Thanks for the query to ATD for an opinion,
The bleeding post anal intercourse in your case is definitely due to presence of internal haemorrhoids which got injured during anal sex and hence you bled heavy. The presence of dark stools and history of chronic constipation with confirmation of internal haemorrhoid since earlier confirms the differential diagnosis to a great extent. The conservative management would involve softening of stools and this could be achieved with increased intake of water and stopping the iron intake completely at present. The bleeding shall continue till constipation persists, so increase your roughage intake in diet in terms of green leafy veggies and also use of milk and curd during the day in form of shakes. This shall help softening the stools.
Bleeding shall occur when passing stools and that can occur till next one week till stools soften. You may visit your physician for a local anal examination and get evaluated for presence and stage of internal haemorrhoids which can then be treated surgically or through sclerotherapy after complete evaluation. You may not disclose about anal sex but can always mention about previous history of haemorrhoid, as being told to you earlier.
I hope i have answered your query in detail,
Wishing you good health,
Regards

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