Here is my 2 cents worth of theory. I don’t have bleeding except when I wipe. This was never a problem before PFS but since the withdrawal I often have “out of sorts” bowel movements that are very loose, don’t seem to finish, tenesmus, etc.
Causes are probably multifactorial but:
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unfinished/disordered movements are pelvic floor dysfunction. MRIs are now showing many CPPS patients (I also developed CPPS about 2 years before PFS) have brains which have trouble relaxing the pelvic floor- they fail to release muscles used to hold back urine and stool. The role of 5-alpha reduced neuro steroids in this dysfunction is not yet well known.
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the anus is easier to tear and irritate- partially due to Pelvic floor dysfunction- and partially due to dry skin. Why?
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dry penis, anus, eyes, and rest of your skin- all these tissues need oil production. Meibomian glands in your eyelids are related to your sebum glands throughout your skin and those tissues are specialized for lubrication in penis and anus. And androgens are critical for function of sebum glands we know- critical for meibomian glands (research of DA Sullivan IIRC) and I expect a role for them for sure in penile skin (duh) and anal too. Many animals have anal oil glands and I think human anus does too though quite different from say a dog’s.
I put a light layer of A&D ointment on my anus, and travel with a portable bidet to keep clean. If I have a bad poop the acid (which was not much of a problem for first 30+ years) can really irritate for hours if not washed off right away so I use the portable bidet. I use another moisturizer on my dick as needed. I also find that certain foods, alcohol etc make defecation more painful and disordered so I tend to avoid and plan ahead so I can have at least a few good days a week.
Oh and be very minimal when you wipe. Some doctors told me 1 wipe is the max…which is usually possible if you use the portable bidet.
Good luck and try to stay positive!