Does receptive anal intercourse increase long-term risk of fecal incontinence?

1. What the largest studies report: notable associations, not causation

Large surveys of men who have sex with men (MSM) and population surveys report that RAI is associated with higher FI prevalence and that frequency and related practices raise the odds. A 21,762‑person MSM survey found FI prevalence of 12.7% for men reporting RAI ≥1/week versus 5.7% for men reporting no RAI, and identified independent associations with higher RAI frequency (OR 1.64), chemsex, fist‑fucking and low socioeconomic status ^{[1] [2]}. A U.S. national survey using NHANES data likewise concluded that anal intercourse should be assessed as a factor contributing to FI, particularly among men ^{[5] [3]}.

2. Evidence in women: smaller studies and mixed samples

Clinical and registry‑based cross‑sectional work in women has also reported higher Fecal Incontinence Severity Index scores among those reporting recent anal penetrative intercourse (API). One study reported fecal incontinence in 28.3% of women reporting API in the previous month versus 14.4% of women who did not, with an odds ratio of about 2.48 ^[6]. Narrative reviews that pooled many references conclude API is a risk factor for both men and women ^[4].

3. Which behaviors and contexts seem to matter most

Reporting of FI is more strongly linked to high‑intensity or higher‑risk practices than to occasional, "simple" RAI. The MSM survey and clinical commentaries single out RAI frequency (≥ once weekly), chemsex (drug‑assisted sex), and "fisting" or hard BDSM practices as key correlates of increased FI risk; studies note that RAI once a week without those additional factors did not show a significant excess risk in some analyses ^{[7] [1] [2]}.

4. Limitations of the evidence — what the sources themselves acknowledge

All cited large studies are cross‑sectional surveys that measure exposure and symptoms at the same time, so they can identify associations but cannot prove that RAI causes long‑term FI. Self‑reported leakage in online or interview questionnaires can be influenced by recall, selection, and reporting biases ^{[3] [7]}. Reviews and authors call for prospective and mechanistic studies to establish causality and dose‑response relationships ^{[4] [3]}.

5. Possible mechanisms discussed in the literature

Authors and reviews propose mechanisms such as anorectal sphincter injury, pelvic‑floor dysfunction, and altered anal sphincter pressures after repetitive penetration or traumatic practices; several studies reference sphincter injury and reduced manometry pressures among people reporting anal intercourse ^{[6] [3] [4]}. These mechanistic ideas are plausible but not proven as the definitive pathway in population‑level outcomes ^[4].

6. Clinical implications and harm‑reduction viewpoints

Some authors recommend clinicians ask about anal intercourse when evaluating FI and consider counseling or pelvic‑floor therapy as part of management or prevention strategies; pelvic‑floor physical therapy is discussed as a potential preventive or therapeutic option in reviews ^{[3] [4] [8]}. Patient advocates and sexual‑health clinicians emphasize contextualized counseling focused on safer techniques, consent, and communication rather than stigmatization ^{[7] [3]}.

7. Competing or cautious perspectives present in the sources

While many sources report associations, some emphasize that occasional or "simple" RAI—defined in one analysis as about once weekly without additional risk behaviors—was not clearly linked to higher FI risk, highlighting a more nuanced view that frequency and partner/practice context matter ^{[7] [1]}. Narrative reviews compile heterogeneous studies and therefore call for careful interpretation ^[4].

8. Bottom line for readers and unanswered questions

Available studies consistently show an association between anal penetrative intercourse and higher reported rates of fecal incontinence, especially when RAI is frequent or accompanied by high‑risk practices ^{[1] [2] [6]}. However, the evidence is observational and cannot by itself establish long‑term causality or quantify individual lifetime risk; prospective, longitudinal, and physiologic studies are needed to clarify causation and mechanisms ^{[3] [4]}.

If you want, I can summarize practical harm‑reduction steps and clinical questions to raise with a provider, drawing on the counseling and pelvic‑floor therapy suggestions noted in these reviews and studies ^{[3] [4]}.