Clean freak

Dear Andrea:
I'm 40 and experiencing a sexual renaissance. I've turned into a squirter, which I'm coming to terms with. Guys seem to like it: I haven't met one yet who complained about being wet all the way down to his toes.
The problem is that occasionally when I'm really having a good time I also lose a little bit of stool. Sometimes it's just a smearing on the sheets, sometimes it's a little more significant. This happens with regular vaginal intercourse, even without any anal. I find it incredibly embarrassing, though the guys I've been with have been cool about it. One of them was very gallant: we were moving around to a rear entry position when he told me I needed to go clean up because "he had pushed some poop out of me.” Nice of him to take the blame.
So, why is this happening and what can I do about it? I've had hemorrhoids, though I don't have them currently. I have some skin tags around my rectum as a result. I had a vaginal hysterectomy (I don't have my cervix but do have my ovaries), and I wonder if there might be some rectal prolapse going on? I don't have health insurance right now and haven't wanted to see a doctor about what doesn't seem terribly urgent, just embarrassing. Are there Kegels for the rectum? Do I need to start anal douching before intercourse now?
Losing It
Dear It:
I'm impressed. Of course you're embarrassed, but a lot of people would be too mortified to go on. You, dare I say it, suffer incontinence with extraordinary aplomb. You poop with poise. How many people can claim likewise?
This didn't sound particularly familiar to me so I read around a bit, thinking there must be some study or other connecting vaginal hysterectomy with fecal incontinence, but I really couldn't find anything. One study specifically queried abdominal and vaginal hysterectomy patients about their bowel health and habits and concluded this: “Patients undergoing abdominal hysterectomy may run an increased risk for developing mild to moderate anal incontinence postoperatively and this risk is increased by simultaneous bilateral salpingo-oopherectomy. An increased risk of anal incontinence symptoms could not be identified in patients undergoing vaginal hysterectomy.”
Salpingo-oopherectomy, for those following along at home, is removal of ovaries and fallopian tubes, and just think, if I'd gone to med school, I could use words like that all day. Oh well. Just because those doctors didn't find any connection doesn't mean you haven't experienced one. Major surgery, with the scalpels and the nerves and everything, sounds a more likely culprit than do hemorrhoids or skin tags. Seeing a proctologist or surgeon seems like a good idea — something's wrong here — but there's no rush on that; you're coping rather brilliantly.
In the meantime, yes, there are Kegel-y things you can do. They're pretty much self-explanatory: squeeze, release, repeat. Do not douche right before partnered sex, or you may regret it in yuckier ways than I can bear to get into here. The night before is safer, and do what your mother would tell you to do, provided you talked to your mother about this sort of thing: eat more of what she used to call roughage. Lots more. The idea is to get so regular and so thorough in your elimination that there's nothing left around to put in a surprise appearance later. And then, let's get real: get some insurance. I don't care how, just do it. Once we're 40, running around with no coverage ceases to be devil-may-care and starts being stupid.
Dear Andrea:
You once wrote, "The human ass can clean itself. If it couldn't, we'd all be dead. Internal ass hygiene requires only fiber (ingested, not shoved up there) and water (likewise)." But when I do anal, "something" is left on my penis. Isn't there a way that my girlfriend could clean her ass so much that this would not happen? In the porno movies everything seems so clean.

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