A Guide to Sex With Irritable Bowel Syndrome

Few people want their bowels to play a role in the bedroom, but when you have irritable bowel syndrome (IBS), your symptoms may be difficult to ignore.

IBS does not have to cause the end of your sex life. It only requires a few adjustments and acknowledgment of its impact.

What is IBS?

"IBS is a common functional condition that affects the digestive system," said Sunni Patel, Ph.D., a London-based wellness coach and the founder of Dish Dash Deets.

The symptoms of IBS may include, according to NHS Inform:

• Abdominal pain
• Bloating
• Flatulence
• Changes in bowel habits, such as diarrhea or constipation
• Lethargy
• Heartburn

"It presents with symptoms like stomach cramps, bloating, diarrhea and constipation that tend to come and go over time and can last for days, weeks or months at a time," Patel said.

IBS affects approximately 10 percent to 15 percent of adults in the United States, according to the American College of Gastroenterology. This health condition is more likely to affect women.

Stress is often the most common trigger for people who experience IBS.

How do you know if you have IBS?

Long-term abdominal pain with bloating may be a sign of IBS. But IBS could mimic other, more serious health conditions. If you're experiencing chronic pain, don't assume you have IBS. Speak with your doctor.

"There's no test for IBS, but the physician may request a series of tests to rule out other possible causes of the symptoms," Patel said.

Keep track of your day-to-day symptoms for your doctor's appointment. Such a list may come in handy.

"The criteria for a diagnosis of IBS require that a person be experiencing chronic abdominal pain or discomfort at least three days over the course of the last three months, with an onset of symptoms at least six months prior," Patel said.

Treatment of IBS depends on the patient. However, doctors may recommend the following:

• Dietary changes, such as identifying and eliminating trigger foods
• SSRI antidepressants
• Probiotics
• Antispasmodic medicine, such as mebeverine (currently only available in the U.K.), dicyclomine or hyoscyamine
• Mental health therapies to manage stress

"IBS as a diagnosis can be hard to get to grips with for some as it can sometimes lead to unanswered questions, particularly as many gastroenterologists don't discuss its impact on sexual enjoyment," said Ness Cooper, U.K.-based clinical sexologist and certified sex relationship therapist.

What is the impact of IBS on sex?

"IBS patients report a high rate of intercourse avoidance with reports of symptoms of worsening during menstruation," Patel said. "The most common sexual dysfunction in IBS patients may be decreased libido."

The IBS experience can vary, but the chronic bloating and bowel issues can make it difficult to feel good enough to have sex—or to feel sexy. Add in changes in IBS that occur with menstruation, and you may have days you feel downright rotten.

About 36 percent of male patients with IBS reported decreased libido compared to 28 percent of women, according to a 2010 study published in the Journal of Neurogastroenterology Motility.

The impact on mental health must also be considered, said Gemma Stuart, founder and CEO of Gut Wealth in Edinburgh, Scotland.

"Because IBS symptoms can often be unpredictable and flare-ups can occur, it can also lead to anxiety and low mood—two emotions that can affect sex drive," Stuart said. "Some studies have found that IBS sufferers choose not to have sex, even though they were in the mood, because of their gut symptoms. And many don't want to reveal their body to a new partner due to bloating."

Men with IBS may be at a higher risk of erectile dysfunction. Male IBS sufferers are three times as likely to experience erectile dysfunction, a 2013 study published in the Journal of Andrology Men suggested.

How can you feel comfortable having sex with IBS?

Identifying triggers and tracking symptoms is the key to unlocking your sex life with IBS. Even menopause can affect your IBS symptoms.

"The first piece of advice is to manage your IBS as well as you can so that you minimize the number of flare-ups and it reduces the amount of uncertainty and unpredictability of having a flare-up," Patel said.

This may be easier said than done. You may need to schedule a doctor's visit more often than you're used to.

"See your doctor regularly and follow your treatment plan exactly as prescribed. Keep stress under control. Stress is a common trigger of symptoms, so do what you can to minimize it," Patel said.

It's easy to feel betrayed by bodily malfunctions when dealing with a chronic illness, but you don't have to erase your sexuality. You are still sexy, even if your bowels are rebellious tricksters.

What can you do to remove stress about sex and IBS?

What's one way to unlock great sex even when you have IBS? Foreplay. Decentering penetrative sex and shifting the focus to oral sex, sensual play and using toys takes the pressure off having "normal sex."

"Do not underestimate the power of this act over penetration," Patel said. "It can help build sexual tension and arousal between you and your partner. If penetration isn't for you just yet, then explore each other with toys, oral, manual stimulation—do what makes you feel sexy."

It's OK if you need time to deal with any lingering self-doubts, such as keeping a top on to cover up bloating. Build up to healing vulnerabilities. There is no deadline for eliminating insecurity.

"Find the position that suits you and minimizes pain along the gut or pelvis and hips," Patel said. "Typically, this might include good old missionary. Face-to-face and eye-to-eye contact will also help reassure you and make it feel more loving and tender to reduce any anxiety."

You don't have to stop there.

"Reverse scoop [spooning] still allows you to be horizontal and still feel intimate without any extra physical pressure on your body," Patel said.

You can even lead up to sex with a little IBS healthcare foreplay, Cooper suggested.

"Some people with IBS find having a massage—lower back and abdomen—can help relieve pressure and discomfort in the bowels," Cooper said. "This can be really helpful as pressure in these areas can also put pressure on the pelvic floor and make it harder or more uncomfortable to orgasm."

What should you do if you feel awkward having sex with IBS?

Talking about IBS with a sexual partner can be intimidating and embarrassing. Don't let shame silence you. Your partner needs to know about your current state of health in order to be supportive and accommodate your needs.

"Being as open with your partner as possible about IBS is the key to sexual success," Patel said. "If you have a relatively new partner, you may want to let them know once you get to know each other and share more personal details about your lives."

You don't need to blurt your most intimate details when you first meet someone. However, if you are feeling terrible, you don't want to keep your condition under wraps for too long, either.

"If you're in the midst of an IBS flare-up, you just might not feel up to having sex. Explaining it as soon as possible in your own voice will help you overall," Patel said.

The bottom line

If IBS has made sex a chore, it's time to take back your sexual functioning. It can be a delight. Speak with your partner. Try deep breathing relaxation techniques and work with a therapist to better destress and identify your triggers.

There is no cure for IBS, but you can improve your sex life. Speak with your doctor to learn more.