We Have Questions: IBD/IBS and ED

When it comes to erections, the list of conditions, ailments, situations, diet choices, mental blocks and more that can affect them is extensive. Well, you might need to add irritable and inflamed bowels to the list.

On the flip side, can flaccidity and other problems concerning the act of achieving and maintaining a firm phallus suggest something about your bowels?

Inflammatory bowel disease (IBD) is the umbrella term that covers Crohn's disease and ulcerative colitis, which can cause swelling and irritation of the digestive tract and sometimes abdominal pain, weight loss and blood in the stool. A 2019 cohort study published in the journal Inflammatory Bowel Diseases found 94 percent of the 69 men with IBD—Crohn's or ulcerative colitis—additionally suffered from erectile dysfunction (ED). The mean age of the men in the study was 43.4. Other studies report similar findings.

Irritable bowel syndrome (IBS) refers to an assortment of symptoms that include disruptive changes in bowel movements (e.g., diarrhea, constipation) and often-related abdominal pain. The symptoms can be similar to those associated with IBD. The incidence rate of ED in individuals with IBS is 2.92 times higher compared to men without IBS, according to a Taiwanese nationwide, population-based study published in 2013 in the journal Andrology. Patients with IBS had a higher risk of developing ED than subjects not suffering from IBS, researchers noted.

The association is not just physical. Patients with IBS have a 2.38 times greater chance of developing psychogenic ED, defined as "the inability to achieve sexual arousal or satisfaction in appropriate situations because of mental or emotional disorders," according to a 2015 study involving data from the National Health Insurance Program in Taiwan. That's in addition to an increased risk of experiencing organic ED. IBS patients in the study were more likely to struggle with both kinds of ED.

"Some studies suggest that both psychogenic and organic ED may be twice as common in patients with IBS and IBD as the general population," said Bradley Garden, M.D., a urologist with a special interest in male sexual health, erectile dysfunction, low testosterone, male and female voiding dysfunction, and male and female urinary incontinence.

Garden, who practices at Z Urology in South Florida, drew on his training in general urology and expertise in male sexual health to answer questions about possible ties between IBD, IBS and erectile dysfunction.

In what ways might ED be related to IBS or IBD?

Garden: There are many articles in the scientific literature that discuss the connection between erectile dysfunction and both irritable bowel syndrome and inflammatory bowel disease. Most suggest that ED is much more common in patients with either IBS or IBD. Patients with IBS/IBD can generally feel unwell or have pain, bloating or other symptoms, which can affect how they feel about themselves. Erectile function involves a complex interplay between a person's physiologic, psychologic and emotional qualities; if you're not feeling well, it can affect this balance and make it difficult to perform sexually.

Can IBS or IBD cause or contribute to ED? If so, how might that happen?

While there is no proven connection between these entities, there are proposed mechanisms that suggest the inflammatory milieu of IBS and IBD can affect erectile function. Cytokines are molecules that are released by inflammatory cells [and] play a role in IBD. These cytokines can cause blood vessels to behave abnormally, and blood flow is crucial to the ability to achieve and maintain an erection.

What treatments are available to enable men with IBS/IBD to still engage in sexual intercourse, especially since IBS and IBD can sometimes prove treatment-resistant?

For managing the erectile dysfunction aspect of it, the full range of erectile dysfunction treatments should be available. Typically, I would start a younger patient with newer symptoms of ED with a low dose of on-demand Viagra and Cialis; these medications could be adjusted to achieve their desired results.

Can dietary and lifestyle choices be responsible for both IBD/IBS and ED?

Smoking cigarettes is linked with the development of IBD. Although in the short term, smoking cigarettes may not [impair] erectile function, over time, changes in the blood vessels to the penis can occur and begin to affect erectile function.

What would you tell a guy who struggles with IBD or IBS symptoms and starts having issues related to sexual function?

I would tell a guy…that there are treatment options. I would advise them to see their GI doctor or colorectal surgeon—whoever manages their disease—to discuss further management of their IBS/IBD. I would also lay out their options for managing their erectile dysfunction, whether it's sex therapy, starting medications, etc.

This interview was edited for length and clarity.