Common IBD symptoms and their effect
TIREDNESS AND FATIGUE
Fatigue or extreme tiredness is a very common symptom of IBD. Diarrhea, painful cramps, anemia, and poor appetite or problems absorbing nutrients can leave you weak and lacking in energy. As a result, you may be feeling just too tired for sex, especially during a flare-up – and perhaps even too tired to explain.
However, if you can, you may find it helpful to talk to your partner about your tiredness. It isn’t always easy for people in good health to understand fully just how exhausting IBD can be.
Our section IBD and Fatigue may be useful in this situation. This includes suggestions of ways to deal with fatigue and tiredness. It is also worth talking to your doctor about your symptoms. Fatigue can be difficult to treat but it may be that your tiredness or fatigue can be reduced by a change in medication or by treatment with an iron or vitamin supplement.
If you feel very tired at night, it might be worth timing sex for when you are less tired. It may also help to step back a little, and rather than always trying to have full sex, to look for other ways of being intimate with your partner.
FISTULAS / ABSCESSES
Some people with IBD, especially those with CD, can develop abscesses, fistulas or scarring of the skin around the anus or around the vagina. (A fistula is an abnormal passageway or link between the bowel and the skin or other surrounding organs. For more information see Living with a Fistula) These complications can be embarrassing and may make sexual intercourse extremely painful, or even temporarily impossible. If you have scarring of the skin, abscesses or fistulas, you may find using a lubricating jelly before penetrative vaginal sex is helpful.
However anal sex must be avoided if you have significant stricturing (narrowing) of the anus or abscesses or fistulas in this area. Make sure your doctor is aware that you have a fistula or abscess as these problems can often be treated medically or with surgery. Your doctor or IBD nurse will also be able to advise you on how to manage your fistula on a day to day basis, including which sexual practices are safe.
INCONTINENCE
A major fear for many people with IBD is that they might have an ‘accident’ (for example, a bout of diarrhea) during sex. Even if it doesn’t happen, the constant worry about the possibility of it happening can be very off-putting. For men, the anxiety may cause difficulty with getting an erection. You m
ay find going to the toilet and emptying your bowel before sex makes you feel more confident about avoiding an ‘accident.’ Taking an anti-diarrheal drug, such as loperamide (Imodium) before sex may also help you control your bowel. However, these sorts of antidiarrhoeals are not suitable for everyone with IBD, and should not be taken during a flare-up, so check with your doctor or IBD team before buying a supply. You may also feel more confident if you and your partner try and have sex at the times of day when your bowel is less active. If you are particularly worried about incontinence during intercourse, ask your doctor or IBD team to refer you to a continence specialist. They will be able to advise you about other ways to manage this problem.
ABDOMINAL PAIN
IBD can cause chronic (ongoing) abdominal pain and tenderness. If this affects you, it may help to try different sexual positions. It may be easier to control the level of movement and penetration during sex if you are the one on top. Talk to your IBD team about ways to manage your pain, and whether painkilling medication might be useful. However, some types of painkillers, such as non-steroidal anti-inflammatory drugs (NSAID) which include aspirin, ibuprofen, and diclofenac are not recommended for people with IBD.
