The effects of surgery
Surgery for IBD can often involve removal of part of the small intestine or part or all of the colon and rectum. This may result in an ileostomy or colostomy, or, for UC, the creation of an internal ileo-anal pouch (IPAA). For more information on common operations for IBD, see our IBD Surgery section.
It is very common for people facing stoma surgery to be worried about how it might affect their relationships. Everyone and every relationship is different and it will take time for you and your partner to get used to living with your stoma. But it will gradually become part of your lives. However, in general, having a stoma bag should not be a barrier to having an active sex life. Many people with a stoma have fulfilling sex lives. Provided the stoma bag is attached securely it should not be affected by the sexual position you choose. There are also different types and sizes of bag available, designed to be much more discreet than the usual options.
Your stoma care nurse will be able to help you with support, advice and practical tips. These may include, for example, ensuring the bag is empty before you have sex, swapping it for a much smaller bag or using a decorative cover.
Research on the effect of being given a stoma has found it can improve libido (desire) and sexual satisfaction for people with IBD – probably because people with a stoma no longer have many of the troublesome symptoms of IBD.
Some of the research on IPAA or ‘pouch surgery’ has shown that it can also have a positive effect on sexual functioning. However, other studies have found that surgery may, for example, lead to increased tenderness of the abdominal wall or in the rectal area. It can also alter the position of the organs in the pelvis. This can make having sex more uncomfortable, even painful. As mentioned earlier, a different sexual position may help. Your IBD team or your colorectal surgery team may also be able to give you useful advice.
In men, particularly those over fifty, surgery to remove all or part of the bowel may occasionally cause or worsen difficulties with erections and with ejaculation. A small number of men with IBD may experience this sort of problem even without surgery (and of course it can also happen in men without IBD). These difficulties may be only temporary and may resolve over time. If they continue, it might be helpful to talk to your IBD or colorectal surgery team about referral for treatment, for example with medication (such as Viagra) or a penile implant.
