Sex and The Irritable Bowel
‘My IBS seems to flare up after I have had intercourse. It has put me off the whole idea of sex. How can I deal with this?’
Sex and food are our two major drives and they are also two major factors associated with IBS, but only one of them is ever really talked about. Sex remains private and secret, but is all the more powerful for that. When asked, a third of women and a much smaller fraction of men with IBS admit sex is a problem, but that still seems an underestimate. They report that IBS erodes any desire they have for sex, that intercourse itself is painful and sore and that afterwards their stomach is upset for days. Although many tell how sex makes their pain and bloating worse, some women have told us that having sex can bring on an attack of diarrhoea. An episode of incontinence can kill any passion in seconds. Constipation on the other hand can make penetration difficult and painful.
Sex is the drama and the bedroom the theatre. Like the irritated bowel, sex is a complex interplay of action and emotion. During the build up to sex, feelings of desire increase activity in the parasympathetic nerves, the same system that facilitates digestion and bowel movement. Desire also releases the love hormone, oxytocin, which facilitates attachment and alters reproductive physiology. These actions cause the clitoris to swell and become sensitive, increase vaginal blood flow, secretion and sensitivity, relax the vaginal muscle fibres, and inhibit the tone in the striated muscles of the pelvic floor and perineum, all of which make a woman receptive. But it is not just a matter of physiology, she also has to be open emotionally. If there is too much fear or distrust, the physiology just won’t work. Analogous actions in men cause the penis to swell and become rigid by increasing the blood flow into that organ and reducing its outflow, trapping it in the spaces between a network of gristle. Desire also increases secretion of fluid rich in potassium from the seminal vesicles and the prostate gland while contractions of the vas deferens propel that fluid to a the urethral bulb, a reservoir, just below the prostate gland. Fear and distrust will inhibit all of these actions, most noticeably deflating the penis.
The regular stimulation of the penis, clitoris and vagina during intercourse increase these effects. Oxytocin builds along with an admixture from the sympathetic nervous system, the excitation mounts to a crescendo and at orgasm, seminal fluid is pumped by regular contractions of the bulbo-cavernosus muscle through the urethra and deposited high up in the vagina. If the timing is right, similar orgasmic contractions occur in women, enhancing excitation and bonding.
Couples often feel relaxed and sleepy after intercourse. During this post coital slumber, oxytocin relaxes the cervix and rhythmically contracts the uterus causing the pool of semen at the back of vagina around the cervix to be sucked into the uterus and up into the Fallopian tube, where, if sex has occurred around the time of ovulation, the sperm may encounter an ovum and conception take place.
A woman can remain on a high sexual plateau and receptive for some time and may achieve orgasm several times, each time increasing the chance of conception. Meanwhile her partner may have become refractory, lost interest and gone to sleep. You might think that would allow women to sneak out of bed and seek another partner increasing their chance of conception. Similar phenomena occur in some promiscuous mammals and birds. Physiology does not conform to morality and is ever opportunistic.
That’s all very interesting, you may well exclaim, but what has it got to with my IBS? Well the excitation during arousal can spill over into other abdominal or pelvic organs via neural connections in the spinal cord, increasing the sensitivity of the bowel and bringing on symptoms of IBS, which painfully distract from the enjoyment. It might also stimulate contractions and secretion in the bowel so that orgasm could be accompanied by release of more than sperm. This can make what should be the very epitome of pleasure, a crisis of fear and shame.
IBS is always accompanied by a degree of anxiety. There may also be negative or ambivalent feelings around the idea and act of intercourse: Will I be good enough? Does he really love me? Do I love him? Do I really want to do this? Is it my duty? Am I scared of getting pregnant? There are more conflicting thoughts and feelings around the idea of sex than any other physiological function. It is not just a physiological function, the attachment and identification with the beloved, the way they look, the way they talk, our phantasies can all fuel the experience, heightening the tension and enjoyment, but inducing negative feelings that so easily spoil things, inhibiting the tumescence and lubrication during arousal, contracting the muscles around the vagina (vaginismus) suppressing orgasm or precipitating it, or just making it a job rather than a pleasure. ‘Kevin and I are going to try for a baby again tonight.’
Anxiety during intercourse would generate conflict in the gut in the same way as anxiety during a meal; an antagonism between the sympathetic and parasympathetic branches of the autonomic nervous system. There is so much to go wrong and so much shame and embarrassment and guilt.
Sex is also a major cause of trauma. More sexual abuse and coercion goes on behind bedroom doors or in hotel rooms than we would ever want to hear about. Vulnerable young girls, barely out of puberty and some even younger may be exposed to Internet grooming, peer pressure on social media, sexual abuse and coercion and disinhibiting recreational drugs. Traditional regulators of sexual behavior; the church, the law, parents and the school are no longer effective. Too many women have had any enjoyment of sex damaged by traumatic sexual experience early in life. As a result sex has forever more been tainted by fear, so that pleasure is suppressed, so much so that affected women close down and become non receptive, dry and tight so that sex is painful if not impossible. Since the neural control of the rectum and the vagina is very similar, analogous effects may well occur in the bowel, causing lack of secretion, impaired peristalsis and paradoxical contraction of the anal sphincter (anismus), all of which make defaecation very difficult. It has been reported that upwards of 40% of women who suffer from unexplained anorectal disorders have had a history of sexual abuse (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780137/). Anal intercourse is also more common than is usually acknowledged, adding the possibility of physical damage to the rectum and anus to the psychological trauma.
Sexual trauma does not only affect young girls; boys and young men can be affected too. It has been estimated that as many as 10% of men are openly homosexual and some are predatory (though, I hasten to add, this is not a stereotype). Vulnerable young boys can be anally raped and otherwise abused, most notably but not only, in institutional settings. Vulnerable young men may also be traumatised by the sexual demands and ridicule of predatory women. In the area of sex, everything is possible and most happens. What should be a pleasure garden can become a war zone and can result in disturbances in bowel and bladder function in both sexes.
I have focuses on the psychological aspects of sexual and rectal dysfunction because that is most common, but it is important not to ignore the possibility of a physical illness affecting both. Unless you have obvious symptoms such as discharge or bleeding, it is unlikely that you have any other disease, through some possibilities need to be considered. Endometriosis often causes pain especially at the time of menstruation, though has a disturbance in the motility of the Fallopian tube analogous to the disturbances in colonic motility in IBS allowed the shed endometrium to be reflux end through the tubes and stick to loops of intestine? Ovarian cysts might conceivably make sex uncomfortable and can be associated with bloating. Polycystic ovaries (Stein Leventhal syndrome) can impair sexual function, cause infertility and often IBS. And recent research suggests that disturbances in elastic tissue associated with double jointedness (Ehlers Danlos Syndrome) may make sex difficult and induce constipation. But common things occur commonly and the connections between a person’s experience, their emotion and pelvic function would seem to occur much more frequently.
For most people, the reversal of sexual and bowel function requires first an acknowledgment of the problem and then working with the body by rhythmic movements, walking, dancing, eye movement desensitization, tapping on acupuncture points, drawing , making music, whatever works for the individual to gain a confident sense of their own identity that will enable them to explore and talk about what has happened. In time, with this approach, the emotional tension may wear away and body relax and begin to function normally, but sometimes it may require a person to feel strong enough to remove themselves from a situation that retraumatises them. See ‘Don’t be a victim, be a survivor’ and ‘Take Back Control of Your Life’.
The Sensitive Gut 
I’m male with diagnosed IBS symptoms. part of which gives me bladder/urinary tract pain. After climax these can become very sore. Don’t always experience pleasure at climax either, which I put down to smooth muscle problems too. Of course, when abdominal discomfort is flaring that kills sex drive. Lots of IBS info seems aimed at women. Know statistically females suffer from the condition in greater numbers however men are destroyed by IBS too.
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Thank you, Chris. You are correct of course. IBS does not only kill sex drive in women, it affects men too. Do you know when this is particularly bad? Are there any particular circumstances or context that makes it worse?
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I’ve been suffering with pelvic pains for going on 9 years with no Dr giving me a conclusive diagnosis. I’ve had a colonoscopy, endoscopy, and recently a laproscopy and the biopsy came back negative for endo but was given birth control anyway. Still have pains and sex is now always painful. I have no sexual desire and am a newlywed. I’ve been to countless drs, and natropaths and no one has been able to help me. I can relate to parts of this article and was hoping to find some solutions. Its definitely taken a toll on my life and I don’t know what else to do.
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I’m so sorry to hear that your pelvic pains have had such an impact on your life. Endometriosis would be the diagnosis I would want to rule out, but it sounds that everything is clear from a medical viewpoint. You say you have had this for 9 years. I wonder what was happening in your life around that time. Could it link to the onset of your pelvic pains? It sounds as if painful sex and lack of sexual desire might be more recent. I note you have recently got married and I assume you must feel quite desperate for that part of your married life to be alright. If you would like to tell me a bit more about the context of your symptoms in confidence, I can try to help you make sense of what is going on and find appropriate help.
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Yes I would like to go over my symptoms and see if I can figure out what this is.
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you will be fine.
do yoga.
it is the best option.
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I have digestion prob my age is 26 and also little sex issue
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Hi,
I am a man and I am thirty years old, during sex or sexual stimulation, the fluid is released from the anus, and I find it difficult to get married, which made me feel frustrated. Thank you if you help me
Very thanks
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Really not sure why this is happening. I wonder if there is a build up of mucus in the rectum. Perhaps your GP could look inside the rectum to see if there is any sign of inflammation or impacted faeces.
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You’re stupid. It’s a pretty normal reaction like your article stated. When the genitals are stimulated so can everything that’s close and nearly connected.
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Well informed article but seems the audience the author is trying to reach is a dated year 1900 group with archaic principles and ideas. Update your verbiage and be as open minded as some of your writing.
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Critical comments are always useful, Terry, as they cause me to question my assumptions or prejudices. I will read the article again with yours’ in mind, but we could perhaps have a more useful discussion if your opinions were more qualified with reasons – otherwise they might just seem insulting.
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Read this article and thought the same thing. You seem to be well-intentioned/not actively malicious, so I’m going to try to point this out gently. This article only talks about penetrative heterosexual sex and seems particularly focused on conception for some reason. I have no idea how this relates to IBS. The only mention of queer people happens when you talk about anal sex–effectively reducing gay male sex to this option, and you don’t go into similar detail about how the physiological response happens in men who have anal sex…then you talk about predators in the same sentence…then you go on to talk about how women can victimize men sexually…when the vast majority of predators, regardless of the victim’s sex or age, are heterosexual men. This doesn’t look great. You ignored lesbian women, and it caused me to wonder whether you believe lesbian women can “really” have sex, since there is no penis involved (you at least mention gay men). You also talk about women with multiple partners in a way that somehow conflates the situation with both promiscuity and wanting to have children (two usually “opposing” forces, very close to the Madonna/Whore way of viewing women) and you make references to morality, law, and church as implied positive ways of influencing sexual behavior. I can safely say as someone affected that these influences are not positive for many, many people, especially women and sexual minorities, as well as interracial couples. I understand you probably didn’t intend to do these things, maybe you couldn’t “see” it in the writing because it isn’t your experience, which makes sense and is why I’m taking the time to tell you what messages it sends to some people. Please just consider rewriting parts of the article. I was distracted enough by the way you spoke about and/or erased certain experiences that the points about IBS were obscured, but I applaud you for trying to help.
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Thank you for sharing your thoughts on my post. As you correctly point out, it was written from the viewpoint of pelvic physiology and largely described penetrative sex and it’s possible influence on the symptoms of IBS. I tried to be open minded about gender and sexual politics, but clearly not enough. I wrote the article in 2015 and have become more aware of those issues since then. I certainly did not wish to give offence in any way, but in a short article, I could only focus on those aspects that were within my experience. I should, however, be interested any thoughts or insights you may have on the possible influence of gay sex on any aspect related to IBS.
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Hi I get very bad pain during sex and after it feels like something is in the way inside me and can’t put his parts In me as its very painfull I don’t know what to do im in pain nearly all time
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That doesn’t sound good, Jayne. I think you should go and see your doctor about that.
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since I was 14 years old I have this problem, right after sexual intercourse or masturbation I feel very bad discomfort and I get a lot of gas, a stuffed belly, sometimes I get constipated or diarrhea, these symptoms only pass after defecating the next day , that doesn’t stop me from living, but it makes my life very uncomfortable
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Thank you for sharing your experience, John. As I tried to describe in my post, sexual orgasm is a physiological crisis and will have reflex effects on other pelvic organs including the colon and especially if it is sensitive.
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as you said in your post, this problem is more related to the emotional than the physiological, would you have any tips for me to try to improve this?
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If it is emotional, John, then perhaps you could try to explore what intercourse or masturbation means for you in terms of your experience. Does it make you think of anything or feel any emotion? You might obtain some help with this from a psychosexual counsellor or therapist.
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I have ibs when I orgasm not annal sex but vagina and oral I poop it’s very annoying I’m 53 please help
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When I do masturbate then diarrhea is started next morning what is this?
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