Clinical Presentation And Differential Diagnosis
Symptoms and treatment strategy can differ based on extent of disease. Illustration by Jill Gregory. Printed with permission of ©Mount Sinai Health System.
Extraintestinal manifestations can occur in about a third of patients with ulcerative colitis, and up to a quarter might have extraintestinal manifestations before inflammatory bowel disease diagnosis .75,76 Peripheral arthritis appears to be the most common extraintestinal manifestation primary sclerosing cholangitis and pyoderma gangrenosum are more common in ulcerative colitis than in Crohns disease.75,76 The risk of venous thromboembolism in patients with inflammatory bowel disease is increased three to four times, and is greater when the patient is admitted with a flare or being treated with corticosteroids.7780 Clinicians should have a high index of suspicion for venous thromboembolism, and hospitalised patients with ulcerative colitis should be prescribed venous thromboembolism prophylaxis.81
Overview Of Sexual Dysfunction In Ibd
The first report of SD in patients with IBD was published in 1978 in patients with CD with more than one year of disease progression. Of the 52 married patients, 28 reported that sexual intercourse was less frequent, and another 12 ceased sexual contact completely.10 Subsequently, in 1996 a study that included 50 women with CD revealed that 24% of them had either infrequent or no sexual intercourse compared with 4% of controls, mainly due to abdominal pain , diarrhea , and fear of fecal incontinence , in addition to registering a higher frequency of dyspareunia and vaginal candidiasis.11 Since then, several studies have confirmed that SD rates are higher in patients with IBD than in the general population,12 and affect up to 60% of women and 15% of men with IBD compared with 30% in women and 5% in men in the general population.1214 Data obtained from a recent meta-analysis confirmed these findings, with a relative risk of 1.41 and 1.76 for SD in men and women with IBD, respectively.15
Criterion And Construct Validity
Using the Spearmans rank correlation coefficient, the 10-item IBD-MSDS was highly significant, and inversely correlated with all the subscales of the IIEF: erectile function , orgasmic function , sexual desire , satisfaction in sexual intercourse , and general satisfaction . Supplementary Figure 1 shows these distributions, which establishes strong criterion validity. Similarly, the IBD-MSDS was highly significant and positively correlated with the summary score for the PHQ-9 and with the Active IBD Score . Supplementary Figure 2 shows these distributions, which establishes strong construct validity.
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Can Ulcerative Colitis Cause Erectile Dysfunction
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Erectile Dysfunction And Ulcerative Colitis
There are a variety of reasons why men with UC unfortunately are more likely to suffer from ED. Many of the symptoms of UC likely lead to men to have less sexual desire and increased sexual functioning. When in an active phase, symptoms can include diarrhea, abdominal pain, rectal bleeding, urgent need to move bowels, and a sensation of incomplete evacuation of bowel movements.
Autoimmune diseases such as UC can also carry a psychological toll on mens mental health. A 2017 meta-analysis found that men with UC experiencing depression along with anxiety, stress, and poor social and emotional functioning, were all predictors of sexual problems that followed. Even if these men took antidepressants to deal with issues, antidepressant medication in and of itself, can lead to reduced sexual functioning as well.
Inclusion And Exclusion Criteria
The following guidelines were used to determine the patient eligibility for inclusion: over 18 years of age, with a stable sexual partner for 3 months IBD diagnosed by Chinese Consensus on Diagnosis and Treatment of Inflammatory Bowel Disease data was collected only on the first visit even when there were multiple visits for the same patient ability to fill in and understand the questionnaire sign informed consent and participate voluntarily.
The following guidelines were used to exclude patients: those who couldnt understand or fill out the questionnaire themselves and/or those with mental disorders diagnosis of SD before an IBD diagnosis SD compounded by other diseases: cardiovascular and cerebrovascular diseases, lung diseases, liver and kidney dysfunction, and neoplastic diseases, etc.
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Erectile Dysfunction In Male Ibd Patients
In men, ED was identified in 43.5% of the IBD patients and 12.5% of the healthy controls . The rate of ED was not different between CD and UC patients: 44.3% and 42.4% , respectively . However, The prevalence of ED in CD and UC patients was significantly higher than in the control group . The rate of ED in IBD patients with the active disease was significantly higher than in patients with IBD-remission: 53.6% and 30.9% , respectively , which were significantly higher than healthy controls .
Figure 2 Erectile function of IBD male patients compared with healthy controls according to IIEF-5.
The prevalence of ED in mild, moderate, and severe male IBD patients was 47.1%, 57.7%, and 66.7%, respectively, which are all significantly higher than reported in the control group . As the disease activity increased, the prevalence of ED in male IBD patients increased . The prevalence of ED was higher in moderate and severe IBD patients as compared to the IBD-remission patients , and there was no significant difference between mildly active and IBD-remission patients . However, there was a significant difference in the prevalence between mildly active IBD patients and moderate and severe IBD patients , and between moderately active IBD patients and severe IBD patients .
Table 5 Comparison of IBD patients and healthy controls for IIEF-5.
How To Deal With A Lack Of Sex Drive
Addressing nutritional issues can be an answer for some people who find their libido has changed. Low levels of iron, folic acid, and vitamin B12, in particular, can lead to anemia and leave a person feeling quite tired. With proper supplements, either by mouth or through injection, iron and vitamin B12 levels can be raised to combat the anemia.
Prednisone is a fact of life for some people living with IBD. Patients often work toward reducing the use of prednisone as soon as possible because it can play havoc with so many body functions. With dosage decreases as small as 1 mg, tapering down from 40 mg to 5 mg or 10 mg a day can be a long process. The good news is that once the drug is stopped, many of prednisone’s side effects are usually reversed.
Until fistulas are treated effectively through medication or surgery, they can affect sexual desire. A personal lubricant may help in some instances of recto-vaginal fistulas that are causing discomfort. It’s important here to try to avoid activities or positions that cause discomfort. It may be necessary to avoid penetrating sex but instead to enjoy oral sex or mutual masturbation at times when a fistula is flaring up.
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Im Hiv Positive Do I Have To Tell My Ibd Team
You do not have to tell other healthcare professionals, such as your GP or IBD team, about your HIV status. You may feel that you want to keep this information private. However, your IBD team may need to carry out HIV screening before starting some medicines. This is to make sure you arent taking a medicine that could be harmful to you. See Terrence Higgins Trust for more information.
Try Not To Stress About Sex
The more you stress about your sex drive and performance, the less likely youâll be able to get in the mood. Thatâs why itâs important to give yourself a break if youâre noticing occasional issues, like being too tired to be intimate with your partner. âThatâs normal, especially as we get older,â Berman says.
But if your libido is consistently low or you have issues like vaginal pain or erectile dysfunction, tell your doctor. Some UC medications can impact your sex drive and ability to have sex. A new medication or sexual aid, like lubricant, may improve the way you feel and function. If you have physical problems like a fistula or weak pelvic floor, a specialist should be able to help.
Being open with your partner can also ease anxiety. âIf youâre just dating or in a new relationship, youâll want to establish trust before telling them about your condition,â Berman says. âBut once youâre in a committed relationship, it can take pressure off to be up-front about your needs and fears.â
Consider getting your partner involved in your medical care, too, especially if youâre going to have surgery for your UC. âWe encourage partners to come to appointments and have an open discussion about this stage of treatment,â McClure says. âIt helps make everyone more comfortable and get prepared for what comes next.â
Gastroenterology & Hepatology: âSex-Specific Issues in Inflammatory Bowel Disease.â
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Why Would Ibd Cause Erectile Dysfunction
It is not so clear, and further studies need to be done in this area, says Dr. Kava. The majority of patients diagnosed with IBD are young, between 15 and 40. Typical IBD symptoms include increased bowel frequency, pain in the belly, tiredness, fatigue and/or incontinence. It can be an embarrassing time and a time when one feels less confidence in any intimate encounter. Patients may have less interest anyway in being sexual due to the changes happening in their bodies.
IBD may impact your sexual health. Depression and/or anxiety are the greatest risk factors for sexual dysfunction, whether healthy or being treated for a disease of the colorectal area, says Dr. Kava.
About Irritable Bowel Disease
IBD is a debilitating disease that targets the digestive tract and leads to fatigue, severe diarrhea, weight loss, and abdominal pain. It is a chronic disease of which there are two types: Crohns Disease and Ulcerative Colitis. Irritable bowel disease seems to be shared by both men and women equally, and is characterized further by increased bowel movements, incontinence, anorectal abscesses, and perianal fistulas.
IBD is usually diagnosed between the ages of 15 and 40, which is the time when men and women are developing their body image and possibly initiating intimate relationships.
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Not Feeling Like Having Sex
Low sex drive in people with Crohns or Colitis could be due to:
Future Directions And Controversies
The number of drugs modulating different disease pathways is expected to expand in the near future. There are at least 27 new drugs for ulcerative colitis with either recently completed or active trials.170 One example is the oral pan-janus kinase inhibitor tofacitinib, which has shown higher rates of clinical remission than placebo in phase 2 studies.171 Etrolizumab, a subcutaneous monoclonal antibody that blocks the 7 subunit of the heterodimeric integrins 47 and E7 achieved higher clinical remission rates than placebo in a phase 2 trial.172 An oral anti-4 integrin therapy significantly increased clinical remission and endoscopic healing in a phase 2 trial.173 An oral drug inhibiting sphingosine-1-phosphate receptors that blocks lymphocyte egress from lymph nodes has also shown efficacy.174 In a small trial of 5-ASA non-responders, curcumin increased endoscopic remission in mild to moderate ulcerative colitis as an add-on therapy.175 Biosimilar biological drugs should decrease the cost of therapy. Results from initial studies with an infliximab biosimilar, CT-P13, have shown efficacy at inducing endoscopic healing in ulcerative colitis.176 However, immunogenicity and efficacy remains a concern particularly in patients switching from the originator to the biosimilar.177
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Be Open With Your Gastroenterologist
Your gastroenterologist wants to help improve your overall life and that includes your sex life. If you feel stressed about your IBD and the effects it may have or is having on your day to day sex life, contacts your doctor. And be open to a discussion. Without communication between you and your doctor, you could develop worse symptoms like depression and withdrawal. Dont be embarrassed. Remember the statists mentioned earlier? Almost 40 percent of men say their sexual desire has decreased because of their IBD, over 25 percent say IBD prevents them from having sex and about 20 percent of men say its caused problems for them during sex. You are not alone. Ask your doctor about depression medication or about reducing your corticosteroid use. Possibly consult a sexual health therapist to become more informed on different sexual positions to use if youre in pain.
Benefits Of Pouch Surgery
Pouch surgery for ulcerative colitis has helped to eliminate many symptoms of UC and improves a mans life significantly. Following pouch surgery, about half of the UC patients report improved sexual satisfaction. In a long-term study, ninety percent of UC patients said they were satisfied with their sexual health following pouch surgery. Patients who have had UC pouch therapy report long term symptom relief, elimination of medications, and an overall more satisfying lifestyle.
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Search Strategy And Selection Criteria
We searched for relevant manuscripts in PubMed/MEDLINE, Embase, and Cochrane Central from their inception until March 1, 2016. The search combined the MeSH terms ulcerative colitis and inflammatory bowel disease with the subheadings epidemiology, etiology, physiopathology, innate and adaptive immunity, diagnosis, genetics, diagnosis, endoscopy, therapy, surveillance, and complications. Bibliographies of included articles were searched and experts in inflammatory bowel disease were consulted to identify additional studies. Relevant articles and abstracts published in English were critically reviewed. Priority was given to manuscripts published in the past 5 years, randomised placebo-controlled trials, and meta-analyses.
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