Can Bowel Surgery Cause Erectile Dysfunction?

While uncommon, certain factors can increase the risk

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There are a number of complications that can arise following bowel surgery, most of which are related to infection or isolated episodes of bowel obstruction.

Among men, one of the more common concerns is whether bowel surgery can lead to erectile dysfunction (ED). The association is often made because the surgery involves the same general region of the body as prostate surgery (a procedure which does, in fact, carry the risk of ED).

While understandable, the comparison may be something of a stretch given that the nerves near the prostate gland are central to erectile function while those in the bowel are usually not. But that doesn't mean the ED can't occur following bowel surgery; it sometimes can.

While uncommon, there are certain surgical procedures that carry the risk of ED, particularly those involving the rectum or anus. At the same time, a number of non-surgical factors can also give rise to ED, either by contributing to the condition or causing it entirely on its own.

Cancer and Bowel Surgery

One of the primary reasons for bowel surgery is colorectal cancer. On the whole, colorectal cancers occur more frequently in men than women and are more likely to develop in those over 50.

If surgery is needed to remove a malignancy, it may involve a bowel resection. This is a procedure where a portion of the large intestine (colon) is surgically removed along with the tumor itself.

Typically speaking, a resection of this sort does not increase the risk of ED. However, there are three variations of the procedure that cause post-operative ED:

  • Left hemicolectomy (the removal of the left portion of the colon)
  • Abdominoperineal resection (the removal of the rectum and anus)
  • Proctectomy (the removal of the rectum)

    Because these physiological structures involve sympathetic nerves associated with an erection, anywhere from 10 percent to 65 percent of men who undergo the procedures may experience ED. The disparity is largely related to how much and which specific tissues are involved.

    The actual causes of ED can vary from one man to the next. In some cases, the surgery may result in the loss of skin sensation (sympathetic skin response) while others may affect the sacral reflex (the motor response which controls both the anal sphincter and muscles of the pelvic floor).

    In some cases, the partial or complete restoration of erectile function is possible (although the likelihood is hard to predict in advance of the surgery). As such, if bowel surgery is needed, it is important to discuss the risk of ED with your doctor as well as any surgical alternative that might better avoid this complication.

    Other Risk Factors

    The risk of erectile dysfunction, irrespective of bowel surgery, increases as a man gets older. By the age of 50, the risk is roughly one in three. By 70, the rate can be as high as 45 percent. As such, men undergoing bowel surgery are more vulnerable to ED simply because they tend to be older.

    Additionally, the very trauma of going through major surgery can cause stress that directly interferes with sexual function. Moreover, if there is a loss of sensation or the need for a colostomy, the emotional stresses can be further compounded, interfering with sex even if they don't directly impact erectile function.

    Other factors can also contribute, including:

    • Co-existing medical conditions, such as diabetes, hypertension, or heart disease
    • Cancer chemotherapy or radiation therapy
    • Certain high blood pressure medications
    • Other prescription and non-prescription drugs
    • Anxiety and depression
    • Excessive alcohol use
    • Smoking

    What You Can Do

    Bowel surgery is typically performed when no other options are available. If surgery is recommended, you will need to make an informed choice as to the benefits and consequences of the procedure. This includes the risk of ED.

    Most studies have shown that, when faced with the possibility of ED, the majority of men will opt for the life-saving procedure. This doesn't mean that the decision is always cut and dry, particularly if you are young and planning to have a family. In such case, men will often turn to a sperm bank if there is even the slightest chance of post-operative ​infertility.

    If faced with bowel surgery of any sort, learn as much as you can about the procedure as well as the risks. If you are not getting the answers you need, never hesitate to get a second opinion. While others may be focused on the here-and-now, you need to plan for your recovery and the many years ahead. Ask everything that you need to ask. Don't hold back.

    Sources:

    Averyt, J. and Nishomtoto, P. "Addressing sexual dysfunction in colorectal cancer survivorship care." J Gastrointest Oncol. 2014; 5(5):388-94. DOI: 10.3978/j.issn.2078-6891.2014.059.

    Ellis, R.; Smith, A.; Wilson, S. et al. "The Prevalence of Erectile Dysfunction in Post-Treatment Colorectal Cancer Patients and Their Interests in Seeking Treatment: A Cross-Sectional Survey in the West-Midlands." J Sex Med. 2010; 4(1):1488-91. DOI: 10.1111/j.1743-6109.2009.01461.x.