Diverticulitis and erectile dysfunction (ED) are common conditions affecting many UK adults, particularly those over 50. Whilst diverticulitis involves inflammation of small pouches in the colon wall, ED is the persistent inability to achieve or maintain an erection. Patients occasionally experience both conditions simultaneously, raising questions about potential connections. Although no direct causal link exists in medical literature, shared risk factors—including obesity, cardiovascular disease, and lifestyle factors—may explain their co-occurrence. Additionally, surgical treatment for complicated diverticulitis carries a small risk of nerve damage affecting erectile function. Understanding these relationships helps inform appropriate management strategies for both conditions.

Understanding Diverticulitis and Erectile Dysfunction

Diverticulitis is an inflammatory condition affecting the digestive system, occurring when small pouches (diverticula) in the wall of the colon become inflamed or infected. These pouches develop in weakened areas of the bowel wall, most commonly in the sigmoid colon. Diverticula themselves are very common—affecting around 1 in 3 people over 50 and 2 in 3 over 80 in the UK—but most remain asymptomatic (diverticular disease). Only a minority develop diverticulitis. Symptoms include persistent abdominal pain (usually in the lower left side), fever, nausea, and changes in bowel habits. Complications can range from mild inflammation to severe infections, abscesses, perforation, or fistula formation.

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Prevalence increases with age; studies suggest that up to half of men aged 40–70 experience some degree of ED. It is not simply a natural consequence of ageing but a medical condition with multiple potential causes, including vascular disease, diabetes, neurological conditions, hormonal imbalances, psychological factors, and certain medicines. ED can significantly impact quality of life, relationships, and psychological wellbeing.

Whilst these two conditions may seem unrelated, patients occasionally report experiencing both simultaneously, leading to questions about potential connections. Understanding whether diverticulitis directly causes erectile dysfunction requires examination of anatomical relationships, shared risk factors, and potential mechanisms through which one condition might influence the other. Both conditions share certain demographic patterns, particularly affecting middle-aged and older adults, which may contribute to their co-occurrence in some individuals.

Can Diverticulitis Cause Erectile Dysfunction?

There is no established direct causal link between diverticulitis and erectile dysfunction in medical literature. However, several indirect mechanisms may explain why some men experience both conditions or notice erectile difficulties during or after diverticulitis episodes.

Shared risk factors represent the most significant connection between these conditions. Both diverticulitis and ED are associated with:

• Obesity – increases intra-abdominal pressure (promoting diverticula formation) and impairs vascular function (contributing to ED)

• Sedentary lifestyle – linked to poor bowel motility and reduced cardiovascular health

• Poor dietary habits – low-fibre diets may increase diverticulitis risk, whilst poor nutrition affects vascular health

• Smoking – damages blood vessels throughout the body, including those supplying the bowel and penis

• Cardiovascular disease – atherosclerosis can affect both mesenteric and pudendal arteries

Surgical complications following treatment for complicated diverticulitis may occasionally affect erectile function. Sigmoid colectomy or other pelvic surgery carries a small risk of nerve damage. The autonomic nerves controlling erection (particularly the hypogastric plexus) lie close to the sigmoid colon and rectum. Nerve-sparing surgical techniques have reduced this risk significantly, but damage remains possible, particularly during low pelvic dissection for complicated disease. The risk varies with the extent and complexity of surgery.

Inflammatory effects during acute diverticulitis may temporarily affect sexual function through multiple pathways. Systemic inflammation may theoretically impair endothelial function throughout the vascular system, though evidence is limited. Additionally, severe pain, fever, and general malaise naturally suppress libido and sexual function during acute illness. These effects typically resolve once the infection is treated.

Medicine side effects also warrant consideration. Antibiotics used to treat diverticulitis rarely cause ED directly. However, some medicines used for other conditions—such as certain antidepressants (e.g., selective serotonin reuptake inhibitors), some antihypertensives (e.g., beta-blockers, thiazide diuretics), and other drugs—may contribute to erectile difficulties.

Managing Erectile Dysfunction with Diverticulitis

Lifestyle modifications form the cornerstone of managing both conditions simultaneously and addressing shared risk factors:

• Dietary improvements – Adopt a high-fibre diet (30g daily for adults) including whole grains, fruits, vegetables, and legumes. A balanced diet supports bowel health and cardiovascular function, potentially improving erectile function. The Mediterranean diet, recommended by NICE for cardiovascular disease prevention, benefits both conditions.

• Regular physical activity – Aim for 150 minutes of moderate-intensity exercise weekly. Physical activity is associated with lower diverticulitis risk and significantly improves erectile function through enhanced cardiovascular fitness and endothelial function.

• Weight management – Achieving a healthy BMI (18.5–24.9 kg/m²) reduces intra-abdominal pressure and improves vascular health.

• Smoking cessation – Essential for both conditions; NHS Stop Smoking Services provide evidence-based support.

• Alcohol moderation – Limit intake to 14 units weekly, spread over several days, as per UK Chief Medical Officers' guidelines.

Medical treatments for erectile dysfunction remain appropriate for men with a history of diverticulitis. Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil are first-line treatments and are not contraindicated in diverticulitis. These medicines enhance nitric oxide-mediated smooth muscle relaxation in penile arteries, improving blood flow. They should be taken as prescribed, typically 30–60 minutes before sexual activity (or daily for tadalafil 5mg).

Important safety information for PDE5 inhibitors:

• Contraindications include concurrent use of nitrates or riociguat, recent myocardial infarction or stroke (within 6 months), severe hypotension, and unstable cardiovascular disease.

• Caution is required with alpha-blockers (risk of hypotension); discuss timing and dosing with your GP.

• Common side effects include headache, flushing, indigestion, nasal congestion, dizziness, and visual disturbances.

• If you have significant cardiovascular disease, discuss with your GP before starting treatment.

• Report suspected side effects via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Psychological support is important, as chronic illness can affect mental health and sexual confidence. Cognitive behavioural therapy (CBT) or psychosexual counselling may help address anxiety or relationship concerns. NHS Talking Therapies services are available across the UK, and some sexual health clinics provide holistic assessment and support.

Managing diverticulitis effectively may indirectly improve erectile function by reducing systemic inflammation, pain, and psychological distress. Following NICE guidance (NG147), management includes:

• Analgesia – Paracetamol is first-line; avoid NSAIDs and opioids where possible.

• Antibiotics – Not routinely offered for uncomplicated acute diverticulitis; consider if systemically unwell, immunosuppressed, or with complicated disease.

• Dietary modification – A balanced diet with adequate fibre.

• Follow-up – After a first episode of complicated diverticulitis, colonoscopy (around 6 weeks later) may be considered to exclude colorectal cancer.

• Elective surgery – May be considered for recurrent complicated disease; discuss with a specialist.

When to Seek Medical Advice

For erectile dysfunction, consult your GP if you experience persistent difficulties achieving or maintaining erections for more than three months. Early assessment is particularly important because ED can be an early warning sign of cardiovascular disease. Your GP will:

• Take a comprehensive medical and sexual history

• Perform cardiovascular risk assessment

• Check blood pressure and conduct physical examination

• Arrange blood tests (HbA1c or fasting glucose, lipids, morning total testosterone—repeated if low—and other tests such as prolactin if indicated)

• Review current medicines for potential contributing factors

• Discuss treatment options and provide lifestyle advice

Routine GP consultation is warranted if you experience:

• Sudden onset of ED following pelvic surgery

• Loss of morning erections or complete inability to achieve erections

• Penile deformity or painful erections (possible Peyronie's disease)

• Symptoms of low testosterone (fatigue, reduced muscle mass, mood changes)

Emergency assessment (999 or A&E) is required for:

• Priapism – painful erection lasting more than 4 hours

• Chest pain, breathlessness, or other acute cardiovascular symptoms

For diverticulitis symptoms, seek prompt medical attention if you develop:

• Persistent abdominal pain, particularly in the lower left side

• Fever above 38°C with abdominal pain

• Rectal bleeding or blood in stools

• Persistent vomiting or inability to tolerate fluids

• Severe constipation or inability to pass wind (may indicate obstruction and requires urgent same-day assessment)

Emergency assessment (999 or A&E) is required for:

• Severe, sudden abdominal pain

• Signs of peritonitis (rigid, tender abdomen)

• Significant rectal bleeding

• Symptoms of sepsis (high fever, confusion, rapid heartbeat, breathlessness)

If you have had complicated diverticulitis, your GP may arrange follow-up colonoscopy to exclude colorectal cancer. If you have symptoms suggestive of colorectal cancer (e.g., unexplained weight loss, persistent change in bowel habit, rectal bleeding), your GP will refer you urgently under the suspected cancer pathway (NICE NG12).

Integrated care is essential when managing both conditions. Inform all healthcare professionals about your complete medical history, as this enables comprehensive assessment and appropriate treatment planning. Your GP can coordinate care between gastroenterology and sexual health services if needed, ensuring that treatments for one condition do not adversely affect the other. Regular follow-up allows monitoring of both conditions and adjustment of management strategies as required.

Frequently Asked Questions