Can hemorrhoids cause erectile dysfunction?

If you are dealing with hemorrhoids and are also having trouble getting or keeping an erection, you may wonder: Can hemorrhoids cause erectile dysfunction (ED)?  

The short answer is no. There is no good evidence that hemorrhoids directly cause ED, but the pain, discomfort, and stress they bring may indirectly contribute to temporary erection problems in some men.

Although this has not been well studied, the symptoms and experiences associated with hemorrhoids may make it more difficult to get or maintain an erection.

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Pain and discomfort

Not all hemorrhoids have symptoms. But if they do, hemorrhoids can cause pain, bleeding, itchiness, and overall discomfort, which may interfere with your ability to get an erection. Research has linked chronic pain with sexual difficulties in general.

Psychological distress

Hemorrhoids may affect your mental health, contributing to feelings of shame, embarrassment, and stress, and might even play into symptoms of anxiety and depression in some people. Research suggests that anxiety may make it more difficult to get or maintain an erection, potentially creating a cycle in which worries about sexual performance further contribute to ED.

Poor sleep

If hemorrhoid pain or discomfort interferes with your sleep, poor sleep may become another factor affecting your overall well-being  Research suggests that men who do not get enough sleep are more likely to have erectile dysfunction. However, this does not prove that poor sleep causes ED, since other health conditions may contribute to both.

Hemorrhoids and ED can occur together, and certain contributing factors, such as older age, blood vessel problems, and pelvic floor dysfunction, may explain the link.

In one study of over 38,000 men, nearly 25% of men with ED had previously been diagnosed with hemorrhoids, compared with about 14% of men without ED — a difference the study's authors reported was most pronounced in men under 40. Keep in mind this was an observational study and does not prove causation, meaning it cannot establish that hemorrhoids caused ED.

Here are some possible reasons for the connection: 

• Age. The risk of hemorrhoids and ED appears to increase with age. Some research estimates that about 40% of men at age 40 have some degree of ED. However, estimates vary depending on how ED is defined and the population studied. This risk increases by about 10% per decade. Hemorrhoids also become more common as you get older.

• Shared blood vessel health. Erections depend on healthy blood flow, and hemorrhoids involve changes to the blood vessels in and around the anus. While these are different processes, some researchers speculate that underlying vascular changes may help explain why the two conditions are often seen together.

• Pelvic floor dysfunction. Pelvic floor dysfunction has been linked to both hemorrhoids and ED. Research found that constipation and difficulty coordinating the pelvic floor muscles during bowel movements are more common among people with hemorrhoids.Similarly, pelvic floor dysfunction may lead to sexual dysfunctions such as ED and premature ejaculation.

• Shared risk factors. Hemorrhoids and ED share several risk factors, including older age, smoking, excess weight, and high blood pressure. It is not known whether these factors explain the association between the two conditions.

Dealing with erection issues and hemorrhoids can be frustrating and uncomfortable, but treatments exist. Here is what to consider:

Treat hemorrhoids 

If pain, bleeding, or other hemorrhoid symptoms are affecting your sex life, treating the hemorrhoids may bring some relief. Treatment depends on how severe your symptoms are, but may include lifestyle changes, topical medications, in-office procedures, or even surgery. 

In one small study, men who underwent hemorrhoid surgery saw modest improvements in erectile function around six months later. However, the study was small and did not include a  comparison group, so more research is needed to fully understand whether treating hemorrhoids directly improves ED.

Other tips to improve hemorrhoids include:

• Over-the-counter topical creams 

• Increasing your fiber intake

• Taking stool softeners

• Drinking more water

• Avoiding straining during bowel movements

• Not sitting on the toilet for long periods

• Using sitz baths

Address ED symptoms

If ED symptoms persist, check in with a healthcare provider about treatment options. First-line treatments for ED include prescription medications such as sildenafil (Viagra) and tadalafil (Cialis). These medications improve blood flow to the penis when you are sexually aroused, making it easier to get and maintain an erection.

A healthcare provider can also evaluate for other possible contributors to ED, such as diabetes, cardiovascular disease, low testosterone, medication side effects, or mental health issues.

Other ways to help support erectile function (and overall health) include:

• Addressing underlying health conditions

• Exercising regularly

• Following a healthy diet

• Avoiding smoking

• Limiting alcohol

• Getting enough high-quality sleep

• Talking to a therapist about performance anxiety 

Consider pelvic floor therapy

If pelvic floor dysfunction is contributing to either hemorrhoids or ED, performing pelvic floor exercises (e.g. Kegels) or seeing a healthcare provider for pelvic floor massage may help to improve muscle coordination and reduce symptoms of both.

Other tips to support pelvic floor function include:

• Practicing deep breathing and pelvic floor relaxation techniques

• Working with a pelvic floor physical therapist

• Trying biofeedback, if recommended by your provider

While hemorrhoids and erectile dysfunction are both common, neither should be ignored, even if they are hard to talk about. A healthcare provider can help you figure out what is causing your symptoms, recommend the right treatment, and rule out other underlying conditions.

Because symptoms such as rectal bleeding, anal pain, and itching can have causes other than hemorrhoids, check in with a healthcare provider. See a healthcare provider if you notice any changes in your bowel habits, including:

• Rectal bleeding or hemorrhoid symptoms that do not improve after about a week of home care

• Black or tarry stool

• Unexplained weight loss

• Changes in bowel habits or abdominal pain

• Sudden erectile dysfunction with no obvious cause

Seek urgent care for anal pain with bleeding, fever, diarrhea, or abdominal pain.

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Hemorrhoids and ED can occur together, but this does not mean that hemorrhoids cause erection problems. 

. Here is what we know:

• Hemorrhoids may indirectly contribute to ED. Pain, discomfort, stress, and other symptoms associated with hemorrhoids may make sexual activity or arousal more difficult, but this has not been well studied.

• Hemorrhoids and ED share several underlying risk factors. Older age and certain health or lifestyle factors are associated with both conditions, but it is not known whether they explain the observed connection. Pelvic floor dysfunction is another possible — but unproven — factor.

• Treating hemorrhoids may improve your symptoms and sexual function. Lifestyle changes, medications, procedures, and surgery may help relieve hemorrhoid symptoms such as pain, bleeding, itching, and discomfort and may make sexual activity more comfortable. If ED symptoms persist, your healthcare provider may recommend treatments such as Viagra or Cialis.

• Hemorrhoids are unlikely to fully explain persistent ED. A healthcare provider can assess both conditions, identify root causes, and recommend the most appropriate treatment plan.