Laxatives: A Silent Cause Of Erectile Dysfunction?

can laxatives cause erectile dysfunction

Laxatives are often used to treat constipation, a common side effect of opioid agonist therapy (OAT) and methadone maintenance therapy (MMT). While laxatives can help with constipation, they may also have potential side effects, including erectile dysfunction (ED). ED is a sexual dysfunction characterised by difficulties in achieving or maintaining an erection. It can be caused by various factors, including certain medications and medical conditions. According to the principles of Ayurveda, a natural system of medicine, constipation can lead to an imbalance of Apana Vayu, which is responsible for male sexual functions, including erection and ejaculation.

Characteristics Values
Laxatives Can be used to treat constipation, a side effect of opioid agonist therapy (OAT) and methadone maintenance therapy (MMT)
Opioid agonist therapy (OAT) and methadone maintenance therapy (MMT) Are effective medical interventions for opioid use disorder (OUD) but can cause side effects such as constipation and sexual dysfunction, including erectile dysfunction (ED)


Laxatives and erectile dysfunction medications can treat opioid use disorder side effects

Opioid use disorder (OUD) is a significant health crisis in Canada and worldwide, affecting people from all walks of life. OUD is characterised by a dangerous dependency on opioid drugs or prescription medications, with individuals experiencing a euphoric high. Treatment for OUD typically involves a combination of behavioural and pharmacological interventions, such as opioid agonist therapy (OAT) and methadone maintenance therapy (MMT). While these treatments effectively reduce withdrawal symptoms, they also come with their own set of side effects, including constipation and sexual dysfunction, or erectile dysfunction (ED) in men.

The discomfort and distress caused by these side effects can discourage patients from continuing with OAT or MMT, increasing the risk of relapse. Opioid-induced constipation, a common issue with all opioid drugs, can lead to bloating, discomfort, and a reduced quality of life. It is often treated with dietary and lifestyle changes, as well as laxatives, including stimulants, stool softeners, and fibre supplements. However, there is limited information available on the best practices for treating constipation in patients undergoing OUD treatment.

Sexual dysfunction, another side effect of opioid drugs and OUD treatments, affects both men and women, causing abnormalities in sexual desire, arousal, and satisfaction. In men, this often manifests as ED, which has various underlying causes, including physiologic, social, and psychological factors. While treatments for ED are available, there is a lack of guidance on the best practices for addressing ED as a side effect of OAT or MMT in patients with OUD.

Given the benefits of OAT and MMT in treating OUD, it is crucial to address the side effects to ensure patient comfort and adherence to treatment. This includes exploring the potential of laxatives and erectile dysfunction medications to manage the side effects of opioid agonist and methadone maintenance therapy. By identifying and summarising the clinical effectiveness and recommendations for these treatments, healthcare providers can make informed decisions to support patients in their journey towards recovery from opioid use disorder.


Diuretics and high blood pressure drugs can cause ED

It is important to note that not all high blood pressure drugs cause ED. Some medications, such as ACE inhibitors, angiotensin-receptor blockers, and alpha-blockers, rarely cause ED. In some cases, these drugs may even improve sexual function in men with high blood pressure. For example, one study found that a small number of men experienced a 100% improvement in their ED after taking the alpha-blocker Cardura for two years.

If you are experiencing ED and are taking a diuretic or high blood pressure medication, it is important to consult your doctor. They may be able to switch you to a different medication that is less likely to cause ED or prescribe a combination of medications to control your blood pressure and lower the risk of ED. Do not stop taking your medication without first speaking to your doctor, as this can be dangerous.

While it may be tempting to stop taking a medication that is causing ED, it is important to prioritize your health and work with your doctor to find a solution. ED can be a side effect of many common drugs, and it is estimated that 25% of all cases of ED are caused by medication. Additionally, high blood pressure itself can also be a cause of ED, so it is crucial to get your blood pressure checked and treated if necessary.

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Antidepressants, anti-anxiety drugs, and antihistamines are linked to ED

Antidepressants, anti-anxiety drugs, and antihistamines have been linked to ED. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed medications for anxiety and depression. While they are effective in treating these conditions, they are also known to cause ED in many people. SSRIs, for example, can affect up to 76% of people who use them, while some, like fluoxetine and sertraline, are considered to have a lower risk of sexual side effects. SNRIs can impact up to 70% of people, causing sexual problems.

Benzodiazepines, a type of sedative, are also used to treat anxiety and are known to cause or worsen ED. Men who take them may be two to three times more likely to experience ED. Antipsychotic medications, such as haloperidol and risperidone, can also contribute to ED symptoms by blocking dopamine and increasing prolactin levels in the body.

Tricyclic antidepressants (TCAs) are another class of antidepressants that are sometimes prescribed to treat depression and anxiety. They are less common than SSRIs and SNRIs due to their higher incidence of side effects. TCAs have been linked to ED, with estimates suggesting that about 30% of people taking these medications experience sexual side effects.

Antihistamines, primarily used to treat allergies and cold and flu symptoms, have also emerged as a promising way to treat short-term anxiety. While not all antihistamines are approved by the FDA for treating anxiety, hydroxyzine (Vistaril) has been approved and is prescribed for this purpose. It is important to note that antihistamines are not a long-term solution for anxiety disorders and should be used with caution under the guidance of a healthcare professional.

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Corticosteroids and antidepressants can negatively impact sexual function in IBD patients

Inflammatory bowel disease (IBD) is a chronic illness that affects patients between the ages of 15 and 40, a time when body image, intimate relationships, sexual activity, and emotional security are particularly important. Corticosteroids, which are often used to treat IBD, are the biggest concern regarding sexual function. The adverse effects of corticosteroid therapy include mood changes, acne, weight gain, stretch marks, hirsutism, and an increased risk of oral and vaginal Candida infections, all of which can negatively impact a patient's body image. Additionally, corticosteroid use can increase the risk of diabetes, which is a known risk factor for sexual dysfunction.

Antidepressants are also commonly used to treat IBD and have been significantly associated with sexual dysfunction. Sexual dysfunction is a common side effect of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). These medications can affect all four phases of the sexual response cycle: desire, arousal, orgasm, and resolution. Elevated serotonin levels, which are a result of SSRIs and SNRIs, are thought to diminish sexual function by inhibiting dopamine and norepinephrine pathways in the brain.

The impact of corticosteroids and antidepressants on sexual function can be both physiologic and psychosocial. Physiologic factors, such as fatigue, joint pain, abdominal pain, and dyspareunia, can be addressed by a gastroenterologist. From a psychosocial perspective, depressed mood and anxiety, which are common in patients with IBD, can impair sexual function, with depression being the greatest independent risk factor for sexual dysfunction.

The management of antidepressant-associated sexual dysfunction is complex and requires a partnership between research and practice. While some evidence suggests that certain antidepressants, such as bupropion and nefazodone, are less likely to cause sexual dysfunction, the overall management of sexual dysfunction will involve pre- and post-test sexual dysfunction and depression surveys to understand the efficacy of interventions.

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Opioid-induced constipation is a common side effect

Opioid-induced constipation (OIC) is a common side effect of opioid use, affecting between 40% and 60% of patients without cancer who are receiving opioids. OIC is caused by the activation of enteric mu-opioid receptors, which leads to reduced gastric, biliary, pancreatic, and intestinal secretions, increased absorption of water from bowel contents, and decreased gastric motility. The condition is characterised by harder stools and less frequent and less effective defecation.

To prevent OIC, laxatives must be started at the same time as opioid therapy. If OIC is not prevented, it can be treated with both pharmacological and non-pharmacological therapies. Non-pharmacological treatments include increasing dietary fibre, fluid intake, and physical exercise. Pharmacological treatments include a range of over-the-counter and prescription medications.

Over-the-counter medications include stimulant laxatives, stool softeners, and enemas. Stimulant laxatives irritate sensory nerve endings to stimulate colonic motility and reduce colonic water absorption. Stool softeners, such as docusate sodium, are surfactants that allow water and lipids to penetrate the stool, hydrating and softening it. Lubricants, such as mineral oil, soften the stool and lubricate the lining of the gut. Osmotic laxatives, such as polyethylene glycol, draw water into the gut to hydrate the stool.

Prescription medications for OIC include lubiprostone, methylnaltrexone, naloxegol, and naldemedine. Lubiprostone is a chloride channel activator that increases fluid secretion in the GI tract, resulting in increased tone, enhanced peristalsis, and accelerated small bowel and colonic transit times. Methylnaltrexone is a peripherally acting opiate antagonist that does not cross the blood-brain barrier, thereby avoiding symptoms of opioid withdrawal. Naloxegol and naldemedine are also peripherally acting mu-opioid receptor antagonists that do not interfere with the analgesic effects of opioids.

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Frequently asked questions

Laxatives are not listed as a cause of erectile dysfunction. However, constipation can cause erectile dysfunction, and laxatives are used to treat constipation.

The most common types of medication that are linked to erectile dysfunction include antidepressants, anti-ulcer drugs, tranquilizers, and diuretics.

According to Ayurveda, a natural remedy for erectile dysfunction is to drink warm milk with a teaspoon of ghee at night.

Talk to your doctor or healthcare provider. Do not stop taking any medication without first seeking advice from a medical professional.

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