Nearly 38% of men seen for defecatory disorders also have erectile dysfunction (ED), according to new research presented at the ACG Annual Scientific Meeting — but the connection isn't as straightforward as shared anatomy might suggest. Despite the anorectum and penis sharing nerve supply from the same sacral spinal segments, anorectal pressure profiles and balloon expulsion test results were similar between men with and without ED.

Instead, ED in this population was strongly linked to older age, urinary symptoms, prostate disease, and psychiatric comorbidities. In younger men (under 45), diabetes and rectal hypersensitivity were the top predictors — a finding that hints at a possible "dysregulated brain–gut–pelvic floor axis," where altered pelvic sensory processing may play a shared role.

Key Takeaways:

• ED was found in 37.8% of 717 men evaluated for defecatory symptoms
• In men under 45, diabetes was the strongest ED predictor (OR = 6.35), followed by urinary symptoms and rectal hypersensitivity
• In men over 45, prostate disease topped the list (OR = 3.32)
• Fecal incontinence was significantly more common in men with ED (33.2% vs. 18.2%)

Why it matters: Many men won't volunteer information about ED unless directly asked. Gastroenterologists have a unique opportunity during defecatory disorder evaluations to screen for sexual health issues and connect patients to urology or other specialists — potentially catching treatable causes of ED years earlier than they otherwise would be.