TL;DR

• Diverticulosis: Presence of small pouches (diverticula) in the colon wall. Often asymptomatic.

• Diverticulitis: Inflammation or infection of diverticula. Not the best time to engage in anal sex without medical advice because you may have an infection (you also probably will feel too crummy to do so). Wait until fully recovered/ out of the flare or cleared by your doctor.

• Anal sex/bottoming does NOT cause Diverticulitis or Diverticulosis (you can not get diverticulitis from bottoming).

• Diverticulosis and Diverticulitis are NOT CONTAGIOUS!

General Guidance

Avoid rough, or excessive penetrative sex during flares of Diverticulitis

• Penetration may possibly increase intra-abdominal pressure and strain, which may worsen symptoms or trigger pain.

• Anal sex may be particularly painful as well if you have inflammation in the anal/rectal area (if that is where your diverticula are)

• If you have active diverticulitis that is causing perianal symptoms (which is really rare, since it mostly affects the colon)

• The occurrence of symptomatic rectal diverticula is even more rare.

• Because of that being a veeeeery rare situation, that is one where you should contact your doctor and seek their advice.

• If you are dealing with isolated rectal diverticulum with rectal prolapse and/or outlet obstruction, this is usually managed surgically!

• After surgery, your surgeon and doctor will help set you up with a game plan for recovery and return to your sexual health!

• If you need a little refresher on talking to healthcare providers about sexual health and GI health, see here.

• The main rules of the road discussed here, here, here, and everywhere on this site always apply - go slow, communicate, lube, and stop if anything hurts or feels weird.

• Anal sex likely does not affect Diverticulitis, especially depending on the location of your disease/pouches of inflammation.

• Of course, this is a conversation to be had with your doctor - if your disease activity is in the very bottom of your anus/rectum area (super duper rare though), you should resume anal sex only after a healthcare provider’s clearance.

• Interestingly, physical activity decreases diverticulitis complications so do with that information what you will.

• No one will know your body better than you, and you will know when is best for you. It is important to take things at your own pace, which is different for everyone. This page is just here for guidance!

  It can NOT Be Transmitted!

• Diverticulitis is not contagious or cancerous.

• It occurs when food waste moves too slowly through the colon, causing pressure and the formation of weak spots and sacs.

Prioritize Soft Stools & Gut Health

• Constipation and straining are risk factors for diverticular disease progression and pain, which also make bottoming tougher and less enjoyable (and increase hemorrhoid risk, and are overall, not fun or good!)

• Some dietary things you may consider (if your situation allows)

  • Implementing a high-fiber diet when not in flare and when you are feeling better.

  • If you have bloating or gas, cut down the amount of fiber you eat for a few days.

  • If a high fiber diet is not possible, consider fiber supplements.

  • High fiber foods that are good to eat:

  • Fruits, such as tangerines, prunes, apples, bananas, peaches, and pears.

  • Tender cooked vegetables, such as asparagus, beets, mushrooms, turnips, pumpkin, broccoli, artichokes, lima beans, squash, carrots, and sweet potatoes.

  • Lettuce, leafy greens, and peeled potatoes.

  • Vegetable juices.

  • High-fiber cereals such as shredded wheat) and muffins.

  • Hot cereals, such as oatmeal, farina, and cream of wheat.

  • Whole-grain breads (whole wheat or whole rye)

  • Adequate hydration. Drink WATER!!! Iced coffee is NOT HYDRATION!! (I am guilty of drinking too much iced coffee and not enough water, so don’t feel alone there).

  • Stool softeners (if advised).

  • Avoid enemas during flares; use only when cleared and done gently.

  • The old school advice was to avoid popcorn, nuts and seeds, but you don't have to worry about that now! We learned more.

  • The evidence does not show a higher risk of diverticulitis in people who eat a lot of those foods, compared with people who don't.

Start with Non-Penetrative Play, Work Your Way Up

• Explore external anal stimulation, prostate massage, rimming, toys with depth control.

• Use fingers with proper lubrication.

• Stay within comfort levels, especially post-inflammation.

• Things talked about here may also be of interest, starting with things like external anal massage may be a good starting point until you feel more comfortable working your way back up.

• If your specific case of diverticulitis causes masses on the urethra (rare), or an infection of the glands surrounding the sexual/reproductive organs, this can cause pain during intercourse (depending on what you like to do).

Use Lubrication Generously

• Lube is important for individuals with IBD and people coming fresh out of a diverticular disease flare, because the tissue is very “fresh” and sensitive, easily damaged or friable.

• People with IBD and Diverticular disease report needing more lube than the average person. (I don’t really know the scientific reason behind this, possibly due to irritation of the mucous/mucosa membranes post-flare/mucous lining post-disease flare, or tissue elasticity decreasing. I don’t know!)

• Lube helps reduces trauma to anal tissues and lowers pressure during penetration.

• Silicone-based lubes last longer, but water-based are safer with toys or condoms. (if your dildo is silicone and you use a silicone based lubricant, you will learn really quickly that it leads to degradation)

Go Slow & Communicate

• Use gentle, shallow penetration initially.

• Avoid positions that put pressure on the lower abdomen or colon (e.g., you may try a position with legs pressed against chest, or laying on on your side rather than something where you are laying flat on your abdomen putting direct pressure on it).

• There are several sex positions that are recommended for pelvic pain and spasms.

• As with everything GI related, you might need to experiment to find what positions work best for you in a flare up.

• Ask your doctor if you can take a pain reliever before sex, and if so, which one is safe with UC/CD/Diverticulosis/diverticular disease /whatever you may have going on.

• I DON’T RECOMMEND USING LIDOCAINE CREAM/GEL ON YOUR ANUS/RECTUM BEFORE BOTTOMING! That is how you get hurt, since you can’t feel if anything is “wrong” or hurting.

• Stop if there’s any pain, cramping, or unusual pressure.

Be Kind To Yourself!

• Feelings of Shame or Fear Are Valid! But try not to internalize them.

• Living with a digestive condition changes how you relate to your body sexually, and that can be hard to deal with - and that is perfectly normal. But don’t let it stay that way!

• Talk to your partner(s) about the things and symptoms you are feeling. You don’t need to disclose all the medical details, but discussing what feels safe or off-limits right now helps build trust.

If You Have to Have Surgery

For some people, their diverticular disease is too complicated, life threatening or severe to be managed at home or with antibiotics and they have to have surgery. But don’t fret - you can go back to your best self afterwards

Two Main Types of Diverticulitis Disease Surgery

Bowel resection with primary anastomosis

• Your surgeon removes any infected colon (colectomy) and sews together the cut ends of the two healthy pieces from either side of the previously infected area (anastomosis).

  Bowel resection with colostomy

• Your surgeon performs a colectomy and connects your bowel through an opening in your abdomen (colostomy).

• This opening is called a stoma.

• Your surgeon may do a colostomy if there’s too much colon inflammation. Depending upon how well you recover over the next few months, the colostomy may be either temporary or permanent.

• Information on sex and intimacy after colorectal surgery can be found here.

• Every surgeon has a different timeline, and every person is different, but the UOAA (United Ostomy Association of America) says that many colorectal surgeons advise their patients to wait anywhere from 4-8 weeks after surgery depending on how they are feeling.

• Different surgeons are different with their guidelines, though, for example, an Oregon surgical practice with guidelines for diverticular disease post-op care says that they recommend their patients can begin having sex again when they feel ready, usually 2 to 4 weeks post surgery.