Ulcerative Colitis with Associated Gastrointestinal and Urological Symptoms: A Case of Constipation, Knee Pain, and Sexual Dysfunction in a Middle-Aged Male

The patient is a 45-year-old male with a height of 510, fair complexion, and a slim build with mild abdominal adiposity. He was married in 2013 and was diagnosed with ulcerative colitis via colonoscopy and rectal biopsy in 2006. Despite the diagnosis, he has never experienced major symptoms such as bloody stools. He underwent allopathic treatment for approximately two years, during which his life remained relatively normal.

Over the past 1.5 to 2 years, the patient has experienced constipation, often characterized by hard stools that become dry and cause discomfort near the anus, without the urge to defecate. He reports reduced thirst but maintains a habit of drinking two glasses of lukewarm water on an empty stomach each morning, which helps manage stool hardness. His stools are not consistently hard and are often normal. However, he often feels that his bowel movements are incomplete.

The patient has no history of substance abuse but consumes tea in excess. He reports crepitus (cracking sounds) in his knees, mild pain during stair climbing, and descending. He also experiences excessive sexual thoughts but finds limited satisfaction in sexual activity, despite a high frequency of intercourse in the initial five years of marriage (5 times/week), which has now reduced to 1 or 2 times per week. Partner satisfaction remains above 75%, though his own enjoyment has decreased. He does not experience sudden erections but does not have erectile dysfunction during intercourse. He reports less frequent morning erections but often experiences strong erections during deep sleep.

Additional concerns include impaired memory, a weak urinary stream, the sensation of incomplete bladder emptying, less frequent morning erections, and deep sleep with dreams after sexual activity. Please suggest medicines.