Fertility and IBD Part 2

Crohn’s Disease and Ulcerative Colitis (the two main forms of Inflammatory Bowel Disease – IBD) are often first diagnosed in people in their 20s and 30s. This is also the age at which many couples are thinking of having children. If you or your partner have IBD and are thinking of starting a family, you may be concerned about how IBD might affect your fertility. This series of articles look at the main ways in which UC or Crohn’s, or the treatments for these conditions, may sometimes have an effect on fertility


How do IBD drug treatments affect fertility?

The majority of drug treatments for IBD do not affect fertility and are also safe in pregnancy.

However, there are some exceptions, as shown below. If you are trying to start a family, or if you are already pregnant, do discuss this and your drug treatment with your doctor or IBD team. It is better to avoid flare ups while trying to conceive and while pregnant, so most doctors will recommend continuing with your medication unless there are clear reasons not to. If the drugs you are on are not thought to be completely safe, there is usually a good alternative. 

For more information on the drugs mentioned below, see our individual drug treatment leaflets and our booklet Drugs and IBD. 


Specific drug treatments that may affect fertility or conception:

Sulphasalazine (Salazopyrin), a 5-ASA medication commonly used for IBD, is known to reduce fertility in men. This effect is usually temporary however, and fertility should return to normal levels within two to three months of stopping the medication. One study has also suggested that there may be an increased risk of birth defects if the father has been taking sulphasalazine. There are several good alternatives to sulphasalazine, such as mesalazine, olsalazine or balsalazide, which can usually be used instead. These have the same action 
on the colon but do not affect fertility. Sulphasalazine has not been shown to affect fertility in women or to be linked to any birth defects if taken by women. 

Methotrexate, an immunosuppressive drug sometimes prescribed for IBD, can increase the risk of birth defects if taken by women at conception or during pregnancy. It may also affect sperm production and quality. So it should not be taken by either partner when trying to conceive a child. Traces of methotrexate can remain in the body tissues for some time and couples are usually advised to avoid pregnancy for at least 6 months after stopping methotrexate. 

Mycophenolate Mofetil, another immunosuppressant, may cause miscarriages or birth defects if used during pregnancy. Women being treated with this drug will be advised to stop taking it at least 6 weeks before conception. 


The immunosuppressive drugs azathioprine and mercaptopurine (6MP) have not been shown to affect fertility, but one study has suggested that conceiving a child with a man taking these drugs may carry an increased risk of miscarriage or birth defects. Because of this, some doctors have advised men planning to father a child to switch to other medication. 

More recent research has not replicated these findings and many doctors now advise continuing with azathioprine or mercaptopurine, rather than risking a flare-up of the IBD. Similar advice is usually now given to women taking azathioprine or mercaptopurine. Although some doctors may still recommend caution with the use of these drugs during pregnancy, there are growing numbers of women who have had successful births while taking these immunosuppressants. 

Infliximab (Remicade) and adalimumab (Humira) are relatively new drugs, known as ‘biologics’ or ‘antiTNF drugs’. These affect the immune process and are used in severe cases of Crohn’s Disease and sometimes UC, when other drugs have not worked. Research is ongoing into the effect of infliximab and adalimumab on fertility and pregnancy. Several studies have found that women taking infliximab during pregnancy had the same birth outcome as for the general population of pregnant women, or women with IBD who had not been taking infliximab. 

There have also been reports of successful pregnancies in women with Crohn’s who began adalimumab before conception or during pregnancy. However, evidence is still limited about the long term effects on the baby if the mother takes anti-TNF drugs while pregnant. Recent guidelines suggest that doctors should talk through the possible risks and benefits of taking infliximab or adalimumab when pregnant, on an individual basis. They also recommend stopping anti-TNF medication at the end of the second  trimester, when the woman is six months pregnant. If you do decide to stop anti-TNF medication before 
conception, you will need to wait at least 6 months after the last treatment to be certain the drug has left your 
system.

In part 3: Can you improve fertility?

Exercise and IBD

Taking exercise

You may feel that exercising is the last thing you want to do. You may feel too tired or you may be worried about making your IBD worse or having an ‘accident’. While adequate rest is essential, being inactive for too long can lead to problems such as muscle weakness and stiff joints. It can also reduce your motivation and cause difficulty in concentrating. Regular exercise will improve your overall health, keeping your body functioning well. It can help to relieve the fatigue common in IBD. 

Physical activity also helps to strengthen bones, which is particularly important as people with IBD have a higher than usual risk of developing osteoporosis (thinning of the bones). For more information see our leaflet Bones and IBD. 


Besides keeping your body in shape and possibly helping you to avoid other problems, regular exercise also helps you psychologically. Exercise is known to release endorphins, the chemicals in the brain that give you a sense of happiness and act as natural pain killers.

If you are not used to regular exercise and find the idea rather daunting, you could try beginning gently with walking as an exercise. Start with a short walk several times a week and then gradually increase the time and distance you walk. Just getting out of the house into the fresh air can help you feel more positive.

While any activity can make some people want to open their bowels, taking exercise will not worsen your IBD. Plan your route in advance if you are worried about needing a toilet urgently and this may help build up your confidence. You could also think about exercising at a gym or a sports club with toilet facilities on site.

It is sensible to talk to your doctor or specialist nurse before starting any strenuous exercise.

Guest Writer - Peter

Hi my name is Peter.  I have had Crohn's Disease since 2006; maybe a long time before that. After finding out how badly damaged my small bowel was after a number of tests and investigations, a full diagnosis was made in 2006.

The beginning of my journey with Crohn's Disease was a very bad experience, since I knew virtually nothing about the condition, to find out that this was going to be with me for  life  was a very daunting prospect.

I went through all the normal drugs and treatments but as many of you are aware some people suffer from a flare up from time to time and the first line drugs can help put you back in remission. For me these first and second line drugs  just don't cut the mustard. The most important thing I have found to deal with this condition is to keep a positive attitude and support.

So after surgery in 2007, I enjoyed a five year remission. Looking back I was very fortunate for this to happen but surgery did leave me with other problems. I was left with permanently loose stools but this was relatively easy for me to cope with in comparison to the horrible pain  I had endured before surgery.

In 2012 my Crohn's Disease came back. Six months of tests and investigations revealed inflammation and ulceration on the site of my previous surgery. During this time I decided that I would not just sit back and do nothing. IBD can leave you feeling very isolated and even depressed since you lose so much weight and fatigue starts to set in - to the point that you don't want to leave the house. So, it was time for me to try and spread the awareness of this challenging disease. How was I going to do it? I pondered for a while.

I decided to set up a website devoted to Crohn's disease. It had been fifteen years since I had last created a website but I was determined to try and create a platform for me to help people who were suffering as I was. I created a very basic website www.crohnsdiseasesupport.co.uk and followed that up with a Facebook page and Twitter account. To my amazement I got hundreds and then thousands of visitors to my site.  I was very reluctant, at first, to bare all about my condition and story to the world but I found the more I shared my journey, the more people wanted to share their experience with me. I also found it a great way to let off steam and got so involved with creating the website that I found it much easier to get through my  dark days.

The website was so successful in getting my message of support across to others that I then developed and ran my own professional website www.crohnsupport.com

The website gets over 1,000 views per month.

The website would not be as sucessful as it is without the support of my fellow Crohnie brothers and sisters.

The biggest help to me was joining a Facebook support group called Bowel Disease One Global Family. I met so many amazing patients that were willing to share their experience and knowledge with others. It was, and still is, a truly inspirational group. If you just reach out for support there are so many patients willing to support each other.

With the support of fellow patients and the IBD specialist nurse service at my local hospital,  life is now much easier. What I find heart-warming is that, even in the clutches of this disease,  I have someone to turn to for support - even if it's just a simple question of how best to prepare for an investigation. I know I will get some great advice or support whilst I am preparing.  I think it's just so important to know that I have support from patients that have been in my shoes and their advice and support is always valued.

My overall message to anyone diagnosed with IBD (Crohn's Disease or Ulcerative Colitis) is to talk to your IBD nurse if your condition worsens. Don't wait for your next appointment, these angels can get you the right care at the right time. Most of all they understand the condition, unlike many doctors. They are specially trained to care for people with IBD. Please don't be alone, get support from other patients, they know how you feel and can help you get through some of the tough times. I am very lucky to have an amazing wife, family and friends whom I can talk to but talking to another patient who is willing to share their experience with IBD is really amazing.

Thanks for reading and get some support "patient to patient is the best medicine".

Peter Buckley

Travel and IBD Part 1 Transport and Deep Vein Thrombosis

If you have Crohn’s Disease or Ulcerative Colitis (the two main forms of Inflammatory Bowel Disease or IBD) you may find the thought of travelling daunting. A change of climate, water, or food can upset anyone’s bowels. Yet many people with IBD travel widely, both in the UK and abroad. They may go for a short break or a long holiday lasting several weeks or months. With careful planning ahead it should be possible for you to travel to most places. This series of articles sets out to answer some of the questions that you may have when thinking about going on holiday or on a business trip.

Transport


You may be travelling on holiday via car, bus, train, ferry or airplane. Whichever way you are travelling, there are issues that you may wish to consider. If you are travelling by car, you may wish to check the location of accessible toilet facilities when planning your route. They can often be found in places such as Tourist Information Centres, supermarkets, and fast food restaurants, as well as service stations. You can get a key for UK toilets for disabled people from RADAR.

A Euro key for toilets for disabled people in Germany and some other European countries can be bought from from CBF Darmstadt. When travelling by bus, train, or airplane, it may be worth checking whether there is an accessible toilet on board, and, if possible, booking a seat close to it.


If you are flying, you can usually prearrange your in-flight meals for any particular dietary requirements, such as dairy free or low-fat. If you are going on a long flight you might want to consider taking an anti-diarrhoeal beforehand. Cabin air is often very dry and drinking plenty of water and avoiding alcohol and caffeine should help to prevent dehydration.


Avoiding Deep Vein Thrombosis (DVT)

DVT or blood clots can be a risk for anyone sitting still on a long journey. Long haul flights lasting over 8 hours are thought to be more likely to cause blood clots, but long journeys by car, bus or train can also put you at danger. People with IBD have an increased risk of blood clots. You may also be at risk if you have had recent surgery. You can reduce this risk during the journey by:

• Wearing loose fitting, comfortable clothing
• Drinking plenty of fluids but avoiding alcoholic and caffeinated drinks before and during the journey 
• Avoiding smoking
• Rotating your ankles regularly
• Taking regular deep breaths
• Walking at regular intervals around the  plane cabin or train carriage or during stops on bus and car travel
• Wearing travel compression socks/stockings – it is vital that they are properly fitted

The British Medical Association does not recommend taking aspirin to prevent travel related DVT. You may want to talk to your specialist about your risk and whether you should wear compression stockings or take anti-coagulant medication.

In Part 2 - Insurance and Vaccinations

Staying Well with IBD

Living with a long term illness like IBD can affect you both physically and emotionally. This article looks at some factors that may help you to stay well more of the time.



Having a Flare-Up Plan
The unpredictability of flare-ups can be one of the more troublesome aspects of IBD. It may help to plan ahead with your doctor or specialist team about what to do if you do get a flare-up. This might include adjusting your medication. Taking an active role in your medical care like this can also help you feel more in control.



Healthy Eating
Eating a balanced and nutritious diet is important for good general health. However, some people with IBD may find this difficult. Certain foods may affect you, especially if you have Crohn’s Disease, and you may need to avoid these. Also, if you have Crohn’s in your small intestine, you may have difficulty absorbing certain vitamins and minerals. 

Diarrhoea is a very common symptom in IBD and you may find it helps to cut down on fibre-rich foods for a while. See our Managing Diarrhoea leaflet for more details. 

If you do have to avoid foods it is even more important to try and make sure that you still keep your overall diet well balanced. You may also need to take nutritional supplements to make up for any deficiencies. 

It is often useful to get specialist help and advice on diet, particularly if you have Crohn’s. You can ask your IBD team to refer you to a dietitian on the NHS or contact The British Dietetic Association to find a dietitian. Our Food and IBD booklet has more information and suggestions about healthy eating with IBD. 

Staying Hydrated
Drinking enough fluids is also a key factor in staying well. As someone with IBD, you may be more likely to become dehydrated if, for example, you have a lot of diarrhoea or have had certain types of surgery. Our leaflet, Dehydration, has more details on how to avoid or treat dehydration.

Keeping up your fluid balance can be especially difficult if you have an ileostomy. You may find information from IA or Ostomy Lifestyle useful.

Enteral Nutrition Therapy
Some people with Crohn’s Disease use enteral nutrition (specially designed liquid feeds) as part of their treatment programme. There are several types of enteral diets but all contain a very high level of nutrients and can be used instead of food or, in smaller quantities, as a supplement. Exclusive enteral nutrition (liquid food only) is most often used as a treatment for children with Crohn’s, as it can promote growth and avoid the use of steroids. Several studies have suggested that using these feeds as long term supplements may also help adults to keep Crohn’s in remission. But, more research is needed to confirm this. 

Prebiotics and Probiotics
You may read or hear about prebiotics and probiotics helping people to stay well. We all have billions of bacteria in our gut, some of which are good for our health, others harmful. Prebiotics are fermented carbohydrates that can stimulate growth of potentially good bacteria in the gut. They can be taken as supplements and usually have to be taken continuously to maintain their effectiveness. Research is still ongoing into how useful they may be in IBD, but there is some evidence that particular prebiotics may have a role in reducing inflammation, especially when combined with probiotics (see below).

Probiotics are live micro-organisms or ‘friendly’ bacteria, which can also be taken as supplements to increase the good bacteria already in the intestine. Some studies have suggested that certain probiotics such as VSL #3 may be helpful in UC. In particular, if you have had surgery for UC and have had a pouch  created, VSL #3 may help prevent and treat pouchitis. As yet there is little evidence that probiotics are useful for people with Crohn’s Disease. 

More research is needed on the effectiveness of prebiotics and probiotics, but it may be worth discussing these supplements with your GP, specialist or dietitian.

Guest Writer - Vicky Talks About Diagnosis

Hello:)

 

Vicky, 29, has UC

Here I am again!

In case you missed my last post, my name is Vicky, aka Vic, I'm 29 (!) and I was diagnosed with Ulcerative Colitis in May 2011. I had suffered symptoms for a very long time prior to this though and the road to diagnosis was LONG.….

I am delighted to be a guest writer on this exciting project, I really feel that it does help to share your experiences and feelings with others and I find the support of the online IBD community very comforting at times.

Today I'm going to talk about initial diagnosis, feelings etc. As I said my road to diagnosis was long, some stories I have heard have been worse than mine, and some people have been very lucky and been diagnosed almost immediately after experiencing their first symptoms.

My initial reaction on being diagnosed was 'thank goodness they've finally figured out what's wrong with me'. I think a lot of people may experience this initial relief, but this can quickly be followed with confusion and shock. You may not have been expecting to be diagnosed with a long-term illness, particularly one with no known cure at present. You may be confused with trying to take in all that the consultants/doctors have told you.

It can seem like a lot of information in a short space of time! It can also seem confusing at first as there is no known cure and there is little known about what causes the diseases. Also your treatment plan will depend on how you personally respond to initial treatment, so there is not even any guarantee that the first treatments you receive will work.

 

These are all normal reactions and I personally have had the lot!

I think I mentioned previously that I find it helpful to share things with other sufferers, and that it partly why I started my own personal blog (insert link). I find sometimes it is easier to point someone that I may not know very well to my blog rather than describe my illness to them.

Everyone is different and emotionally we all deal with things in different ways.

I find that I directly tell the people that need to know (family, close friends, essential colleagues (ie bosses) and then assess everyone else as I get to know them. There are only a few people that know about my illness in my current job. It's not that I'm embarrassed (if you are, don't worry) it's more that it's just not the kind of thing you bring up in everyday conversation…!

It can be very difficult to explain to someone that doesn't understand the illness, you may find it helpful to give them the Crohn's and Colitis UK web address www.crohnsandcolitis.org.uk so that they can have a read. Lack of understanding can make people around you react in different ways. Those close to you may be constantly asking if you are okay, you may find yourself answering that you're fine, even if you're not to stop them worrying. I find I sometimes do this to my mum! It's not always ideal, but we do not want to worry those around us who we love.

There will be those around you who are the other extreme and try to tell you that there is nothing wrong with you, or to 'Get Well Soon'. Although this is not particularly helpful, I'm pretty sure they are doing this with the best intentions. I tend to just smile sweetly (and fume inwardly) when this scenario occurs. We can try to educate people as much as possible, and sometimes it is frustrating when they don't understand, the important thing is that you know your body better than anyone and if you need to take a break or say 'no' to someone, or something, then please don't feel guilty about it!! Again this a perfectly natural feeling. It may be that you have gone from living life to the full, to hardly leaving the house within a very short period of time. It can sometimes feel like there is no light at the end of the tunnel.

I promise, there is. I am living proof of that :)

Employment and IBD Part 4 - Leaving Work and Financial Help

If you have Crohn’s Disease or Ulcerative Colitis – conditions collectively known as Inflammatory Bowel Disease (IBD) – you may be concerned about your employment position. You may be employed or looking for a new job. You may be on benefits and are thinking about returning to work. While IBD is a chronic condition, with appropriate treatment it is often possible to remain well for long periods and many people with IBD are able to work full-time.

This series of articles sets out to answer some questions you may have about your possible options and how you may be protected by law. The quotations that are included are all from people who have IBD  who responded to a 2011 Crohn’s and Colitis UK survey on IBD and employment.

What can I do if my employment is no longer suitable?

You may find that having tried changes to your current employment such as altering your working hours, job-sharing, working part-time, or a change of location closer to home, your condition still makes it difficult to continue despite reasonable adjustments. In this case, it is not unusual to feel angry or upset at the impact of IBD on your working life or career. There are various options you could consider including:

• Self-employment – you may feel daunted at the prospect of setting up your own business or worry that you would miss socialising at work. But some advantages are that you can often work the hours to suit your energy levels and, if you can work from home, reduce the fear or possibility of having an ‘accident’ in public.

You can get help and advice about self employment from several organisations including the Citizens Advice Bureau, Leonard Cheshire Disability, the Northern Pinetree Trust and from government schemes such as Access to Work, as mentioned in the previous article.

“As I am self-employed, this gives

me more flexibility than
employment. If I didn’t have IBD
and its symptoms I might have gone
back to employment, but now I
consider self-employment more
suitable.”

• Re-training – you may find that another kind of job makes it possible for you to work more comfortably. There are a number of organisations that offer training such as the Shaw Trust, Ability Net, Leonard Cheshire Disability, and SHARE Community.

Volunteering – if income is not crucial, you might consider voluntary work, which could provide a challenge while allowing you to give something to others. You can contact national volunteering organisations such as Volunteer Now, Volunteer Development Scotland, Volunteering England, Volunteering Wales, or Do It  for ideas and opportunities. They each provide an online database of volunteer jobs. Crohn's and Colitis UK also has volunteering opportunities around the UK. For further information contact our Member Involvement and Volunteering Team on 01727 734475 or email: enquiries@crohnsandcolitis.org.uk.

What Financial Help is Available?
If you have care or mobility needs arising from your IBD you may be eligible for Disability Living Allowance (DLA), whether you are working or not. We provide a Guide to Claiming DLA, or you contact our Information Line for a copy (0845 130 2233).

If you are in employment, your employer should pay Statutory Sick Pay if you are too ill to work. This starts after you have been off sick for 4 days and can be paid for up to 28 weeks. If you are not well enough to return to work after this time, or if your employment is terminated, you may qualify for Employment and Support Allowance (ESA). Some employers may make additional payments through their own sick pay scheme. This will depend on your terms and conditions of employment.

If you are well enough to look for work you may be eligible for Jobseeker's Allowance. You may also get help and support through schemes available to help people get back into work. For more information contact Jobcentre Plus or see the directgov website.

If you have been on benefits and are going to start a job, you may be able to obtain a job grant. This is a one-off tax free payment.

If you are on a low income or on certain benefits you may be entitled to claim help with fares to hospital through the Health Care Travel Costs Scheme. The scheme allows travel by public transport or private car. 

You can get more information about these and other benefits and details of helpful organisations from our guide: An Overview of Welfare Benefits for people with Ulcerative Colitis and Crohn's Disease.

For further help call the Crohn's and Colitis UK Information Line on 0845 130 2233 open Mon-Fr 10m-1pm or email info@crohnsandcolitis.org.uk

For all the information contained in this series of articles, and more, read our Employment and IBD: a guide for employees information leaflet.

Fertility and IBD Part 1

Crohn’s Disease and Ulcerative Colitis (the two main forms of Inflammatory Bowel Disease – IBD) are often first diagnosed in people in their 20s and 30s. This is also the age at which many couples are thinking of having children. If you or your partner have IBD and are thinking of starting a family, you may be concerned about how IBD might affect your fertility. This article looks at the main ways in which UC or Crohn’s, or the treatments for these conditions, may sometimes have an effect on fertility. We also have an information sheet Pregnancy and IBD, which covers concerns you may have about IBD once you have conceived. 


How might having IBD affect my fertility?

If you are a woman...
In general, women who have inactive IBD - either Crohn’s or UC - should have no more difficulty in becoming pregnant than women without IBD. However, some women with active IBD, especially Crohn’s Disease, may have problems, particularly if they are underweight and eating poorly. Also, severe inflammation in the small intestine can sometimes affect the normal functioning of the ovaries or cause adhesions (bands of scar tissue) that affect the fallopian tubes.


Complications such as abscesses and fistulas in the pelvic and anal area may make you less interested in sex and so less likely to conceive. Some of the other general difficulties associated with living with IBD, such as fatigue, abdominal pain, diarrhoea and a poor body image can have a similar effect. 

For all these reasons doctors generally recommend getting your IBD under control before you try to become pregnant. Studies have also shown that if your disease is very active when you conceive, your symptoms may remain troublesome through your pregnancy. The likelihood of miscarriage is also higher. That said,  numerous women have had uneventful and successful pregnancies even when they have conceived during active phases of IBD.

If you are a man... 
In general, male fertility is not affected by IBD. A few studies have suggested that sperm quality may be affected by Crohn’s disease, but it is not clear whether this is more likely to be the effect of poor  nourishment. Treatment of the disease should restore fertility to its usual level. 

However, for men as well as women, problems such as fatigue and a poor body image can affect sexual relationships and make it more difficult to conceive a child. Abscesses and fistulas in the pelvis and anal regions may also cause some difficulties with erection and ejaculation. 

What about surgery: can this affect my fertility?

Surgery for women
Research has shown that Ileo pouch–anal anastomosis surgery (also known as IPAA or pouch surgery), often carried out for UC, can reduce fertility in women. This appears to be much less likely with a colectomy and the formation of an ileostomy - the usual alternative to pouch surgery. (For more details on these and other types of surgery for IBD see our information sheets Surgery for Ulcerative Colitis and Surgery for Crohn’s Disease.)


However, any pelvic surgery, including surgery for Crohn’s, may carry a small risk of infertility in women as this may also lead to adhesions or scarring on the fallopian tubes. So if you are considering surgery for IBD and want to get pregnant, do discuss this possibility with your IBD team - and if necessary with a fertility specialist. 

If you have recently had IBD surgery of any kind, you may find that you are advised to wait a year after surgery before trying to become pregnant, in order to give your body time to recover fully. Again, this should be discussed with your doctor.

Surgery for men
Very rarely, men with IBD who have had an IPAA or pouch operation, or have had both their colon and their rectum removed by surgery, may have difficulty having an erection. However, this problem is usually temporary or can be successfully treated with medication.

Why Not Share Your Real Stories of Life with IBD?

There's nothing better than hearing from others who are going through the same thing as you - whether it's practical problems, emotions or worries. The same goes for living with IBD (Crohn's and Colitis). For that reason, we're featuring guest blogs from young people who have got something to tell you about their lives. So far we've heard from Vicky and Sadie and we've got others coming up for you.

Is there something you'd like to share with other IBDers? Perhaps you'd like to reassure someone who's just been diagnosed or are just going through the diagnosis process yourself and want to share your experiences? Maybe you've lived with IBD for some time now and would like to offer some guidance on the day-to-day things that help you? Or maybe you want to share a funny story?!

                                                                           sad                  

                                                                              happy

                                     worried

                                                                             Real Stories         
                                                                        Tips            
                                                                Strategies
                                                         positive

                                             Questions

                                 Humour

Whatever you'd like to share, we'd like to hear from you. Get in touch to find out more or to send in a guest blog post: crohnsandcolitisukpress@yahoo.co.uk  We will link back to your blog if you have one.

Can Changing My Diet Help Diarrhoea?

You may find that you have diarrhoea whatever you eat or drink, but some people find altering their diet helps to reduce diarrhoea. Everyone is different and what works for others may not work for you. However, the following suggestions may be of some assistance.

Eating

• Eat small, frequent meals.
• Keep a food diary and note down any foods that seem to upset you, so you can avoid them. It is important not to cut out too many food groups, however, and if you find you are avoiding lots of different types of food it may be helpful to consult a dietitian to help you balance your diet. Some sensitivities may be only temporary and you may be able to re-introduce that food at a later date. 
• For many people foods rich in fibre tend to make diarrhoea worse. Don’t give up all fruit and vegetables, but try cutting down on high fibre foods such as bran cereal, pulses (peas and beans) and the type of fruits or vegetables usually eaten with the skins, pips and seeds. Onions can be particularly troublesome. 
• Avoid very hot or spicy foods if they don’t agree with you.
• If milk makes your diarrhoea worse, try using a lactose free milk and avoiding foods made with milk such as custards and sauces. Some medicines also contain lactose, but do not stop taking any prescribed medication without checking with your IBD team. 
• Chicken and rice soup is a traditional remedy for diarrhoea, which some people have found useful. Carrot soup is also said to be soothing for the gut, and is rich in beta-carotene which may promote healing. 
• The BRAT diet, (bananas, rice, applesauce and toast – or tea) is also traditionally recommended as a way of reducing acute diarrhoea, but does not contain enough nutrients to be a healthy long term option.

Other ‘special diets’ may also reduce diarrhoea. However, in order to make sure that you are still getting a balanced and nutritious intake, these are best used only with the advice of a qualified dietitian. 

Drinking

• Many people are sensitive to caffeine, so try opting for decaffeinated coffee, tea, and cola drinks.
• Avoid alcohol, as this is known to have a laxative effect.
• Drinks made with artificial sweeteners can also cause diarrhoea.

For more information on healthy eating with IBD see our booklet, Food and IBD Check out our information leaflet for more guidance on Managing Diarrhoea.

University and IBD Part 3 - Help with Deadlines and Stress

Planning to go to university or college can be an exciting but daunting time for anyone. If you have Inflammatory Bowel Disease (IBD) – Crohn’s Disease or Ulcerative Colitis (UC) – you are likely to face even greater challenges and have more concerns and questions. This series of articles sets out to answer some of those questions, and to give you some tips and suggestions based on professional advice and also on the experiences of other students with IBD.


Can I get help to cope with exams?

The intense pressure of exams affects most people, and having IBD you may find the stress triggers a flare-up. Try to pace yourself and find ways that help you to relax, such as taking regular exercise, deep breathing exercises, or yoga. If you have a Study Needs Agreement or you have talked to your tutor about your condition, and are able to provide a medical certificate from your doctor, you may be able to make advance arrangements for exams. These might include, for example, sitting close to the exit nearest the toilets, having someone ready to accompany you if necessary, and being able to request extra time if needed.

In some circumstances, if you are completely unable to sit an exam, you may be able to defer sitting it until you are better, without a cap on your grade.




What about course work deadlines?

One of your main concerns is likely to be about getting work in on time, especially when you are having a flare-up or if you have to go into hospital. Being able to request a coursework extension should you have a flare up is likely to be in your Study Needs Agreement if you have one.

You may also be given an automatic extension if you are in hospital. If you do find yourself having to negotiate a coursework extension, try to be realistic about how much time you need to recover and how much work you can do when you’re still not feeling completely well.


What other support is there?

Sometimes the pressure of exams, coursework, being away from home, feeling isolated when ill – any or all of these – may become too much to deal with on your own, even if you have the support of friends and family. If you do find you are feeling anxious, stressed, or depressed, you can turn to the counselling service at your university or college in complete confidence. You may find that as well as face to face counselling services, there are also phone-based helplines, accessible from the privacy of your room.



Counselling can help with all kinds of issues, health related or more general, such as dealing with dilemmas or making difficult decisions, relationship difficulties, sexual problems, or identity issues.

At Crohn's and Colitis UK we have a web–based discussion board for people aged 16-29 living with IBD. This can be found at www.ibdandme.nacc.org.uk. There are also Crohn’s and Colitis UK groups around the UK, some with subgroups for young people, and you might find it helpful to contact the group nearest your university or college. Check our website or contact our office for locations.

We also operate a supportive listening service, Crohn’s and Colitis Support, and a general Information Line. (0845 130 2233).


And finally…

Take time to plan, talk to the relevant people and develop a supportive network – don’t wait until you are feeling unwell and having a flare-up before you seek help. There may be setbacks along the way, such as having to take time out. If this means taking an extra year, it might seem like a lot of time, but try to keep in mind that, in the long run, it will probably not make a lot of difference.

“One thing I would say is don’t let

having IBD stop you from achieving

anything. I refuse to let my disease

get the better of me.”

(Student with IBD)

For all the information contained in these articles, and more useful contact details, see our full information sheets Students with IBD: A Guide for Students

Employment and IBD Part 3 - Travelling to Work and Returning to Work After Time Off

If you have Crohn’s Disease or Ulcerative Colitis – conditions collectively known as Inflammatory Bowel Disease (IBD) – you may be concerned about your employment position. You may be employed or looking for a new job. You may be on benefits and are thinking about returning to work. While IBD is a chronic condition, with appropriate treatment it is often possible to remain well for long periods and many people with IBD are able to work full-time.

This series of articles sets out to answer some questions you may have about your possible options and how you may be protected by law. The quotations that are included are all from people who have IBD who responded to a 2011 Crohn’s and Colitis UK survey on IBD and employment

Travelling to work

Many people with IBD tell us that travelling to work or jobs that require travelling are particularly difficult. You may find it helpful to obtain a key for locked public toilets for disabled people from RADAR (The Royal Association for Disability and Rehabilitation). RADAR runs a National Key
Scheme for people to access specially adapted toilets that are kept locked to avoid vandalism.

They also provide a location guide to approximately 7,000 toilets throughout the UK. You may also get help with travel costs from Access to Work, as mentioned in the previous article.

“Because of lack of toilets I have to be

careful about my route and avoid

stressful situations like tube

stoppages. I dread being stuck on

the tube. Once I am in work I am

generally OK.”

Returning to work after a long absence 

If you have been off work for several weeks or months because of your IBD, you may feel anxious about returning to work. It is common for people to lose confidence about being able to return to work even after a relatively short time away on sick leave. Keeping in touch with an employer can help, and it may be helpful to set up an agreed procedure, if possible in advance, for how your employer will maintain contact with you whenever you are absent. This could specify a timescale, for example, suggest contact once you are absent formore than two weeks and/or specify the method by which you would prefer to be contacted e.g. phone, email or personal visit. You may prefer contact from a coworker, close colleague or union representative rather than your direct line manager.

It is important not to feel pressured into returning to work too soon before you are well. You might want to discuss a phased return to work, as you may not be able to work a full day at first. For example you might want to start working only a few hours each day and gradually increase your hours over time. Or perhaps you may want to ask for a reduced work load or lighter duties to begin with. Generally the more open you are about your needs, the more likely it is for your employer to be open and willing to make reasonable adjustments to help you back to work.

If you have to remain away from work until reasonable adjustments are in place (for example, moving your work station close to a toilet), arguably this should not be recorded as ‘sick leave’. 

“My employer is very supportive and

gave me full pay when I returned to

work from operations, and asked me

to return on a phased basis for the

good of my health e.g. two hours a

day first week back, three hours a

day the second week etc., until back

up to seven hours a day.”

If you are absent from work because of a disability-related sickness, it is important that this is recorded separately from other sickness absences, such as having a cold. This is to make sure that you are not discriminated against if, for example, decisions about promotion or bonuses take other sickness absences into account.

In Part 4 - Leaving Work and Financial Help