Tag: irritable bowel syndrome

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How to cope with IBD at work

How to cope with IBD at work

Sometimes it seems that living with IBD is a full-time job (albeit one with zero pay or benefits!). Time spent at the hospital, recovering from flares and trying to live a healthy life can all add up. Unfortunately, most of us are not millionaires and work is a necessity, and for lots of us a fulfilling part of our lives. Working with IBD isn’t always easy but for the vast majority of us it is possible. However, you may need to talk to your employer and have adaptions made.

 

Be honest

It is very important that you are honest with your employer about your condition and what it involves. IBD, like any chronic illness, is covered under the 2010 Equality Act since it is a physical and long-term impairment (definition of disability under the Equality Act 2010, 2015). This means employers must make necessary adaptions to help you in your role. This could include flexible working hours, access to a disabled toilet or a fridge to store your medicine in. Most employers are accommodating if you talk to them and explain what your condition actually entails (and if this is disclosed at interview, employers cannot discriminate against you in the recruitment process).

 

Be realistic

Many people with inflammatory bowel disease have really high expectations of themselves, which is also reflected in their careers. However, it is important to reflect on your career path and whether it is adaptable to life with IBD. Does it involve lots of travel? Is it stressful? Are you often on the go? Having IBD doesn’t mean giving up on your career dreams but just making sure the job is right for you.

 

Be informed

Reading the paperwork and the terms and conditions that comes with a job is more important than ever with IBD. Here are some things you need to find out:

  • What is the sick pay entitlement?
  • What is the policy for long-term periods of sickness?
  • How flexible are the working hours?
  • If you are working abroad, is medical insurance included and does this include pre-existing conditions?
  • Will you get regular breaks? (This can be easy for office workers; not so easy for those in retail.)
  • Is there the possibility of reduced hours or going part-time further down the line?

Keep records

It may be worth having a notebook to keep a list of any time you have had to take off work for IBD and the corresponding symptoms and hospital trips.

 

My experience of working with IBD

I am a teacher by trade and have taught both in the UK and abroad. In every job, I’ve been honest about my conditions from day one and luckily all my employers have been great. When I was on infliximab, my employers were great at giving me time off to go to hospital appointments and in my previous role I had surgery and the school arranged for me to come back on a phased return. It can be really hard teaching with IBD – I have had days where I felt like I wanted to faint in front of a class – but luckily most of the time I’m fine. In some ways doing a demanding job means I often forget about my symptoms, but I have had to dash out of class on a few occasions. I think this is why talking with colleagues about your condition is so important – it has meant they have been able to quickly step in if needed. Yet over the years, I think I’ve also become more realistic about my teaching career and this year I’ve reduced my workload to three days a week, aiming to spend more time on my health and my writing. I don’t see this as a step down but a necessary adaption to help me live as balanced a life as possible; hopefully I can combine the security of a teaching job with my other passions in life – writing and nutrition.

This blog is taken from Managing IBD: A balanced guide to inflammatory bowel disease by Jenna Farmer.

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Books on Prescription: Reading Well for Long Term Conditions

We are delighted to announce that Fighting Fatigue and Irritable Bowel Syndrome: Navigating Your Way to Recovery have been placed on the Reading Well scheme for long term conditions.

If the pen is mightier than the sword, perhaps the book is mightier than the drug.

These stirring words from Professor Martin Marshall at the 2017 Reading Well launch really summed up the miraculous effect that books have on us.

Bibliotherapy –  the use of books and reading to facilitate management of and recovery from illness – is not a new concept, but it has found increased recognition in recent years thanks in part to the Reading Well scheme. Continue reading Books on Prescription: Reading Well for Long Term Conditions

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Is it ‘just’ indigestion?

Indigestion is that uncomfortable feeling most of us have experienced at some point in the upper abdomen or lower part of the chest – usually after eating or drinking (but not always). The official medical definition is upper abdominal discomfort or pain that may be described as a burning sensation, heaviness or an ache. It is often related to eating and may be accompanied by other symptoms, such as nausea, fullness in the upper abdomen or belching. It’s usually worse if you lie down directly after eating a heavy meal.

Other names for indigestion include dyspepsia and acid reflux or heartburn. It is basically an inflammation of the gullet (oesophagus) – the long pipe that runs from the mouth to the stomach. Indigestion is so common most people will have experienced it at some time and it’s usually more of a fleeting inconvenience than a major health problem. Most people don’t see their doctor about it and either grin and bear it or simply treat it themselves with remedies they can buy over the counter from a chemist. Only a quarter of people who suffer indigestion see their GP about their symptoms and about 10 per cent of these consultations will be referred for further investigations.

Indigestion is rarely a symptom of a serious underlying medical condition (but if you are worried check out our list of reasons for an urgent referral, below). In people who have an endoscopy to investigate their indigestion, 30 per cent will have no abnormal findings and 10 to 17 per cent will have oesophagitis (inflammation of the oesophagus) and the rest will have gastric or duodenal ulcers, gastritis, duodenitis (inflammation of the duodenum) or hiatus hernias, according to the British Society of Gastroenterology.

But, having said that, we’re not saying indigestion can’t still affect your quality of life and be a pain to deal with. If you’re one of the unfortunate ones who suffer from recurrent severe bouts of indigestion, Chapter 8 in What’s Up With Your Gut may help you get to the root of what’s causing your symptoms, help you find some long term relief and enable you to enjoy your food again.

Symptom Checker

If you have one or more of the following symptoms, you may have one of the conditions discussed in this blog.

  • Burning sensation, fullness, heaviness or ache in upper abdomen or lower chest
  • Burning, griping pain in the abdomen, lower gut and back
  • Sharp, persistent pain at the top of the stomach or above ribs on right
  • Bitter taste in the mouth
  • Nausea, vomiting
  • Bloating
  • Belching and burping
  • Lump in your throat
  • Tickly cough

What causes indigestion?

Diet

Most people associate indigestion with overdoing it, with a big meal, sometimes with a high fat or spice content – creamy curry sauces and dishes containing chilli for instance. You might also notice that particular foods can trigger your symptoms, including curries, fatty foods, citrus fruits, bananas and cucumbers – it’s very individual though. Sometimes however, it can be down to something simple such as eating too fast or too close to bedtime. Drinking too much alcohol, or caffeine in coffee, tea and chocolate may have a similar effect.

Drug side effects

There are many other causes of indigestion and sometimes the cause isn’t so obvious. These other causes include the side effects of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) taken to relieve the pain of arthritis (such as ibuprofen and aspirin) and nitrates prescribed for angina for instance.

Acid reflux or GORD

A major cause of recurring indigestion is acid reflux, or gastro-oesophageal reflux disease (GORD), which is caused by the sphincter in the oesophagus failing to close and prevent

large amounts of stomach contents, including acid, moving back up from the stomach and causing irritation and inflammation in the oesophagus. The inside of the oesophagus has a protective lining but it can become irritated and inflamed by stomach acid. If the lining becomes ulcerated by the stomach acid, it causes a condition called oesophagitis. Sometimes stomach acid can escape back up from the stomach to the oesophagus due to gastric and duodenal ulcers (known collectively as peptic ulcers), which are sores which develop in the lining of the stomach or duodenum. Peptic ulcers can be caused by a bacterial infection called Helicobacter pylori.

Another cause of GORD is hiatus hernia – where part of the stomach pushes up through the diaphragm (the sheet of muscle between the abdomen and the chest, needed for breathing), partially blocking refluxed stomach acid in the oesophagus. Being overweight or obese (including weight gain due to pregnancy) will make it more likely you’ll suffer from acid reflux – obesity causes more pressure in the abdomen which forces acid back up into the gullet. This is also true if you are constipated or wearing clothes with a tight waistband. Chemicals in cigarette smoke can also relax the ring of muscle that divides the stomach from the oesophagus and make it easier for stomach acid to escape back into the gullet, causing acid reflux/heartburn symptoms. Stress and anxiety are also believed to play a part in indigestion, as is increasing age.

If you have some of the ‘alarm bell’ symptoms described below you should be considered for urgent endoscopy referral rather than taking any prolonged treatments which may mask the symptoms of a more serious illness.

Reasons for an urgent referral

NICE advises that:

  • people with an upper abdominal mass require urgent referral for endoscopic investigation (an appointment within two weeks) [National Collaborating Centre for Cancer, 2015].
  • urgent direct access upper gastrointestinal endoscopy should be performed within two weeks to assess for stomach cancer in people with dysphagia (swallowing problems) or aged 55 and over with weight loss and any of the following: upper abdominal pain, reflux, dyspepsia.
  • referral for non-urgent direct access upper gastrointestinal endoscopy should be considered to assess for stomach cancer in people with haematemesis (vomiting blood) and in people aged 55 or over with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain; or nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain [National Collaborating Centre for Cancer, 2015].

If you’re struggling with indigestion don’t panic, but don’t let it ruin your life. If you have any doubts at all about whether your indigestion might be something more serious, visit your doctor and tell them ALL the symptoms.

What’s Up With Your Gut is available now as paperback and ebook.

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How to work out what’s wrong with your bowel

Apart from the red flag symptoms listed in the previous blog, where do you start when trying to work out what’s up with your gut?

You can help yourself and your doctor by:

Keeping a diary of your symptoms.

It helps your doctor make a diagnosis if you can be specific about how long you’ve had your symptoms, what they are, what seems to trigger them or whether they are present all the time, and how much weight you have lost. Keeping a diary of your gut symptoms will help you remember and give your doctor valuable information. One gastroenterologist has told how increasingly patients will photograph or video their bloated stomachs on their mobile phones to document their symptoms.

Not being embarrassed.

People literally die of embarrassment because they can’t get their heads round describing their stools/piles/diarrhoea to their doctors. Get over it. If you don’t like describing what your poo looks like ask your doctor if you can point it out on the Bristol Stool Chart.

Mentioning any family history of gut disease to your doctor.

Some complaints do have a genetic basis so it will be another piece in the jigsaw for your doctor if you can supply details of conditions such as bowel cancer or inflammatory bowel diseases in your immediate family. (Volunteer this if they don’t ask you first.)

Not cutting out food groups on a hunch.

If you do have an autoimmune condition, such as coeliac disease, where the body reacts to gluten and causes bowel symptoms, it’s important you don’t cut out any foods you suspect are to blame, such as bread or breakfast cereals, until your condition has been fully investigated. This is because you may need a gut biopsy to confirm your diagnosis (the villi – fingerlike projections in the gut which absorb nutrients – will be damaged and shrunken if you have coeliac disease) and if you have stopped eating gluten they may have returned to normal, giving a false negative diagnosis.

Being persistent.

If your doctor has told you to eat more bran to help with constipation and your symptoms are getting worse, go back and tell him or her. Whilst eating more fibre helps in a lot of cases of constipation, in up to 30 per cent of cases it doesn’t. (The cause could be slow transit in the gut, in which case too much fibre will make it worse!)

Not self-medicating for the long term.

Obviously it’s fine to buy over-the-counter remedies if your gut problems are short term, but if you are relying on laxatives, antacids or anti-diarrhoea medication in the long term it’s advisable to see a doctor and find out the underlying cause.

Finding reliable sources of information.

There are an awful lot of ‘snake oil’ salesmen out there on the internet, peddling dodgy cures or extreme diets with no good science to recommend them. Charities are good sources of accurate information about managing your condition and their online resources are written in a reader-friendly consumer style. Don’t forget organisations such as NICE (the National Institute for Health and Care Excellence) produce guideline summaries on the management of health conditions written especially for patients, setting out clearly what investigations and treatments are recommended.

For more information and advice on how to manage difficult bowel symptoms and improve gut health problems such as IBS and IBD, read What’s Up With Your Gut, out now.

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Recognising red flags when suffering from bowel problems

There are some gut symptoms associated with bowel problems you should never ignore and we thought it best to flag them up here – if you are think these symptoms may apply to you talk to your doctor. Chances are it’s nothing to worry about, but better safe than sorry.

New symptoms

A lot of people endure symptoms such as pain, alternating bowel habits and food intolerance. These may have gone on for a long time, fluctuating in intensity and are sometimes helped by one or two dietary changes, and sometimes not. But recent changes are likely to be more serious than something that has persisted for years. If you had similar problems in your 20s to those in your 50s  and in between), it is unfortunate that you may have had to wait so long to get any answers, but it is not likely to be a life-threatening condition. If the symptoms have just started, it is far more worrying.

Don’t be embarrassed. Help your GP assess what needs to be done. Be sure to describe how long you have had the symptoms and explain exactly what you mean. In particular, be sure to tell your GP about the following symptoms as they may indicate a serious condition:

  • abdominal pain and fever
  • anaemia
  • blood in your stools
  • change in bowel habits
  • jaundice and definite lumps you can feel
  • unexplained weight loss.

Abdominal pain and fever

Fever and sharp, stabbing abdominal pain can have several causes and you may need to go to A&E or even call an ambulance if these are severe and sudden in onset.

Anaemia

Anaemia, which will make you look pale and feel tired, may be due to hidden (‘occult’) blood loss, and your GP may organise for you to have an endoscopy and/or colonoscopy, together with blood tests for coeliac disease, iron, B12 and folate deficiency.

Blood in your stools

Blood in your stools must be investigated. If it occurs only on wiping the anus with toilet tissue, it may just be haemorrhoids (piles) or an anal fissure (tear), but this should be checked by an examination, and then perhaps by a limited flexible sigmoidoscopy. If there is blood mixed in with the stools, you should be referred to a gastroenterologist or colorectal surgeon and have further tests, such as colonoscopy (or possibly a CT scan), to be certain bowel cancer and ulcerative colitis have been excluded. These are major diseases which are much more successfully treated if caught early and are not difficult to diagnose with the proper tests, so get your GP to refer you to a gastroenterologist if you suspect one of these. Although bowel cancer increases in likelihood as you get older, it is common enough that people aged 40 to 50 or younger can get it. If you know that you have a family history of bowel cancer you are also more at risk. The good news is that, when you have had a colonoscopy, you can be sure for quite a long time (several years) that this has been excluded as the cause of your symptoms. The faecal calprotectin test is now also useful in predicting if you do need a colonoscopy. If you are older, be sure to get the routine screening tests that are now offered.

Change in bowel habits

If you have a recent change in your bowel habit, then tell your GP and be prepared to get more tests. Clearly, if everyone in your family has just got the same symptoms after eating the same food, or you have just come back from an area where gastroenteritis is common, and the symptoms are not too bad, you can wait a week or two to see whether things go back to normal. But if they do not, and particularly if there is blood in the stools, then you MUST get tests.

Jaundice and definite lumps you can feel

Jaundice symptoms (yellow eyes and skin) and definite lumps, particularly if they are tender, must not be ignored. The lumps may turn out to be only hard faeces but you want to be sure that a definite diagnosis is made in case it might be an inflamed gall bladder, an ovarian or another cyst, or possibly a stomach or bowel tumour. Hernias in the groin or in other places in the abdomen may also feel like painful lumps and can also cause problems until they are treated.

Unexplained weight loss

Unexplained weight loss is important and will lead to other blood tests and probably hospital referral. Sometimes there is a gut disease (coeliac disease or Crohn’s disease, for instance) or cancer, but in other cases can be due to an endocrine disorder, such as an over-active thyroid, or to a wide range of other disorders, including neurological or mental health problems (you cannot buy, cook or chew your food), or cannot easily eat (dental problems, for instance or Alzheimer’s). These should be fairly easy for your GP to diagnose.

It can be very hard to start figuring out what’s up with your gut, so listen to your body and be aware of any possible symptoms that you should tell a doctor or other health professional who may be able to help. For less serious conditions, just keeping track of how you feel can help you to improve your symptoms on your own.

For more advice on how to track your symptoms and get to the bottom of your bowel issues read our next blog: Working out what’s wrong with your bowel, and order your copy of What’s Up With Your Gut? by Jo Waters and Professor Julian Walters.

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IBS: a guide for family, friends and colleagues

Although IBS is invisible, it is a very real illness and it can be hard to know how to support people we care about when we can’t necessarily see the physical symptoms of what they are going through. Dr Megan Arroll and Professor Christine Dancey have combined their extensive knowledge to provide a helpful guide for supporting friends and family members with IBS.

There are many conditions where people look fine, even very well, but they are in fact in a great deal of discomfort and pain. It can be hard when you are suffering from the symptoms but look fine on the outside. Try to remember when you last had a headache. You probably looked fine on the outside, despite being in pain. Now imagine feeling like this constantly.

Not only does suffering an invisible illness make you feel physically awful, but people with IBS often face a lack of support from those close to them. Work and social situations can also be challenging; without outward signs of ill-health, someone with IBS can feel very isolated. People with IBS often find it very hard to acknowledge their condition and to discuss it with others due to the embarrassing nature of the symptoms.

Additionally, IBS can attract stigma as it is a complex condition and there are no scans, investigations, or blood tests which can show that a person has IBS. It is a multi-faceted condition and we are only just learning about the physiological processes underlying it.

So, someone with IBS may appear perfectly fine – in fact, almost anyone will say ‘good’ or ‘well’ if you ask them how they are – this does not mean that IBS is not a debilitating and intrusive illness. All it means is that your friend, sibling or workmate who has IBS is trying to put their brave face on.

What you can do to help a friend or family member with IBS

You don’t need to know everything about IBS; just by accepting what your friend says about what he or she is feeling is a great help and support. IBS can take a long time to diagnose and is often misdiagnosed. Both the struggle for a diagnosis and the feeling of frustration engendered by being misdiagnosed can be difficult, and this is on top of feeling unwell. While it can be tricky for friends and family members to offer the right help and support to someone with IBS, here are a few simple rules to help make living with IBS a little less irritable.

Never question the existence of IBS, even if your friend looks and seems well.

Be patient with the process of diagnosis and finding an effective treatment – it can take time.

Try not to be over protective or treat the person with IBS as if they are fragile.

Try to limit giving advice, even if well-intentioned.

Be willing to find IBS-friendly activities which are of interest to both of you.

Understand that plans may be cancelled at short notice.

Offer practical support, such as help with the children, shopping, housework, gardening, etc.

If IBS is affecting your sexual relationship or damaging your relationship overall, seek external and professional support.

Overall, simply being there and accepting that the person with IBS is trying their best to overcome this misunderstood condition will be an invaluable support. IBS is an embarrassing and stigmatised illness that can challenge someone’s relationship with their body. Support, whether emotional or practical, can limit the likelihood of depression and isolation, factors which we know are detrimental to us all.

For more detailed guidance on how best to support someone who is suffering from IBS buy your copy of Irritable Bowel Syndrome: Navigating Your Way to Recovery and follow Dr Arroll on twitter.

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10 Foods IBS Sufferers Should Avoid

It can be frustrating and take quite some time to discover if certain foods are affecting your Irritable Bowel Syndrome symptoms. Some dietary changes may work for one person but not another. Below we outline the safest foods for IBS sufferers, and the foods you should avoid – those that have the most chance of aggravating your IBS symptoms.

Information is taken from Irritable Bowel Syndrome: Navigating Your Way to Recovery by Professor Christine Dancey and Dr Megan Arroll. Dancey is Professor Emeritus of Chronic Illness Research at the University of East London (UEL). As a researcher into invisible long-term conditions and a mis-diagnosed sufferer, she has a unique insight into what people with IBS want and need to know.

Dr Megan Arroll is a Senior Lecturer in Health Psychology at BPP University and is a member of the Health and Illness Research Team (HIRT), a group that works to better understand IBS and other invisible long-term conditions.

The most commonly recommended way to find out if you have a food intolerance is an exclusion, or ‘elimination’ diet, where you cut out certain types of food from your diet for three to four weeks and slowly reintroduce them one by one to see if any of your symptoms come back or worsen.

Safe Foods for IBS

The foods which are considered the safest for sufferers of Irritable Bowel Syndrome include:

Rice and quinoa

Rice milk

Fish, lamb, venison and duck

Pine nuts, flax seeds

All vegetables except nightshade vegetables (see above)

Non-citrus fruits

Herbal tea

 

Foods to Avoid for IBS

The ten foods, or food groups, generally considered the worst for aggravating symptoms of Irritable Bowel Syndrome are:

Foods containing gluten, such as wheat, corn, barley and rye

Dairy products and eggs

Soy and soy products such as tofu

Meats such as pork, beef and chicken

Beans and lentils

Nightshade vegetables such as tomatoes, potatoes, aubergines and peppers

Citrus fruits

Caffeine

Alcohol

Refined sugars

Doing an exclusion diet isn’t easy, especially at first, so it is worth preparing foods you can eat in advance. After three to four weeks, you can add one type of food back into your diet. It is worth keeping a food diary as you reintroduce foods and seeing if your symptoms reoccur. It is essential to be methodical and keep a food diary, so for a full list of foods and a more detailed guide through the elimination diet for IBS order your copy of Irritable Bowel Syndrome: Navigating Your Way to Recovery.

Follow @HHealthBooks and @DrMegHealthPsy on twitter for the latest updates on IBS and chronic illness.