Body Acceptance Rules to Live By

Medically reviewed by Jenny Blair, MD
Edited by Kristen Sturt

“I glance at myself in the mirror at the end of the aisle. My eyes immediately go to my pouch and the belt that helps support it. I keep the belt tight and it cuts deep into the fat of my belly. Skin spills down over the top of the belt, obscuring a large part of it. ‘This is what they mean by muffin-top,’ I think to myself. I pinch a mound of flesh between my fingers and sigh again. Despite all the swimming and working out that I do, I can’t seem to lose any of the fat around my midsection. I put on my shirt and remember back to when I was in college and how most days after swim practice, I would just leave the locker room shirtless. That was a lifetime ago, when I had 4 percent body fat, a six-pack and tanned skin from constant training beneath the Florida sun.”

These powerful words were shared by IBD advocate Ryan Stevens (Instagram: @rp_stevens), 45, Maumee, Ohio, who was diagnosed with Crohn’s disease at age 35. Ryan has an ostomy and a parastomal hernia that cannot be repaired due to his history of fistulizing disease. 

When you live with IBD, struggling with body image and self-esteem is common and understandable. Many of us lose bowel, have bowel repaired or have bowel on the outside of our skin. We all face unique challenges and struggles.

On a personal level, when I was diagnosed with Crohn’s disease at age 21, I aspired to be a television reporter and anchor. As you can imagine, being on 60 milligrams of prednisone and dealing with an acne-covered “moon face” didn’t help with my job search. I went from loving the camera to not allowing anyone to take a photo of me. When I did land a TV job, I spent the first 10 months behind the camera. Of course, my boss never attributed me being off-camera to my looks—but deep down I knew that was why. It was amazing how I was put on camera once I was done with steroids and back to “normal.”

Coming to terms with your body post-diagnosis and throughout your patient journey takes time. I had the chance to interview several IBD patients who have endured j-pouch, ileostomy and colostomy surgeries, along with a clinical psychologist in gastroenterology who lives with Crohn’s herself. Here’s their advice for coping with body image issues.

Make Peace With the Adolescent Spotlight

“In psychology we have a term called ‘the adolescent spotlight,’ in that as adolescents, we naturally feel other people are paying much more attention to our every move and function than they actually are. This is a normal phase in life that we should grow out of, but IBD can really make it feel like that spotlight is right in our faces,” explains Tiffany Taft, PsyD, a clinical psychologist at Northwestern University Feinberg School of Medicine in Chicago, Illinois. “The easiest example is people with IBD worry if they’re out with friends and are in the bathroom too long. When I talk about this concept and explore whether other people really are judging a person with IBD, most of the time there isn’t a lot of evidence to support it. We can apply this to scars and ostomies as well.”

Marisa Troy (Instagram: @JournalingIBD), 32, Westchester County, New York, was 13 when she was diagnosed with IBD. In the beginning, it was weight fluctuations related to flare-ups and prednisone. However, when she began her surgical journey at the age of 15, things slowly started hitting her more and more.

“When I had my j-pouch, I was very aware of my enormous surgical scar on my abdomen, along with the tons of stretch marks I had because of steroids,” she says. “However, I was strangely never embarrassed by my scar. I think my mind was starting to accept the fact that I was different. I wasn’t like everyone else my age, so if I had marks on my body that showed that, well, there was nothing I could do about it.”

Her ostomy was a different story. Troy had a difficult time coming to terms with the fact that she was unable to go to the bathroom like a “normal person.”

“As a teenager, I felt like I had to hide my body,” she explains. “I was so petrified that someone would find out my ‘dirty little secret’ that my entire life became about making sure no one found out. This feeling led me to have enormous anxiety.”

When Rachel Wigell (Twitter: @salty_data_eng), 26, Boston, Massachusetts, was diagnosed with Crohn’s, she was only 14 years old. She had barely had time to form a body image that didn’t include living with this disease. Wigell finds that showing herself empathy has helped her overcome self-esteem issues.

“This body has gone through a lot! There have been times when I could barely walk, stand up or even roll over in bed,” she says. “Going through that makes the stuff that I might feel insecure about, like occasional gassiness or the mess of scars all over my belly, feel like small beans in comparison. I try to think of it all as just physical evidence of the difficulties I have braved. In this way, I am redirecting my insecurities towards something I am proud of instead—my courage and strength.”

Change Your Self-Talk

It’s important to remember we are not what happens to us. Rather, we had an identity before IBD, and we are that person experiencing IBD. Our worth is not lessened because we have scars or are dealing with embarrassing physical side effects of our medications. If you’re feeling sad or angry, think about what you are telling yourself about your body. Is it accurate? We tend to be much kinder to others than ourselves.

“Instead of fighting the emotions, accept they are part of living with IBD and they will pass,” says Dr. Taft. “Allow yourself 15 to 20 minutes of ‘worry time’ or to cry—space for whatever emotions you’re feeling. Instead of trying to change emotions, notice what it feels like and pick the best word that describes how you’re feeling. Accept the feeling as a natural reaction to living with the effects of IBD on your body. Notice how your body feels when you’re in that emotional state. Do you feel tense? What’s your facial expression? How’s your breathing? As time passes, how do your thoughts, feelings and body change? With time, it should become easier to sit with uncomfortable feelings as they arise without letting them get away from you or out of control.”

Keith Thomas (Twitter: @keiththom2014), 57, Llanelli, United Kingdom, was diagnosed with ulcerative colitis at age 46. To him, having an ileostomy just means he has a different toilet routine.

“I love who I am, and I would not change anything. Keep telling yourself that others don’t see you as you see yourself. You are you and you have to learn to love yourself.”

Look in the Mirror

Some people avoid looking at their scars. That was the case for Richard Barnes (Twitter: @richmbarnes1), 44, Nottingham, United Kingdom. He woke up from surgery to discover he had a stoma and an ileostomy.

“It made me seriously unhappy, depressed, angry and I contemplated suicide,” he says. “It really got me down. I hated the look of my body and couldn’t and didn’t accept it for many months. I don’t think I looked in a mirror for five months. It really was hard to deal with.”

If you have similar trouble, schedule time each day to look at yourself in the mirror.  You can start off small, at 10 seconds. One minute. Whatever you can tolerate.

“Look at your body and pay attention to your thoughts and feelings,” explains Dr. Taft. “Don’t try to fight them off, just let them come to you. When you’re done with your mirror time, take one or two of your negative thoughts and reverse them so they’re positive. For example, ‘My stomach looks so gross with this scar’ to ‘My stomach looks pretty cool with this scar.’ You’re not going to believe it at first, but with time and practice the negative should become less intense.”

Then, each day, add a little more mirror time, until you can look at yourself without judgment. “It doesn’t have to turn into immense body positivity; neutrality is okay too,” says Dr. Taft. “Avoidance will only perpetuate the negative feelings and the tug-of-war with low self-esteem.”

Work on Acceptance

As hard as it may be, try to accept that your old self—the pre-diagnosis you—is still there underneath all your body changes. And even though you may never look like you once did, it is okay. Wigell says she’s slowly shifted from feeling like certain events, such as j-pouch failure and needing a permanent ileostomy, would be the end of the world. Now she accepts the possibilities.

“The suffering my colon put me through helps me to appreciate my j-pouch, even when it's being bratty, and the same will apply to a stoma if I need to get one someday,” she says. “It took some serious time and work to get to this place, mentally.”

Focus on What You Can Control

Troy finds it empowering to spend time on the parts of her appearance she has power over; it helps her to feel more confident and comfortable in her own skin. While she says her hair is a lot thinner since her diagnosis, she can change the style and color. She finds getting manicures makes her feel more put together and human. Troy also finds joy in picking out a wardrobe that makes her feel comfortable around her ostomy.

Don’t Be Afraid to Ask for Help

As an IBD warrior, you've already been through a lot because of your condition. It's not fair to add to your struggles with negative thoughts about your body. If you’re unable to be gentle with yourself, consider therapy. There is no shame in asking for help. Many in your situation need help coping.

Aside from in-person therapy, there are apps created to help keep you on track, including ACT (Acceptance and Commitment Therapy) Coach (created by the Department of Veterans Affairs), ACT Companion, Breethe and Stop, Breathe, & Think.

Connect With the IBD Community

Always know you are not alone in your worries or struggles. The best and most beneficial conversations you will have regarding body image and self-worth will often be with those who live with IBD and can genuinely relate. You will feel understood. You will feel validated. You will feel comforted. The “IBD family” has a heavy social media presence, especially on Instagram and Twitter. Don’t hesitate to reach out. You’ll quickly notice how easy it is to bond with a friend—in person or virtually—who shares your experiences.

Not ready to share your personal health details on social media? Create an anonymous account. Read what others are posting and reach out without disclosing your identity. Check out IBD blogs written by patient advocates who are passionate about sharing their stories and viewpoints in hopes of helping others.

Look at the Big Picture

As IBD patients, our bodies go through unthinkable trauma. The fact that we still function is something to be proud of. Remember that your worth is not measured by your reflection, your outward appearance or how you go to the bathroom. Rather, it’s about how you treat others and live your life. Allow yourself to feel. Allow yourself to mourn the physical and emotional changes IBD causes. Don’t forget to cut yourself some slack.

“When I work with patients, I often am in the role of cheerleader in that I remind them of all the stuff they’ve been through, and how maybe a lot of the time they were thinking ‘I can’t do this—it’s going to be catastrophically bad.’” says Dr. Taft. “Yet, here they are today.”

4 Foods to Eat—and 4 to Avoid—When You Have IBD

Medically reviewed by Matthew J. Hamilton, MD

When you have inflammatory bowel disease (IBD), choosing the right foods can help you manage your condition whether you’re in a flare or in remission. While there’s no one-size-fits-all approach, certain foods can be beneficial—while others should generally be avoided.

“Science is pointing in the direction of anti-inflammatory diets, like the Mediterranean diet, to use as a frame for how to create meals,” says Laura Manning, MPH, RD, CDN, Clinical Nutrition Coordinator at the Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai Medical Center in New York City. “We want patients to eat mostly plants, minimal red meat, lots of fish—and steer away from heavily processed foods, like fast food.”

Your food choices may change depending on whether or not you’re in a flare. But generally speaking, it can help to eat—and avoid—these foods when you have IBD.

Pile Up the Veggies

Vegetables are an excellent source of dietary fiber, which helps aid digestion. “We encourage patients to focus their diet mostly on plants, which sounds scary to a lot of people, but the benefits of fiber have been shown to be protective,” explains Manning. “Make changes in fiber content and textures when you’re in a flare, but embrace fiber when you’re in remission.”

A general rule of thumb is that raw or leafy green vegetables can be irritating. “Leaning more towards starchy root vegetables can be helpful,” adds Manning, like potatoes and squash.

Enjoy Fruits

Fruits are another quality source of fiber to add to your IBD diet. “Cantaloupe, honeydew, mango, papaya, avocados, bananas, and peeled apples, pears, and peaches are all good fruit sources for people with IBD,” says Manning. “They don’t have a lot of thick skins or seeds in them, and they tend to be pretty soothing when eaten.”

Be cautious with fruits that have a particularly high fiber content, like berries, which may irritate your symptoms, adds Manning.

Opt for Grains

Grains, like bread, rice, pasta, and barley, are essential sources of fiber, B-vitamins, iron, magnesium, and selenium. When you’re feeling well, be sure to incorporate plenty of whole grains in your diet; though you may want to switch to refined grains during a flare, as they’re easier to digest.

“Oats are fantastic—and there are different ways of getting oats, like instant oats or steel cut oats, depending on your tolerance,” says Manning. “They can be used in cereals, breads, muffins, or overnight oats—there’s a million ways, and there’s a lot of really protective characteristics with oats.”

Pick Protein

Protein is another important component of a healthy diet for IBD. You can get your daily intake of protein from a variety of sources—like meat, fish, poultry, and dairy. “Seed butters are also popular, and they’re easy-to-digest protein sources, along with Greek yogurt and cheeses,” adds Manning.

Avoid Caffeine

“It’s typical for caffeine to be problematic, whether it’s in coffee, tea, soda, or even chocolate,” says Manning. “Caffeine is a bowel stimulant—a lot of people use caffeine to go to the bathroom, but in IBD we don’t want that.” It can also be dehydrating—and when you have IBD and are dealing with symptoms like diarrhea, it’s important to stay hydrated. So be sure to cut back on caffeine, especially during a flare.

Skip Alcohol

Like caffeine, alcohol is another gastrointestinal irritant, meaning it can lead to increased bowel movements—and it can also be dehydrating. “We don’t want patients to avoid alcohol completely forever. Just be mindful of it,” says Manning. Talk to your doctor about which medications you’re taking, as alcohol should be avoided with certain drugs. Otherwise, stick with the general recommendations of no more than one drink per day for women; two for men.

Steer Clear of Fatty Foods

When you have IBD, it’s important to focus on nutrition—which means eating things like fast food and processed foods in moderation. “When you’re in a flare, bowels are very sensitive to food in general,” says Manning. “And an overload of grease in the food can exacerbate bowel movements more.”

Avoid Dairy If Necessary

“Having dairy products is healthy,” explains Manning. “They contain calcium and vitamin D, and can be part of a healthy diet.” While some people who have IBD are fine with dairy, others aren’t. “Some patients have temporary lactose intolerance when they’re in a flare,” explains Manning. “In that case, things like lactose-free dairy products, hard aged cheeses, or even Greek yogurt are usually well-tolerated.”

Embrace Trial and Error

When it comes to eating with IBD, what works for some may not work for others. Food choices are a very individualized thing, and it can take time to figure out which foods are best for you. “It really has to be a lot of trial and error,” says Manning. “Start with some very simple, basic foods, and build on them.”

9 Ways to Help Your Partner with IBD

Medically reviewed by Matthew J. Hamilton, MD

Dealing with a chronic illness can challenge any relationship, whether you’ve been married for decades or just started dating. It can be especially tough watching your partner deal with the pain, stress and everyday struggles of inflammatory bowel disease (IBD). The good news is, helping a significant other handle their IBD can bring you closer together. Here are a few tips to get you started.

1. Talk About Your Role.

Want to know how you can best support your partner? Ask them. Sit down and have an open, honest dialogue about your involvement in their IBD. Bring up specific questions to nail down boundaries and expectations: Where do they need the most help? When should you pitch in? When should you butt out? Keep the discussion open-ended. Revisit it occasionally, and understand that your role may change with your partner’s health status, or as you get more comfortable with each other.

2. Just Listen.

People with IBD can find it hard to discuss their disease. They may fear being judged, or want to avoid burdening other people. So, let your partner know you’re all ears. Encourage them to talk about their symptoms, their day-to-day life and their emotional ups and downs. Listen without judgment and validate their feelings—tell them being sad, stressed, angry or frustrated is perfectly normal. Make sure they realize it’s not a one-time offer, either, and they can always talk to you about their IBD.

3. Lend a Hand with Their IBD.

Clear it with your significant other (SO) first, but if they give the go-ahead, one of the best ways to help anyone with IBD is taking part in disease management. That could mean picking up medications, keeping track of symptoms and triggers, or going with them to doctor’s appointments. Again, ask how you can be most useful.

Don’t forget: They’re your partner, not your patient. Accept it’s their body and they may make mistakes or health decisions you don’t agree with. Avoid judgment and pick your battles wisely.

4. Pitch in Around the House.

When pain and bowel issues keep your partner from chores, childcare or simple everyday activities, try to pick up the slack. That’s goes double after IBD surgery—during recovery, patients can have trouble with even minimal movements like lifting or bending.

Remember, too, that fatigue is a common symptom in people with IBD. Your SO might be not be in obvious distress, but trust them when they say they’re too exhausted to cook or clean.

5. Be Flexible.

IBD is unpredictable. Your partner’s illness may limit their ability to socialize—or even leave the house. Patients often have to arrange their calendar around their disease, and when symptoms act up, they may need to cancel plans last-minute. When this happens, don’t blame your partner or make them feel guilty. Understand they’re sad and frustrated, too, and roll with the new situation. Settle in for a game night or invite friends over if possible. Offer alternatives and stay positive.

6. Brainstorm New Ways to Spend Time with Each Other.

What can you do together that will go easy on your SO, especially when symptoms are acting up? Be creative, and think of how to best accommodate their needs. For example, if you’re heading out, weigh location, toilet access and crowds; any place with long bathroom lines is likely a bad idea. Take restaurant menus into account, as certain food or drinks can aggravate your partner’s IBD. Plan around bedtimes, too, since good sleep is critical to disease management. When in doubt? A movie night at home never fails.

7. Talk About Sex.

Sex with IBD can be tricky. Your partner’s desire and ability may be shaped by fatigue, pain, accidents and body image, among other things. That’s why it’s important to A) boost their confidence as much as you can, and B) communicate. Talk honestly about concerns preferences—especially what they can and can’t handle. Work with their capabilities the best you can and explore other ways of being physically intimate. Kissing and snuggling are powerful ways to build your bond.

8. Be an Advocate.

On a smaller level, try to help friends and family members understand your partner’s IBD. Give them good medical information, and be open to questions and conversations. On a larger level—and only with your SO’s go-ahead—dive into the IBD community. Get involved with local support groups and programs focused on awareness and education. Volunteer and take part in fundraisers, whether it’s a walk program or an Ironman event. Look online for available opportunities; there’s sure to be one for you.

9. Remember Self-Care.

Caring for a partner is tough if you’re burned out yourself—so don’t ignore your own mental and physical health. Take breaks when you need them, and set time aside for your interests, whether it’s a hobby or a ballgame. If you’re overwhelmed, talk to a trusted friend or counselor about your feelings, and look to loved ones to pitch in with everyday responsibilities. Remember: It’s okay to ask for help.

7 Questions to Ask Your Doctor Before Joining an IBD Clinical Trial

Medically reviewed by Jenny Blair, MD

So you’re thinking about joining a clinical trial? Maybe you’ve searched for and found some that you’re interested in participating in. The next step? Having a lengthy discussion with your doctor. It’s important to understand what you’re signing up for and how participating may affect you.

Start by asking your gastroenterologist these key questions about joining a clinical trial.

1. Do you think I’m a good candidate for a clinical trial?

Each clinical trial has its own set of eligibility criteria, including things like age and gender, and which medication you currently take or whether or not you’re in remission. Talk with your doctor about how well you’re currently managing, and get their opinion on whether or not you should join a clinical trial.

2. Do you have any recommendations for clinical trials that I may be eligible for?

You may have done your research and identified a few trials you’re interested in before you meet with your doctor. If not, you can work together with your care team to search all available clinical trials through the Crohn’s & Colitis Foundation Clinical Trial Finder to identify which ones might be a good fit for you.

3. What are the potential risks of participating?

Clinical trials are conducted to help test and ensure the safety and effectiveness of a new treatment before it’s approved by the FDA for the rest of the human population. That means that, at the time of the trial, the safety and effectiveness may not yet be fully understood—so there is a certain level of risk that you take when you sign up. It’s important to fully understand the potential risks before you agree to participate.

4. What are the potential advantages of participating in a clinical trial?

For starters, you’re helping to move the needle forward in IBD treatment. Not everyone with IBD responds to medication, and those who do may lose responsiveness to treatment over time. So there’s an ongoing need to develop new treatment options to help everyone with IBD control their disease. What’s more, clinical trials give you advanced access to new drugs that may help you gain better control of your condition. Regardless, before you sign up, it’s important to carefully talk through and weigh the pros and cons of participating in a clinical trial.

5. If I do decide to participate, will I still see you for follow-up care as usual?

Participation in a clinical trial is not a substitute for your routine medical care. It’s important to make sure you stay on top of your regular doctor visits so that your doctor can monitor your condition as usual. Therefore, it’s important to make sure your doctor is on board with your decision to participate and can keep any trial participation in mind while overseeing the rest of your medical care.

6. What are next steps if I decide to sign up?

Once you and your doctor have identified and agreed upon a particular trial you’re considering signing up for, the next step is to find the nearest trial site to you and contact the site coordinator to set up a consultation. That’s where you’ll have an opportunity to discuss the process of that particular trial at length with the coordinator, who can also answer any questions you may have before you sign consent forms agreeing to participate.

7. What can I do if I change my mind about participating before the trial is over?

Your participation in a clinical trial is voluntary. Even after you meet with the research coordinator and sign consent forms, you can still drop out at any time.

Dining Out? 10 Tips for a Stress-Free Experience

Medically reviewed by Jenny Blair, MD

These days, having a social life often means attending gatherings that involve eating and drinking. When you have inflammatory bowel disease (IBD), participating in these types of social events—like going out to eat—can be anxiety-provoking. But it doesn’t have to be.

“When in a flare state, it can be scary to dine out, but with a bit of prep in advance, the experience can be pleasant,” says Kelly Krikhely MS, RD, CDN (Twitter: @NYC_Nutrition), a New York City-based nutritionist specializing in digestive disorders. “The first trip to a new restaurant is usually the hardest. Once you identify items on the menu that you tolerate well, return trips will be much less stressful.”

Next time your friend group wants to go out to eat, keep these tips in mind.

1. Do Your Research in Advance.

Don’t wait until the pressure is on and the server is taking your order to decide what to eat. “Research the menu in advance to come up with a strategy for what you plan to order,” says Krikhely. You can even call ahead if you have specific questions about the menu or how a particular dish is prepared to help you identify “safe” dishes to order before you even arrive at the restaurant.

2. Have a Snack Before You Go.

Avoid showing up at the restaurant too hungry, as hunger can cloud your judgment, and lead you to not make smart food choices. “Sometimes I'll eat a little something before heading out so I am not too hungry and can keep my meal simple when in public,” says Natalie Hayden, who was diagnosed with Crohn’s disease in 2005.

3. Dress for the Occasion.

“I recommend wearing pants with an elastic waistband or a dress versus wearing jeans or dress pants if you can get away with it,” adds Hayden. “Oftentimes when I'm bloated, restricting my stomach adds to the pain.”

4. Stake Out the Nearest Restroom.

“Once you arrive at the restaurant, it can be helpful to check out where the bathrooms are and to sit on the outside of the booth in case you need to make a mad dash,” adds Hayden.

5. Avoid Trigger Foods.

Especially if you’re in a flare, you’ll want to avoid foods that can make symptoms worse. That means choosing nutritious foods that are easy to digest and have little soluble fiber, like cooked vegetables and fruits, oatmeal, and lean sources of protein like chicken or eggs.

“As a general rule of thumb, try to choose menu items with simple ingredients,” says Krikhely. “A broth-based soup, a simple turkey sandwich, or grilled salmon or chicken with white rice or skinless baked potato are examples of go-to items that are typically well-tolerated.”

6. Consider How Foods Are Prepared.

“It's usually preferable to limit fried foods when dining out,” says Krikhely. “Key words on the menu that can commonly be considered red flags include fried, creamy, crispy, crunchy, battered, and spicy.” Large quantities of fat or spicy foods are often not well tolerated, she explains—though, she adds, that’s only the case for some IBD patients, and only during a flare. You may want to stick to preparation methods that are well-tolerated by people with IBD—like baked, broiled, boiled, steamed, poached, grilled, or sautéed.

7. Make Special Requests as Needed.

Many restaurants are happy to accommodate special requests to alter how a dish is prepared—all you need to do is ask. “You can ask the chef to customize your dish to eliminate items you know may be poorly tolerated,” says Krikhely. “You can also ask to adjust the method of preparation, grilled fish instead of fried fish, for example. And because many sauces contain lots of fat and spices that may not be well-tolerated, requesting sauce on the side can be a simple solution.”

8. Consider Portion Sizes.

When you have IBD, portion size can make a difference. “During flares, small, frequent meals are typically better tolerated than large portions,” says Krikhely. “Share your entree with a friend, or eat half the portion and take the rest home to enjoy the next day.” You can also order an appetizer, which is typically a smaller portion than an entrée—just avoid those that are fried.

“I try not to overeat when I dine out,” says Jordan Wilson, who was diagnosed with ulcerative colitis in 2010. “I make sure to keep it light and relatively clean.” By “clean”, Jordan explains, he means meals prepared simply with only a few fresh ingredients.

9. Schedule Outings Wisely.

“Sometimes a heavy lunch or dinner can't be avoided. If that's the case, I make sure to keep my afternoon calendar clear of appointments,” says Wilson. Though you can also be prepared by using things like adult diapers or other protective garments—and keeping a spare stash (plus a change of clothes!) in your bag or car.

10. Ask Your Doctor if Meds Can Help.

Depending on your specific symptoms, your doctor may recommend anti-diarrheal medications, antispasmodics, or lactase supplements to help you go out to dinner with ease.

4 Ways Stress Affects Your Body When You Have IBD

Medically reviewed by Matthew J. Hamilton, MD

The link between stress and inflammatory bowel disease (IBD) is not a new concept—the discussion of how emotional life events affect IBD was first discussed back in 1930. We’ve learned a lot since then, including how stress affects your body, and what you can do about it.

Here’s what you should know.

Stress can increase your risk of flares. Living with a chronic condition like IBD where an unexpected flare-up can strike at any time can be stressful. Yet, stress can actually make flares worse. “Perceived stress, or when you feel like you’re in a high stress situation, like a high level of work stress or family stress, is one of the primary triggers that have been identified for a flare,” says Megan Riehl, PsyD, a clinical psychologist and assistant professor of medicine in the Division of Gastroenterology at the University of Michigan Health System in Ann Arbor.

Stress can result in the need for more potent medications. “Stress can make it more difficult to follow your treatment plan—meaning you might be less likely to take your medications as prescribed,” says Dr. Riehl, “and you may end up actually needing more potent medications.”

Stress can lead to IBD-related anxiety and depression. “Managing the relapsing-remitting nature of the disease—where you can be doing really well for a while then a specific stressor triggers a flare, or you can flare for no reason—dealing with the complexities of that is something that can create added anxiety and depression,” says Riehl.

Stress can affect your emotional health. “Stress can lead to more isolation, so you’re not as actively involved with family or friends,” explains Riehl. “It can make you less productive at work, leading to more missed days of work.” And living with IBD can lead to issues with body image or intimacy, which can also impact your emotional health.

The Importance of Stress Management

In order to take steps to keep stress at bay and stay healthy, it’s important to establish your personal tolerance to stress. Everyone handles stress differently—situations like changing jobs or buying a new house may stress some people out, where others might not bat an eyelash.

“When you have insight into what stressors are going on in your environment, that can really help you utilize your healthy coping resources,” says Riehl. That includes a range of strategies, from following a healthy lifestyle by eating a healthy diet, exercising regularly and getting quality sleep each night; to using relaxation techniques like meditation and visualization; to making sure you take time for yourself each and every day; to cultivating and leaning on your support system.

“Also try to be aware of when your body is carrying more tension or when you’re having more IBD symptoms, and then assess how you’re doing with self-care and stress management.”

Signs You Should Seek Help for Stress

There may be times when your stress coping techniques just aren’t cutting it and you need help overcoming the stress in your life. “If an acute stressor becomes more chronic, that can be a big red flag that you may need to make some adjustments in scheduling or ask for additional help and support,” says Riehl. If that’s the case for you, “Seek help sooner rather than later.”

9 Stress Relief Tips

Medically reviewed Matthew J. Hamilton, MD

When you live with inflammatory bowel disease (IBD), the stress often feels overwhelming—especially during a flare. Pain, fear, stigma, sleeplessness and the unpredictability of the disease can all factor into your worries. And while stress doesn’t cause IBD, it may worsen symptoms, contribute to flares and damage your quality of life. Try these tips to keep it in check.

1. Acknowledge your stress.

“It’s really important to be checking in with yourself and identifying how you are feeling,” says Megan Riehl, PsyD, Clinical Director of the GI Behavioral Health Program at the University of Michigan in Ann Arbor. “Recognize that this is really common,” she adds, and that your feelings are normal.

Once you’ve accepted how you feel, concentrate on next steps. Dr. Riehl recommends asking “What do I have control over in my life?” or “What can I modify?” Let go of what you can’t change and focus on what you can.

2. Take time for yourself.

Self-care is an important component of managing stress. Whether it’s reading a book or having lunch with a friend, set time aside every day to do something you enjoy, to relax and take your mind off things. Mark it in your calendar to make it official, or to let others know you’ll be unavailable.

At the same time, beware of overcommitting. Listen to your body, and be aware of how too many obligations might affect your disease. Remember that it’s okay to RSVP “no” to an event if you’re not feeling up to it.

3. Lean on your social circle.

“Whether we have a chronic illness or not, we don’t want to burden our loved ones,” says Dr. Riehl. “I work with patients to recognize the importance of a support system and develop communication skills to say, ‘I could really use some help.’”

So, be open about your situation with family and friends. Most importantly, “be very specific about what would be helpful for you.” Whether you need a sympathetic ear or a nap, making clear requests takes the onus off others—and can help you feel better, faster.

4. Anticipate stress and plan ahead.

Think about potentially stressful situations in your day-to-day life and head them off by being prepared. Busy mornings? Pick an outfit or pack lunch at night, and build in extra time for rest and medical care. Getting dinner with friends? Map out bathrooms and bring an emergency kit with wipes, spare clothes, extra supplies and doctor-approved rescue medications. Going on vacation? Make sure you have enough medication and supplies for the trip. A little organizing up front can ease your mind down the line.

5. Prioritize good sleep.

Sleep troubles are common in IBD, which can then lead to fatigue—a chief stressor among patients. “If you’re feeling fatigued, it can certainly give you less energy to take care of your health and the day-to-day things that we all deal with,” says Dr. Riehl.

To sleep better, keep your room quiet, cool and dim before turning in. Stick to a consistent bedtime and wake-up time. Nix caffeine, screens and big meals in the hours before bed. See your provider, too, who can adjust your meds and find you a sleep specialist.

6. Get moving.

Regular exercise is a well-known stressbuster—and for IBD patients, it may reduce inflammation and improve bowel function, as well. However, people with IBD often find it difficult to work out due to symptoms, especially during a flare. So, talk to a provider, who can refer an experienced trainer or suggest the best regimen for you. As your disease allows, try light physical activities like walking, biking, swimming, yoga or tai chi. Even a post-lunch stroll can work wonders on your mood.

7. Try relaxation techniques.

Many patients find certain practices help reduce stress, such as meditation, guided imagery, soothing recordings or progressive muscle relaxation. Others are more successful with deep breathing exercises. Slowly inhaling, holding your breath and exhaling can ease muscle tension, lower blood pressure and sharpen your focus, among other benefits. Ask your provider about options. It may not be the first thing you try—or even second or third—but it’s important to keep trying until you find the right technique for you.

8. Know when stress is something more serious.

Anxiety and depression are common in IBD patients. If you’re avoiding people and favorite activities, are preoccupied with worrisome thoughts or feel hopeless about the future, see a mental health professional. They can start medication and other treatments, like cognitive behavioral therapy [CBT], which helps address negative thought patterns and is proven to help many with IBD. “CBT is very commonly used in gastrointestinal (GI) psychology and we really tailor it to GI-specific anxieties,” says Dr. Riehl.

9. Understand that stress won’t go away overnight.

“It’s a process,” says Dr. Riehl. “We can definitely modify stress levels, but it’s certainly going to take time and practice. If you give yourself the grace to recognize you’re learning a new skill, I think that it makes the journey a little bit easier.”

In a Crohn’s Flare? 8 Tips to Try

Girl with IBD gets rest to stay healthy

Medically reviewed by Matthew Hamilton, MD

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When you have Crohn’s disease, you may experience periods of flares, where uncomfortable symptoms like diarrhea, abdominal cramping, and fatigue strike; with periods of remission, when you have no symptoms at all. If you’re currently experiencing a Crohn’s flare, there are certain steps you can take to find relief. Start with these strategies:

1. Call your doctor.

If you’re experiencing a flare, your doctor may want to do some tests to determine if there’s underlying inflammation occurring that needs to be treated. Depending on what your doctor discovers, you may be prescribed additional medication to take to help alleviate inflammation and relieve your symptoms.

2. Find out if OTC meds can help ease discomfort.

Aside from sticking with your prescribed Crohn’s treatment plan, taking certain over-the-counter medications can also help relieve Crohn’s symptoms during a flare—like antidiarrheals, pain relievers or digestive aids. Just be sure to clear any OTC medications with your doctor first before you take them, as some may actually irritate your digestive system or interfere with your prescription Crohn’s medications.

3. Adjust your diet.

When you’re in a flare, avoiding potential trigger foods and focusing on those that are more easily tolerated can help you find relief. It’s also essential to make dietary choices that provide your body with the nutrition it needs to get well. Stay away from foods that can exacerbate your symptoms, like:

  • Raw fruits and vegetables with skin and seeds
  • Dairy
  • Sugar and sugar-substitutes
  • Fatty, fried or greasy foods
  • Spicy foods
  • Alcohol
  • Caffeine
  • Popcorn

Instead, eat foods that are easy-to-digest, like low-fiber fruits, non-cruciferous vegetables, lean protein and refined grains.

4. Consider joining a clinical research study.

If your Crohn’s disease flares up pretty regularly and you’re having trouble finding the right treatment to control your disease, talk to your doctor about joining a clinical research study. Clinical research studies are an essential step in finding new treatment options that can help more people with Crohn’s gain control of their condition.

Currently, IBDiscover’s clinical research studies ADVANCE and MOTIVATE are enrolling individuals with active Crohn’s disease symptoms. Take a minute to fill out this questionnaire to see if you’d be a good candidate for these two Crohn’s clinical research studies.

5. Find ways to relieve stress.

Living with Crohn’s disease can be stressful, but stress may actually trigger an IBD flare. So, finding ways to manage stress can help you relax and feel more in control of a flare. Experiment with different stress management techniques—like breathing exercises, meditation, yoga or tai chi—to find what works best for you.

6. Get moving.

When you’re in a flare, exercise may be the last thing on your mind, but taking time to stay active—even in short, low-intensity intervals—can help reduce stress and boost bone health, two important factors to consider both when you’re going through a flare and during remission.

7. Put down the cigarettes.

Smoking cigarettes is known to trigger Crohn’s flares. In fact, people with Crohn’s who smoke experience more disease activity than those who don’t—and those who quit find that they have fewer flare-ups than before they quit.

8. Take it easy.

Going through a flare can be taxing, so make sure you prioritize self-care. Make sure you’re getting plenty of sleep and rest when you need to.

6 Common Crohn’s Symptoms—And How to Deal with Them

Medically reviewed by Matthew Hamilton, MD

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Crohn’s is a type of inflammatory bowel disease that can affect any part of your gastrointestinal (GI) tract—from your mouth to your anus. While Crohn’s affects everyone differently, certain symptoms are more common than others.

Common Crohn’s Symptoms You Should Know About

With Crohn’s, the underlying inflammation affects the ability of your GI organs to work the way they should, which can lead to these six hallmark digestive symptoms of the disease:

  1. Persistent diarrhea
  2. Rectal bleeding
  3. Abdominal pain or cramping
  4. New or worsened constipation
  5. Urgency to have a bowel movement
  6. Unexplained fevers or weight loss

Crohn’s disease may appear in patches throughout your digestive tract—affecting some areas but not others. Over time, symptoms can also change, and range from more mild to more severe, depending on the location and severity of the underlying inflammation in your body. What’s more, you’ll likely also go through periods of remission, where you experience no symptoms, mixed with periods where symptoms flare up.

How to Find Relief When Crohn’s Symptoms Strike

There’s no cure for Crohn’s—so the best thing you can do to control the underlying inflammation and alleviate Crohn’s symptoms is to work with your doctor to find the right treatment plan that can help you achieve and maintain remission. That said, there are a few steps you can take to find symptom relief:

  • Use a perianal cleansing product to promote good anal hygiene.
  • Use a moist wipe instead of toilet paper to help reduce anal irritation.
  • Apply skin protectant ointment to relieve anal irritation.
  • Bathe in warm water or use a sitz bath to relieve anal soreness.
  • Ask your doctor if you’d benefit from anti-diarrheal medications to relieve persistent diarrhea.
  • Ask your doctor if using over-the-counter pain medications, like acetaminophen, can help relieve abdominal pain and cramping.
  • Alter your diet as needed to help you manage abdominal pain and cramping. Your diet during a flare will likely be different than your diet in remission.
  • Take steps toward self-care—get a good night’s sleep and rest when you need to, and find ways to manage stress.
  • Join a support group to get tried and true tips from others with the condition who are dealing with the same issues—and pay it forward by sharing what works best for you, too.

What to Do When Symptoms Just Won’t Quit

If you feel like you’re always in a flare and you’ve already tried every Crohn’s medication in the book, and you’re still having trouble finding the right treatment plan to control your Crohn’s, you might want to join IBDiscover’s clinical research studies ADVANCE or MOTIVATE. Currently, these two clinical research studies are enrolling individuals who:

  • Have been diagnosed with Crohn’s disease for at least 3 months
  • Are between ages 16 and 80
  • Currently have active Crohn’s symptoms (for example, abdominal pain or an average of 4 or more bowel movements a day), and
  • Have tried biologic therapies for Crohn’s disease, but still have symptoms, or
  • Have never tried biologic therapies for Crohn’s disease, but have tried conventional therapies and still have symptoms

Interested in these clinical research studies? Find out if you’re a good candidate for these clinical research studies by completing the online questionnaire.

Can You Prevent Crohn’s Flares?

Medically reviewed by Matthew J. Hamilton, MD

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When you have Crohn’s disease, your symptoms likely go through periods of remission, where you don’t have any symptoms at all, and periods of flares, where symptoms act up. While Crohn’s flare-ups are not entirely preventable, there are certain steps you can take to help keep them at bay and maintain remission. Start with these strategies:

Speak Up When Medications Aren’t Working

When it comes to Crohn’s treatment, the overarching goal is to achieve and maintain remission. So, if you seem to be experiencing flares more often, it’s essential that you talk to your doctor. This may be a sign that your treatment plan is no longer working for you, and you’d benefit from a change in treatment.

If you feel like you’ve already tried every Crohn’s treatment out there, talk to your doctor about whether or not you’d be a good candidate for IBDiscover’s clinical research studies ADVANCE or MOTIVATE. These two clinical research studies currently are enrolling individuals who:

  • Have been diagnosed with Crohn’s disease for at least 3 months
  • Are between ages 16 and 80
  • Currently have active Crohn’s symptoms (for example, abdominal pain or an average of 4 or more bowel movements a day) and
  • Have tried biologic therapies for Crohn’s disease, but still have symptoms, or
  • Have never tried biologic therapies for Crohn’s disease, but have tried conventional therapies and still have symptoms

Get pre-screened today to see if you qualify for either of these two clinical research studies. 

Avoid Your Triggers

While trying a clinical research study might help you potentially cope with Crohn’s flares, it’s also important to identify which factors could trigger flares. Some possible triggers include:

  • Diet
  • Stress
  • Smoking
  • Medications like aspirin, ibuprofen and some antibiotics
  • Illness

Crohn’s triggers are individualized, so it’s important to be able to identify your specific triggers so you know exactly what to avoid to prevent a flare-up from occurring.

Track Your Crohn’s

You may be able to identify your triggers and accelerate disease management by tracking factors related to your Crohn’s. You can use the Oshi Health app to track everything from your symptoms and medications to lifestyle factors (like diet, stress, physical activity) and more. By tracking every day, you—and your doctor—may be able to identify patterns, so you can better manage your condition. It’s important to share any information you’ve tracked in Oshi with your doctor so you can work together on your Crohn’s care. 

Take Your Medications

The right Crohn’s treatment helps promote intestinal healing and controls Crohn’s symptoms—ideally, putting you in a state of remission where you’re not experiencing flares. In order for you to maintain remission and avoid flares, you need to continue taking your medications, even when you’re feeling well. Skipping a dose or not taking your medication as prescribed can trigger a Crohn’s flare.

Check in Regularly with Your Doctor

It’s important to see your doctor for regular checkups even when you’re feeling well. Your doctor will still need to perform certain tests and screenings to monitor your disease and spot any potential issues that need to be addressed sooner rather than later.

When you’re in remission, you’ll likely need to schedule visits every six months; if you’re in a flare, your doctor may want to see you more often. Remember to keep an open line of communication with your doctor about how well you’re managing—and if you don’t feel like you have a good partnership with your doctor, don’t be afraid to look for a new provider.