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About Crohn's Disease

Ulcerative Colitis and Your Mental Health

ulcerative colitis (UC) can make life hard to predict. A flare-up of symptoms is stressful and can leave you worn out for days, weeks, or even months. Even in remission, you might get tired a lot or have hard time meeting friends or going to work. It’s easy to see why living with this long-term inflammatory disease can affect your mental health.

There’s no evidence that stress actually causes inflammatory bowel disease (IBD), which includes UC and Crohn’s disease. But stress can definitely bring on a flare-up. And you’re more likely to feel anxious and depressed than your friends without UC. Your chances are even higher if you are a woman. Even rats with IBD in lab studies show signs of mood problems.

But there are steps you can take to lift your mood, even when your symptoms get you down.

UC and Mental Health

It’s tough on the body and mind if you’re sick a lot. It’s important to stay tuned in to your emotional well-being if you have a chronic condition such as UC. Mood issues, especially depression, seem to shorten the time between flares in some people. It can also be hard to stick to your treatment when you feel blue. And you are more likely to have symptoms like diarrhea or stomach cramps if you don’t take your medicine.

Experts aren’t sure what the exact link is between stress, mood, and UC flares. But there are some theories:

Inflammation. Stress causes your body to release inflammatory chemicals called cytokines. These proteins can help the body heal if you are hurt or sick. But if they hang around all the time, experts think they may raise your chances of developing depression and anxiety. One reason may be that inflammation affects serotonin, a chemical messenger mostly made in the intestines that are involved with your mood.

Your gut and brain talk. Some experts think anxiety and depression make your UC symptoms worse, and then your upset gut does the same to your mood.

Gut bacteria. The amount and kind of microbes that live in your intestines, also known as the microbiome or microbiota, can change when you feel stressed. Studies show gut bacteria can affect your emotions, immune system, and pain level.

Medication. Corticosteroids that you might take for UC can change your mood while you take them.

Ways to Feel Better

Breathe. You can trigger the body to relax when you take slow breaths that fill your belly with air. Called diaphragmatic breathing, some research shows that it can reduce anxious and depressed feelings. Here’s how you do it:

  1. Breathe in through your nose for 4 or 5 seconds.
  2. Place your hand on your belly. Only your stomach should expand.
  3. Hold your breath for a couple of seconds.
  4. Breathe out through your mouth for about 6 seconds.
  5. Repeat for 5-15 minutes.

Focus your mind. Some studies found that mindfulness-based meditation, like paying attention to your breath, may:

  • Lessen feelings of anxiety and depression
  • Help you feel less pain

Brain scans show that people who pay attention to the moment tend to hurt less because the pain center in their brain is less active.

Intestinal behavioral therapy. You don’t have to have a mental illness to benefit from this kind of treatment. It’s designed for anyone who wants to deal with the stress around UC.

Ask your doctor about:

  • Cognitive-behavioral therapy (CBT)
  • Gut-directed hypnotherapy
  • Stress-management therapy

Get moving. You probably already know that exercise is good for your mood. Studies show it works just as well as antidepressants for some people. But listen to your body. If you are really active for a long time, it can cause more inflammation and make some IBD symptoms worse. Marathon runners sometimes get diarrhea or intestinal bleeding. That might not be a great activity to do if you have UC.

Try this:

  • Moderate-intensity exercises like walking or yoga
  • High-intensity interval training (HIIT) is also safe for people with IBD
  • Weight training, also called resistance exercise, is another option that may lessen depression symptoms.

Reach out to someone. You might feel better if you talk to a therapist, especially one who’s familiar with UC. You can also meet up with people who know what you are going through. The Crohn’s & Colitis Foundation can help you find a support group in your area.

Antidepressants may help. There is evidence they might boost your spirits and ease the pain of your gut symptoms at the same time. But talk to your UC doctor before trying any mediations for your mood. Some can cause side effects that worsen IBD.

Get enough sleep. You should try to snooze long enough that you aren’t tired during the day. That’s probably somewhere between 7-9 hours for adults. Talk to a specialist if you have trouble getting or staying asleep. Insomnia is linked to depression and higher levels of inflammation.

Go outside. Exercising out in nature may lower anxiety more than sweating it out in the gym. There is also evidence that walking in trees or looking at greenery can help lower stress levels in general.

Give yourself a break. You don’t have to pretend everything is fine. Along with all the other things that help you manage your emotions, experts say you will probably feel better sooner if you sit with your bad feelings for a little while instead of trying to make them go away.

Get a Mental Health Check-Up

Hopefully, your doctor would check in with you about your emotional life during your regular UC visit. But if that doesn’t happen, bring it up if your mood is bothering you or has gotten worse. Talk about it even if you don’t think it amounts to mental illness. Don’t just accept it as “the way things are.”

Symptoms to look out for include:

  • You are sad a lot, hopeless, or feel like nothing matters.
  • You no longer enjoy your hobbies.
  • You can’t concentrate.
  • You sleep too much or too little.
  • Your appetite changes.
  • You are irritated.
  • You can’t stop worrying.

If you’ve had thoughts about death or suicide, get help right away. You can talk to your doctor, a counselor, or call the National Suicide Prevention Lifeline at 800-273-8255.

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About Crohn's Disease

Still Tired liveing with crohns

When my Crohn’s disease is active, my fatigue can be debilitating. Sometimes I’m forced to stop answering phone calls because I literally don’t have the energy to construct sentences. I don’t allow myself to drive because it doesn’t feel safe. I’m basically unable to do anything except the bare minimum, and when I come out on the other side I feel like I’ve been in the deepest fog.

How can I be so tired?

After experiencing fatigue like this on and off for quite a while, I began to wonder how I could possibly be SO tired. I was ‘sleeping’ ten to twelve hours a night and taking a nap during the day. What more could my body possibly want? I wasn’t working. I wasn’t moving much. In fact, I wasn’t using any more strength than necessary, and yet, it still felt like too much.

Anyone with IBD knows that when you’re sick, it often feels like more than just stool emptying from your bowels. It feels like life is emptying out too.

Fatigue and mental health

I found the fatigue contributed to my anxiety and depression, affecting my mental health too. It seemed like I was trapped in this awful cycle and all I could do is come up for air between episodes.

During that time, I took prescription sleep medication, I worked with a sleep doctor, and underwent multiple normal sleep studies. I even followed suggestions on reducing screen time, creating sleep hygiene and more, but no matter what, I felt exhausted all of the time.

Sleep versus rest

This was when I learned the difference between being asleep, and getting rest. Being in bed, tossing and turning, waking up during the night – they all impact our ability to achieve deep sleep cycles characterized by faster breathing, a faster pulse, and rapid eye movements, or REM. There were times that my body may have been unconscious, but it most certainly wasn’t at rest.

It became clear to me that I had to learn how to dedicate time to conscious rest when I was awake. To be honest, this felt awkward and like something I was embarrassed about. Have you ever sat down to do something like this?

Changes I made

There were three changes I made that over time have significantly impacted my levels of fatigue, and I’d really like to offer them as suggestions to anyone who is struggling.

  1. Scrolling through social media, even while laying in bed, doesn’t count as resting. When you brain is actively thinking about things you want, need, or are missing out on, it impacts your body’s ability to rest. Schedule in some breaks to put your phone down.
  2. Guided imagery and meditation are real things that relax your mind AND your body. I rely on the Calm app, but there are others out there as well which offer you these services right from your phone. Quieting your brain quiets your body in a real, lasting way.
  3. Aromatherapy – certain scents are tied to physical relaxation. Whether you purchase a linen spray, light a candle, burn incense or diffuse essential oils, or take a bath with bubbles or salts or bombs, aromatherapy draws upon the healing powers of the leaves, flowers, stems, bark, roots or petals of plants to stimulate the natural healing action of both your body and your mind.
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About Crohn's Disease

Tips on Asking for Support During Crohn’s or UC Flares

If you’re living with inflammatory bowel disease, you know that your life, health, abilities, and capabilities can change dramatically in a short period of time. From my experience, no matter how much I plan for the next flare, there are always things I wish I had done, I need but don’t have, or I would really benefit from help.

Asking for help during a Crohn’s or UC flare

I’ve thought a lot about this and about how it feels hard to ask for help. I don’t usually know what to ask for directly so I often keep quiet, and I never know who exactly I should reach out to in the event that I need (or want!) physical things or tangible assistance.

I wanted to share with you some thoughts I’ve put together after a lot of trial and error. To be honest, it’s SO MUCH better for my mental health and my stress levels as my symptoms increase to know that I know how to best ask for support and that I’m not alone in my trials, especially when this disease can feel so isolating.

Things that are helpful when dealing with a flare

In no particular order, here are some things that have worked for me:

  1. Keep a list in your phone of a few people who are local that you trust, and that might be able to do you a favor when you don’t feel well. Depending on your needs, this might mean stopping at the store, dropping off a cooked meal, picking up a prescription, taking you to a doctors appointment, sitting with you in the ER or visiting you at home or in the hospital.
  2. Then, add to the bottom of that list, a few people who might not necessarily be nearby, but who understand your heart. People you can call or facetime or text when you want to cry or vent or be distracted. One important note here: don’t leave out your other friends with IBD! I’ve often avoided telling them that I was doing poorly because I knew they had struggles of their own, and in retrospect, they wished they’d been able to be there for me. They understood my plight directly and agreed they’d tell me if whatever I was telling them or asking them in terms of support felt like too much at any given time.
  3. Think about your necessities during a flare: what foods or meal replacements you can tolerate, what clothes and basic household items that you both need and that would make you more comfortable, and anything that might cheer you up.
  4. If you have a roommate, live with family, have a spouse, children or pets, think about if they can help and/or have needs of their own while you are down and out.
  5. In the event that a friend or family member reaches out and asks what they can do for you, or what they can bring you or send to you, I’ve found politely declining over and over is a loss for both myself and the other person. They genuinely want to help, and I honestly could use it. I have found it to be easiest to have direct and tangible items I can ask for – such as groceries, prepared meals (or meal delivery), conversation to take my mind off of things or company when I don’t have the energy to talk.

Living with inflammatory bowel disease is hard enough, there’s absolutely no reason to decline help or support simply because you don’t know how to ask, or don’t want to inconvenience someone who has already offered.

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About Crohn's Disease

Inflammatory Bowel Disease

What is Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease is a group of chronic lifelong conditions affecting the digestive tract. It includes both Ulcerative Colitis (UC) and Crohn’s Disease (CD) which are similar but affect different parts of the intestine. UC affects the inner lining of the large intestine while CD can affect any part of the digestive tract from the mouth to the anus. You can read further information on IBD in this patient information leaflet

Clinical features of Inflammatory Bowel Disease
The main features of IBD are bloody diarrhoea associated with frequency, urgency and abdominal cramps.  In severe attacks patients may suffer weight loss and anorexia.

In addition patients may have symptoms from outside the digestive tract including:

•         Arthritis (large joints)
•         ankylosing spondylitis
•         erythema nodosum
•         pyoderma gangrenosum
•         iritis and episcleritis (inflammation of the eyeball)
•         primary sclerosing cholangitis (75% pts have IBD, Geonzon –Gonzales 2006)

How common is IBD?

•         15,000 people in Ireland have IBD
•         Incidence in Ireland – 6,000 UC
                                        – 3,000 CD

What causes IBD?
The cause of IBD is unknown but is thought to include:   Genetic susceptibility
A familial tendency 
Environmental factors -smokingstress

non-steroidal anti-inflammatory drugs  

history of appendectomy

history of infection with mycobacteria  

activation of the immune system

possibly diet but not proven

•         Infective agents
•         Seasonal changes
•         Stress – implicated in aetiology of disease  (Mawdsley & Rampton 2005)

Treatment of IBD
Treatment for IBD is often simple and includes both local and oral medications, often the condition can be managed in the community by the patient’s General Practitioner after consultation with a Specialist. Regular review by a specialist is recommended for complex therapies and disease. Surgery may be required in difficult cases.

Mary Kennedy is the IBD Clinical Nurse Specialist at TUH. The IBD nurse is often your first point of contact if you require any advice regarding your disease. She provides a rapid point of access for IBD patients, in particular she can provide support, advice and information on your inflammatory bowel condition. Also, she will play an active role in disease and drug education and management. Treatments such as Infliximab (Remicade) and Adalimumab (Humira) are administered by the IBD Nurse.

An advice line is run by the IBD Nurse and the contact number is 01 414 3855.

TUH Gut Therapy Programme for IBS
The chronic diarrhoea pathway aims to provide patients with diarrhoea symptoms of Irritable Bowel Syndrome (IBS) with fast access to the most appropriate investigations and management of their condition. Patients aged over 45 with chronic diarrhoea of more than one month duration will be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.

Patients aged under 45 with chronic diarrhoea of more than one month duration with red flag symptoms such as bleeding, weight loss, anaemia and family history of bowel cancer or IBD will also be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic. 

Patients under 45 who do not have red flag features will have blood and stool tests done. If these are normal they attend the dietitian led gut therapy clinic, if an abnormality is detected they have a colonoscopy and are managed as appropriate after that.

Its most notable attribute is its effect on wound management and healing. Manuka honey also has antibacterial, antiviral and anti-inflammatory properties that may help treat numerous ailments, including irritable bowel syndrome, gastric ulcers, periodontal disease and upper respiratory infections.

Honey is well known for its anti-inflammatory and antioxidant capacities, which may be useful for the prevention of chronic inflammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti- inflammatory and antioxidant properties of honey

What is the fastest way to get rid of inflammation in the body?Follow these six tips for reducing inflammation in your body:

  1. Load up on anti-inflammatory foods. …
  2. Cut back or eliminate inflammatory foods. …
  3. Control blood sugar. …
  4. Make time to exercise. …
  5. Lose weight. …
  6. Manage stress.

Does b12 reduce inflammation?Vitamin B6, folate (B9), and B12 can lower your levels of homocysteine, an amino acid that’s linked to a greater risk for heart disease and rheumatoid arthritis. But we can’t say for sure that lowering homocysteine will also lower your risk for disease. The same is true for C-reactive protein, a sign of inflammation.

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