IBD FACTS

WHAT IS THE CAUSE OF ULCERATIVE COLITIS AND CROHNS DISEASE?

The origin of IBD is still unknown. It is possible that a combination of factors may be the underlying cause of Crohns disease and ulcerative colitis. Researchers theorize that IBD patients may be genetically predisposed to an immunological deficiency, which allows a foreign agent, such as a virus or bacterium, to trigger the disease.

CAN TENSION AND ANXIETY CAUSE THESE DISEASES?

There is no evidence for this. IBD is a biological disorder.Tension and anxiety can modify how patients experience any such disorders, but they do not cause either disease.

FRIENDS AND NEIGHBORS OFTEN SAY THAT COLITIS IS CAUSED BY NERVES AND EMOTIONAL UPSET. IS THIS CORRECT?

When laypersons, and sometimes physicians, speak of colitis, they may mean the specific disease known as ulcerative colitis, or they may be referring to a completely different condition known as irritable bowel syndrome (IBS). IBS is also called spastic colon or spastic colitis.These terms have caused considerable confusion. IBS is a disturbance of the function of the colon.While IBS can be very painful, it is much less serious than IBD, because it does not cause any inflammation in the intestine. Unlike ulcerative colitis and Crohns disease, IBS is not associated with structural changes in the intestine or bleeding. It does not cause harmful complications, require treatment with powerful medications, or lead to surgery.The cause of IBS is not fully understood either, but in many cases, emotional factors play a strong part. Information about IBS is available from the

International Foundation for Functional Gastrointestinal Disorders (IFFGD),
P.O. Box 17864,
Milwaukee,WI
53217
tel.: 888-964-2001;Web site: www.iffgd.org;
e-mail: iffgd@iffgd.org.

There is no evidence that emotions cause ulcerative colitis or Crohns disease.You may want to offer this brochure as a reference when friends and colleagues seem to think that IBD is caused by being overly emotional. It is very important to correct this common and erroneous impression.

ARE CERTAIN PERSONALITY TYPES MORE PRONE TO DEVELOP ULCERATIVE COLITIS OR CROHNS DISEASE?

No. Beginning about 50 years ago, it was believed that IBD was part of a group of medical disorders that were characteristic of certain personality traits and a specific biological predisposition.The latest research does not bear out this concept. In fact during this earlier period, studies showed that psychoanalysis actually worsened the cases of ulcerative colitis. Of course, this does not mean that people with IBD today should hesitate to see a psychologist or a psychiatrist (see below,Is Psychiatric Consultation Advisable for People With IBD?), if they feel that it would help them cope with the emotional impact of their illness. But it is important to remember that, since the underlying cause of IBD is biological, not emotional, only medical therapy can control the illness itself. It is now recognized that there are no personality traits that predispose to the development of IBD, and today, there are many more mental health professionals who are experienced in treating people with these illnesses.

DO EMOTIONAL FACTORS PLAY ANY PART AT ALL IN THE COURSE OF IBD?

Body and mind are inseparable and are interrelated in numerous and complex ways, something now recognized in medicine. In many centers, mind-body institutes are flourishing. It has been observed that at times of physical or emotional stress, patients may experience flare-ups of symptoms, such as increasing abdominal pain or diarrhea.This relates to changes in the physiologic functioning of the gastrointestinal tract, and decreased resistance to inflammation, rather than to increased inflammation. It has now been shown that severe chronic stress can lead to increased inflammation.These effects, however, should be carefully separated from the primary cause of IBD, which is not emotionally based.The symptoms of many diseases, even those with no known biologic cause can get worse in stressful situations.

CAN THE SYMPTOMS OF CROHNS DISEASE AND ULCERATIVE COLITIS, SUCH AS SEVERE PAIN AND CHRONIC DIARRHEA, CAUSE EMOTIONAL DIFFICULTIES?

Indeed they can. Different persons cope with physical illness in different ways. Some people can cope with severe illness without an extraordinary emotional reaction. Other individuals experience emotional distress when they develop a serious organic and chronic illness like IBD.

WHAT ARE SOME OF THE RESPONSES OF INDIVIDUALS TO IBD?

It is not surprising that some patients will find it difficult to cope with a serious and chronic illness, be it juvenile diabetes, rheumatic heart disease, asthma, or IBD. Such diseases pose a threat to their health-related quality of life, including their physical and emotional well-being, their social functioning, and even their self-concepts. In these situations, individuals may have emotional responses that include anxiety, depression, denial of chronic disease or needs or dependence.These reactions constitute a response to the illness and not its cause.When these emotional responses interfere with daily functioning, then it is important for the patient to work on ways to improve his or her psychological response.This may be accomplished individually, with family or friends, the patients physician, or a mental health counselor.

ARE PATIENTS JUSTIFIED IN FEELING GUILTY THAT THEY HAVE BROUGHT THE ILLNESS UPON THEMSELVES, AND THUS CAUSED PROBLEMS TO THEMSELVES AND THEIR FAMILIES?

Not at all. Guilt feelings may be the result of the patients thinking that IBD is caused by psychological factors, and that somehow the patient might have brought on this disease by not controlling his or her emotions.There is no basis for this way of thinking. IBD is not caused by emotions, nor is there anything that you could have done or could have avoided doing that might have prevented this disease. Guilt feelings are entirely unjustified and unwarranted. Indeed, they make it more difficult to cope with the physical and emotional burden that IBD patients have to bear. It is, therefore, important to dispel such guilt feelings.

ARE FAMILY MEMBERS JUSTIFIED IN FEELING GUILTY THAT THEY SOMEHOW BROUGHT ON THE DISEASE IN THE PATIENT/RELATIVE?

Not at all.As noted above, there is no basis to assume any guilt in causing the onset of IBD, either on the part of the patient or on the part of any family members, such as a husband, wife, children, parents, or siblings.They can be reassured that genetic transmission of the disease is only 5-7% if one parent has Crohns, and less if the disease is ulcerative colitis.

WHAT IS THE BEST WAY TO DEAL WITH THE FEAR OF A FLARE-UP OF THE DISEASES?

The best way to deal with IBD is to seek effective treatment. Most people with IBD can now be managed very well by means of anti-inflammatory drugs. Numerous topical and oral medications have been shown to be effective therapy, particularly in ulcerative colitis.Your physician, who is the expert in dealing with these diseases, will decide which medication is best for your particular condition. In addition, it is important to realize that a good patient-physician relationship makes it possible to deal effectively with almost any complication.

HOW DO YOU DEAL WITH ATTACKS OF GAS, DIARRHEA, OR PAIN IN A PUBLIC PLACE?

For your own comfort and peace of mind, when you are going away from home, it helps to plan your itinerary in advance. Be very practical. Learn where the rest rooms are located in restaurants, shopping areas, on a trip, or while using public transportation. Always carry extra underclothing or toilet tissue in case of sudden need.Try to be matter-of-fact about your needs and your attacks of pain. In this way, you will be able to help yourself and gain cooperation from others because they will follow your lead and understand. Learning more about how your body reacts to certain food groups also may be a big help.You might want to try an elimination diet, in which you stop eating certain foods, then gradually reintroduce them to see how your gut reacts to each one. Avoiding foods that your gut cannot tolerate may help keep you well. Close friends are aware that your condition causesyou to have severe pains that come and go.Theycan learn, with your help, that despite their good intentions, there is little they can do but allow you to handle your pain in the way that is best for you.

WHAT IS THE EMOTIONAL IMPACT OF IBD ON YOUNGSTERS?

Youngsters tend to be more severely affected by any organic illness than individuals who have established a place in life for themselves and have learned to cope with adversity. For example, adolescence is a time when we seek to become more independent and more self-sufficient as a part of normal maturation. Chronic illness may impose a dependency on family, physicians, or the healthcare system.This can be a particularly difficult adjustment for adolescents. Therefore, it is no surprise that emotional difficulties, especially denial of illness, may be somewhat greater in the younger age groups than among older adults. Otherwise, the principles mentioned earlier apply to youngsters as well as adults.

DOES ILEOSTOMY SURGERY HAVE AN EFFECT ON THE PATIENTS EMOTIONAL STATE OR COPING ABILITY?

Surgery is recommended for a minority of IBD patients, when the disease cannot be controlled by drugs.When surgery is needed, it poses some immediate risk to the individual, but in the appropriate circumstances, this risk should be outweighed by the expected benefits.With modern surgery and preand postoperative care, the dangers of serious complications from surgery are low. Some patients unable to be helped by medical treatment or standard resections of the bowel may have to undergo an ileostomy. People with ostomies must wear a pouch on their abdomen, into which wastes are emptied. This form of surgery poses some additional problems of adjustment. Most patients, however, can more easily cope with the problems with the help of informed and informative physicians. Organizations such as the

United Ostomy Association
36 Executive Park, Suite 120,
Irvine, CA 92714
www.uoa.org

and the J-pouch support group

www.j-pouch.org

can be very helpful resources.The national and local ostomy associations address these questions in their numerous publications, meetings, and Web sites, and often can provide helpful counsel for the surgery patient both during the pre operative stage and following the surgery.This counsel usually can be provided through an extensive in-hospital and home visitation program.

One of the major concerns of people who face ostomy surgery is whether they will be able to enjoy a healthy sex life. Experience has shown that sexual activity improves rather than worsens, especially in people who were acutely ill before surgery.

CHECK OUT THIS LINK

OSTOMIES AND SEXUALITY

 

For your listening pleasure I have installed 12 MIDI songs. Look at the top right of this page. If you want to listen, choose a song from the drop-down menu then click PLAY. To stop the music, return to Click for music. To change songs, simply choose and click play. Each page will load with this menu, and I will be adding more songs soon. If you want the code, email me and I will send it to you, if you try to take it from the page it will be all screwed up on your page.