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Counselling Advice — Generally there are no specific dietary restrictions for an IBD patient. Any specific trigger foods that cause IBD symptoms/flare-ups can be easily avoided by patient himself by self-monitoring his diet. In case of flare-ups a low residue, low fiber diet is advisable.
There are certain types of foods which can be avoided in case of flare-ups like -
Caffeine in coffee, tea and other beverages, chocolates Fresh fruits and fruit juices, uncooked vegetables High-fiber foods (such as fiber-rich breads, cereals, nuts and leafy greens) High sugar foods, seeds, prunes, corn, popcorn High fat foods, spicy foods, raw foods Beans and lentils Red meat, large food portions In some cases dairy products, ice-cold liquids are not tolerated well Some vegetables such as cauliflower and broccoli that are gas producers and can cause abdominal distention and discomfortFoods that are considered safe during a ‘Flare’ are -
Soft, low fiber breads and grains Some fruits are going to be okay — the ones that are skinless and seedless Choose well-cooked vegetables and fruits The protein foods chosen need to be healthy and low in fat Maintaining hydration is very, very important during a flare because you could have a lot of fluid loss due to persistent diarrhoea.However, some people who follow the above guidelines may still continue to experience abdominal cramping following eating. In these cases, supportive medications may be helpful.
If the normal method of eating food by the mouth is not allowing enough nutrients to be absorbed, then other methods of getting nutrients must be used. These methods include enteral nutrition (special formulas which can be easily absorbed by intestines) and parenteral nutrition (nutrition provided through intravenous route which enters into blood directly). This type of liquid nutrition prescribed by the doctor is particularly helpful for children with IBD to ensure adequate nutrition when the appetite is poor and growth is a major concern. Certain types of enteral nutrition (through oral/ feeding tube), such as elemental formulas (simple nutrients which can be easily absorbed by inflamed intestines), can decrease inflammation in Crohn’s disease. When extra nutrient-rich calories are needed, supplemental nutrition may also be obtained by formulas prescribed by the doctor that contain a balance of protein, carbohydrates, fat and vitamins. Parenteral nutrition (through IV route) may be needed when a flare is too severe, medical therapy alone is not enough and bowel rest is needed. This form of nutrition may also be needed in Crohn’s disease patients who are severely malnourished or who have short bowel syndrome (short gut causing malabsorption). Do ask your doctor about enteral nutrition formulas suitable for your case.
Counselling Advice — Most IBD patients experience fatigue and weakness due to recurrent diarrhea’s and loss of fluids. Malnutrition and delay in growth is a concern for children with IBD. Correction of nutritional deficiencies (by supplemental nutrition i.e Vitamin B12, Folic acid, Zinc, calcium and Vitamin D) and a balanced diet plan can reduce inflammation in digestive tract and help in better absorption of food from the gut along with prescribed medications for IBD.
This would help in early remission and prolonged flare- free period. In case of flares, apart from dietary modifications and advised medications, here are some few helpful tips to tide over fear/embarrassment due to soiling of clothes in public places
Carry this in your purse/backpack:
Toilet paper Wet wipes Powder Hand sanitizer Small can of air freshener Disposable gloves (to handle any soiled clothes) Large-sized freezer bags (for the soiled clothes) Clean underwear, Clean shorts, pants, or leggings (anything that you can wear until you get home)Tips to reduce IBD discomfort, includes:
To reduce anal irritation, use a moist toilet tissue or wipe instead of dry bathroom tissue. Practice good anal hygiene by showering with a hand shower or using a perianal cleansing product. Apply an all-purpose skin protectant at night to relieve irritation of the skin around the anus. For anal soreness or pain due to an anal fissure (small tear in the lining of anus) or fistula (opening in the skin near the anus that leads into a blind pouch or may connect through a tunnel with the rectum), bathe the buttocks in warm salt water (sitz bath). To help manage diarrhoea, anti-diarrheal OTC medications may be effective. DO NOT take any of the drugs without consulting a doctor or health care provider. For joint-related discomfort, recommend resting the affected joint as well as the occasional use of moist heat. Range of motion exercises, as demonstrated by a physical therapist, may also be helpful. To reduce the irritation of small mouth ulcers, medicinal mouth washes may be helpful along with a balanced diet and a multi-vitamin/mineral supplement. To help manage the symptoms of pain, acetaminophen may be the safest option for IBD patients. Consult with your health care provider about the appropriate pain management options. You definitely can live a normal healthy life. Remember to take care of yourself. Get plenty of sleep, eat well, and take time to recharge and reduce stress.Note: Counselor needs to provide enough reassurance and psychological counselling to all depressed patients. Reinforce positive behavior and ensure adherence to medications prescribed by the doctor.
Counselling Advice — Yes, you can conceive even if you are having IBD. IBD does not affect fertility in women. However, a man's fertility can be affected by one of the drugs used to treat Ulcerative colitis, sulfasalazine. This medication causes sperm abnormalities in about 80 percent of men. These abnormalities resolve when the drug is discontinued.4,5 Most women with IBD have a normal pregnancy and deliver a healthy baby. The severity and extent of IBD in a woman appears to influence the course of her disease during pregnancy. About two-thirds of women in remission (symptom free period) will stay in remission, and women with active disease are likely to have continued active disease during pregnancy.6 Having active disease may make it more difficult to get pregnant, more likely to have a miscarriage, and more likely to have complications such as preterm birth.7 Women with IBD should attempt conception at a time when their disease is in remission.
Preconception Counseling — Preconception counseling offers an opportunity for the healthcare provider to address specific patient concerns regarding the risk of transmission of inflammatory bowel disease (IBD) to their offspring, to optimize control of disease activity and nutritional status, avoid inappropriate medication cessation and discontinue medications that may adversely affect pregnancy.
Care Before Pregnancy — These recommendations apply to any woman who is considering pregnancy.
All women should take a supplement containing at least 400 mcg of folic acid. Taking folic acid can reduce the risk of a specific birth defect, called a neural tube defect. Folic acid should be started before trying to conceive and continued until at least the end of the first trimester. Patients with IBD are at risk for iron and vitamin B12 deficiency. Furthermore, iron requirements increase during pregnancy. Iron and B12 levels should therefore be checked in the first trimester and supplementation should be provided as needed. Women should stop smoking and consuming alcohol or any recreational drugs (eg, marijuana) before trying to become pregnant. Women who take prescription or non-prescription medications should review these with a healthcare provider. Some medications are safe during pregnancy while others are not. In some cases, an alternate medication can be substituted for an unsafe drug. – Caffeine intake should be limited to less than 250 mg per day while trying to become pregnant and during pregnancy. Blood testing for rubella (German measles), varicella (chicken pox), HIV, hepatitis B, and inherited genes (eg, cystic fibrosis) may be recommended before pregnancy. IBD therapy during pregnancy is most successful when a woman receives regular medical care and follows her treatment plan closely. Before becoming pregnant, women with IBD should discuss plans for their care with a healthcare provider. Women who discover that they are pregnant should continue their IBD medications until speaking to a healthcare provider. Having a medication plan in place prior to becoming pregnant is the best way to do it.During pregnancy, care of women with IBD may be shared between a gastroenterologist and an obstetrical provider. Visits with the gastroenterologist should be scheduled based upon he severity of disease during pregnancy. Women with IBD often require medications to control their disease. Some of these medications are probably safe during pregnancy and breastfeeding. In other cases, there is not enough information about the medication to determine if they are safe or not. Women who take one or more of these medications during pregnancy should discuss their concerns with a healthcare provider. They should also understand the risk to the pregnancy if they are stopping medications without consulting their physician and are having a significant flare.
Sulfasalazine – Women who wish to become pregnant can continue taking sulfasalazine during pregnancy and while breastfeeding. Sulfasalazine does not increase the risk of any complications of pregnancy or birth defects. Folic acid 2 mg/day should be taken with sulfasalazine.
Antibiotics – Antibiotics are frequently required in the treatment of Crohn's disease and are sometimes used for people with UC. The most common antibiotics used for treatment of IBD are ciprofloxacin and metronidazole. Short courses of metronidazole are probably safe for use during pregnancy, but metronidazole should be avoided in the first trimester. Ciprofloxacin is not recommended for pregnant or breastfeeding women.
5-ASA – The safety of the 5-ASA drugs during pregnancy and breastfeeding is still being studied. Preliminary studies suggest that they are safe when taken during pregnancy and that women should continue taking these drugs during pregnancy. However, women who take 5-ASA medications should speak to their clinician before trying to conceive. If 5-ASA medications are taken during breastfeeding, the American Academy of Pediatrics recommends monitoring the infant's stool consistency. There have been reports of diarrhoea in breastfeeding infants of women who took rectal 5-ASA.
Steroids – Some studies have suggested that there may be a very small increased risk of cleft lip or cleft palate in the babies of mothers who took oral steroid medications during the first 13 weeks of pregnancy. Women who take steroids during pregnancy may be more likely to develop gestational diabetes and high blood pressure, although these conditions can be detected and managed with regular medical visits. Steroids (eg, prednisone) are probably safe to take during breastfeeding. Azathioprine and 6-mercaptopurine – Azathioprine and 6-mercaptopurine can be continued during pregnancy if other types of treatment cannot be used. Women taking azathioprine and 6-mercaptopurine may breastfeed. There is very minimal transfer in breast milk and virtually none four hours after taking the medication.
Infliximab – Infliximab is probably safe during pregnancy. There is no reported increase in the rate of birth defects with the use of any of the anti-tumor necrosis factor (TNF) medications (infliximab, adalimumab, certolizumab). However, infliximab and adalimumab can cross the placenta and be present in the baby for up to six months from birth. Therefore, these medications are often stopped in the third trimester if the disease is in remission. If you are on one of these medications, the baby should not get live vaccines (rotavirus) in the first six months of life, though all other vaccines can be given on schedule. Very small amounts of infliximab cross in breast milk, so breastfeeding is allowed on this drug. Certolizumab does not cross the placenta at the same rate as infliximab and adalimumab. Therefore, it is dosed on schedule throughout pregnancy, and vaccination schedules are unchanged.
Antidiarrhoeal Drugs – Antidiarrhoeal drugs should be avoided, especially early in pregnancy. Antidiarrhoeals should only be used for severe diarrhoea that cannot be controlled with dietary manipulation and bulking agents (eg, kaolin/pectin, Metamucil, psyllium).
During Labor – In women with Crohn's disease, the type of delivery (vaginal versus Cesarean) depends upon the health of the tissues around the vagina and anus, the patient and clinician's preference, and the woman and baby's progress during labor. If Crohn’s disease affects the areas around the vagina or if a woman has an ileo-anal pouch (high risk for developing fistulas), a Cesarean delivery may be preferred to reduce the risk of developing fistulas. There does not appear to be any risk that IBD will worsen as a result of breastfeeding. Breastfeeding is strongly encouraged because there are a number of benefits for both women and infants.8,9
Counselling Advice – Studies suggest that the course and recommended treatment of IBD in the elderly does not vary greatly from that of a younger patient. The length of time between initial symptoms and diagnosis may be longer for older adults than for younger patients for various reasons. These include the fact that IBD presents with different symptoms in older patients than in younger ones and a patient’s physician must rule out other possible diseases. Special considerations must be taken into account, such as a patient’s ability to live independently, the presence of other diseases or illnesses, and the medications the patient is taking for these other conditions. For example, biologic therapy (one of many treatments for IBD) may have adverse effects if a patient has congestive heart failure, or, if used with certain rheumatoid arthritis medications, may increase the risk for infection.
Extra Support: Depending on their health and mobility, elderly IBD patients may require additional help with medical care and everyday tasks. This may reduce some of the physical and emotional toll the disease takes on a patient’s life. Patients should be made aware of their mediclaim policy and health insurance coverage for treating their chronic illnesses.
Alcohol and Smoking: Alcohol and tobacco affect each IBD patient differently. However, its use should be limited because of its potential for making IBD symptoms worse, damaging the patient’s overall health and interfering with medications.
Diet: While there is no specific diet that will make the inflammation associated with IBD better or worse, for any individual, certain foods may worsen symptoms. The doctor, nurse, or dietitian may outline a diet that meets the patient’s specific needs. It is important to stick to this plan to ensure nutritional and caloric needs are met and flares are kept to a minimum.
Hydration: Seniors are less able to withstand dehydration, which may occur with diarrhea. It is advisable for seniors to drink plenty of fluids, even with infrequent diarrhea.
Medication: One of the easiest ways to manage IBD is by regularly taking prescribed medication. Sticking to a routine, setting reminders, and utilizing pill counters are just a few ways of ensuring that the elderly patient gets every day dose.
Preventive Treatments: In addition to IBD medications, IBD patients may be taking one or more medications to prevent certain illnesses, such as low-dose aspirin or warfarin following a heart attack. These medications may interact with those for IBD, or worsen IBD symptoms. It is important for all elderly patients to tell their doctor about all of the medications they are taking, and alert their physician if they suspect a problem.
Journaling: Elderly patients may need to keep a daily journal to write down information such as daily meals and activities, along with specific details regarding each flare he or she experiences. In time, patterns may help the patient and their doctor understand why they happen, and how to avoid them.
Medical Knowledge and Records: It is important for all patients to maintain a complete and current file of their medical records and understand all their diseases for successful disease management. Along with copies of doctor’s notes and laboratory, endoscopy, pathology, and radiology reports, patients should be made aware of:
Their IBD history and what part of the gastrointestinal tract is involved All other diseases and illnesses Past and current medications, their interactions, and any side effects which could be experienced Gastroenterologists’/treating doctor’s name, address and contact information Local doctor's name and contact information if traveling or living in a temporary residenceIBD patients are at risk for a number of psychological problems, including depression, anxiety, social isolation, and negative self-image. As part of “self-care,” it is important for elderly patients to monitor their emotional state, and reach out for help when times get too tough to handle alone.
Whether the person you are caring for is an adult or child, you can:
Listen and lend a sympathetic ear: Be a good listener. Give them your full attention and let them express their feelings Offer encouragement about how they are coping with their symptoms – this will help get them through times when they are experiencing flare-ups or feeling overwhelmed by their illness Ask them what they need from you – and be prepared to give them some space if that is what they need at that time Be understanding if they are feeling unwell or tired, are constantly visiting the toilet or have any other distressing symptoms or emotions associated with IBD Keep a good sense of humour – it can be helpful to help them see the funny side of things and have a good laugh together Get involved and be their ‘second pair of ears’ (if it is your child who has IBD, you would no doubt be doing this already) Help them to ask questions during medical appointments and discuss the information covered after medical appointments together Offer practical help with shopping, cooking, childcare, etc when they are unwell Offer to tell others about the illness so they won’t have to keep explaining it. However, ask your family member or friend if this is okay – they may only want a select few to know the details Check out local face-to-face and online support groups that are available to help Help and encourage with lifestyle changes such as: Avoid smoking when you are around someone with IBD; cigarette smoke can worsen the symptoms of IBD Eat healthy – a diet with plenty of fresh fruit and vegetables, whole grains and healthy fats, and avoiding processed foods, will be good for both you Avoid foods that trigger symptoms – if you notice that some foods seem to make your child's diarrhoea worse, reduce the amount of these foods in the diet Encourage them to limit alcohol intake, as it can exacerbate a flare-upCounselling Advice – Managing IBD symptoms at work could be challenging without disclosing the chronic nature of disease and its recurring symptoms. It can result in frequent absentees from work and late starts due to early morning urgency to pass bowels (morning diarrhoea). Also IBD patients often require frequent toilet breaks and prefer to remain isolated to avoid embarrassment due to constant gurgling abdominal sounds and bloating and gas. So it is advisable to disclose the nature of the disease to his/her employer and fellow co-workers. This would help him/her for gaining enough support and assistance from the employer and co-working staff. If the co-workers don’t know about his/her condition, they may jump to wrong conclusions or believe that he/she is getting preferential treatment, especially if the employer had made some workplace adjustments.
Co-workers often need to be involved in workplace adjustments (e.g. re-allocation of certain duties or cover for toilet breaks). They’re more likely to co-operate if they understand the reasons behind the request.
For an employed person with IBD, some examples of reasonable workplace adjustments which an employer can consider are:
Time off for medical appointments or treatments which may or may not be covered under paid leaves (as per organization policy or employee health insurance plan) Later starts Shorter, different or flexible working hours, including job-sharing, part-time or working from home Unlimited toilet breaks Locating workstation closer to the toilet Re-allocation of certain duties among other staff membersTo request any such reasonable adjustments, employee must do so in writing. Employee must submit a brief note stating the nature of his/her disease along with sufficient medical documentation to show that the request is medically supported. Approval of such requests depend upon the fair interactions and good relations between any employer and employee.
Counselling Advice – It is advisable to inform your partner about your IBD. Once he/she understands about the nature of disease and the course of treatment including dietary and lifestyle modifications, he/she will surely help you to manage it very effectively with extra care and affection.
Being open about your health related issues will help you to avoid any embarrassments and will strengthen your relationship. IBD does not affect your physical ability to have sexual intercourse with your partner. But, sometimes especially during flares you may feel little uncomfortable.
There are a few things you can do to avoid pain during intercourse:
Use a lubricating jelly if you experience some pain or discomfort during sexual intercourse If you need to use a medicated suppository at night, insert it after sexual intercourse. This will reduce the chances to go to the bathroom during sex If you have a colostomy, empty the colostomy pouch before sex Some medications like steroids may interfere with spontaneous sex life. Talk to your doctor about it. Avoid sex especially if you have painful fistulas/ perianal abscesses. Kissing and cuddling without sex when you’re not feeling well can still bring plenty of pleasure to both partners.Counselling Advice – IBD can cause changes in fat metabolism and may lead to insulin resistance.13 Certain IBD medications like steroids may raise blood sugar levels. They can also raise blood pressure. Some people who have normal blood sugar levels may develop diabetes while they are on steroids, those with pre-existing diabetes and hypertension may have to increase their medication’s dose or should speak to their physician about this. The body's normal steroid production stops when you take corticosteroids. When an attack of IBD is under control the dose of steroids should be reduced gradually to allow the body to take over again. It may take up to 12 months to completely restore normal steroid production.
Counselling Advice – IBD may delay the onset of menses in adolescence, as well as can cause menstrual function irregularities including alterations in cycle length and the duration of flow, especially when the disease is poorly controlled. Possible causes for this delay include growth failure from being underweight and nutritional deficits. Medication usage, as the case with corticosteroids, also contributes to growth retardation and delayed puberty.14,15 When a woman’s IBD is active, the inflammation itself can cause the body to shut down normal hormone function. Restoring health by maintaining good nutrition and adherence to prescribed IBD medications is the way to restore normal and regular periods. Ask your physician about special nutritional formulas or supplements to prevent growth failure. The chances of iron deficiency anemia are higher in women with IBD – an increased chance of bleeding from the inner lining of the intestine and the decreased absorption of iron from an inflamed small intestine make these chances higher. Dietary modifications to treat iron deficiency anemia includes use of iron supplements, red meat, beans, seafood, pork, poultry, dark green leafy vegetables, raisins, and iron-fortified cereals, breads and pastas. Typically NSAIDs are used to treat dysmenorrhea (painful periods), however they are not recommended in patients who have IBD because they can cause ulceration, irritation, and bleeding in the gastrointestinal tract. Talk with your doctor about other pain medications that are safe to use during your period. Use a heating pad or take a warm bath - heat opens vessels and improves blood flow so that pain lessens. Adolescent girls should be instructed to maintain adequate perineal hygiene during menses. In case of perineal abscesses or fistulas, strict adherence to prescribed IBD medications should be maintained for early remission and control of active disease.
Some menstrual hygiene tips -
Wash Regularly: Bathe at least once a day to keep the body clean and avoid odor. Wash your hands before and after going to the bathroom, changing your menstrual protection or cleaning your vagina. Wash the Right Way: Because your vagina is more sensitive than other parts of your body, it requires a different kind of wash. Always wash your vagina externally and never use normal soap, douches or shampoo on your intimate area, which can upset your natural flora and acidity. Opt for a wash specially formulated for intimate use or just use your hand and warm water. Consider Your Wardrobe: Avoid tight clothing or fabrics that don’t breathe. Wearing clothing close to your vagina can cause increased moisture and heat and also irritate your skin. Wear cotton underwear and loose fitting clothing to stay fresh and dry. Change Menstrual Products Often: Continual use of the same sanitary pad or tampon increases your risk of infection. Prolonged exposure to damp sanitary pads can also irritate your skin, which can eventually become broken and risk infection. Wipe from Front to Back: When you wipe from back to front you risk exposing your vagina to harmful anal bacteria that can cause infections such as urinary tract infections and yeast infections. Always wipe front to back and try to keep your vaginal and anal wiping separate.