Questions and Answers about Emotional Factors Associated with Crohns Disease
Crohn's & Colitis Foundation of America, Inc. Publication 051-91

Do emotional factors play any part at all in the course of IBD?
Body and mind are inseperable and are interrelated in numerous and complex ways. It has been observed that flare-ups of IBD can occur at the time of stressful situations either physical or emotional. For instance, the first onset of IBD may occur at the time of an attck of a viral or other infectious illness. It also appears likely that some flare-ups of the disease can be triggered by nervous tension or by emotionally stressful life situations. However, this flare-up effect should be carefully seperated from the primary cause of IBD, which is not emotionally based.

Can the symptoms of Crohn's and UC, such as severe pain and chronic diarrhea, cause emotional problems?
Indeed they can. Different persons cope with physical illness in different ways. Some people can cope with severe illness without an extraordinary emotional reaction. Others experience emotional distress when they develop serious organic and chronic illnesses, among them IBD.

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 patient's 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 cause by emotions, nor is there anything the patient could have done or avoided doing that may have prevented bringing on this disease. Guilt feelings are completly unjustified and unwarranted. Indeed, they make it more difficult to cope with the difficult physical burden that patients with IBD have to bear; it is therefor important to dispel such guilt feelings.

Are family members justifies in feeling guilty that they somehow brought on the disease in the patient/relative?
Not at all. As above, there is no basis to assume any guilt or causation in the onset of IBD, either on the part of the patient or in the part of any family members such as husband, wife, children, parents, or siblings.

What is the best way to deal with the fear of a flare-up of the disease?
The main way to deal with IBD is to seek effective treatment. Most patients with IBD can be handled very well by means of anti-inflammatory drugs. There are numerous topical and oral medications that have shown to be effective therapy. Your physican, who is an expert in dealing with these diseases, will decide which of these medications is best for your particular condition.

How do you deal with attacks of gas, diarrhea or pain in a public place?
For your own comfort and peace of mind, it helps to plan your itinerary when you are away from home. 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. Also try to be matter of fact about your needs and 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. Close friends are aware that your condition causes you to have severe pains that come and go. They can learn, with your help, that despite good intentions, there is little they can do but allow you to handle your pain in the way that is best for you.

Are tranquilizers recommended to cope with the anxiety and fear that goes with IBD?
Tranquilizers can be very useful for some patients but are not necessary for all. If anxiety is difficult to handle, the careful use of tranquilizers can be very helpful, especially during acute flare-ups of the disease or during any stressful life situation.

How are youngsters affected by IBD in terms of emotional impact?
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. Thus, the percentage of individuals who manifest emotional problems in conjunction with IBD is somewhat higher in the younger age groups, among teenagers and young adults, than among older adults.

Is there an effect of ileostomy surgery on the patient's emotional state or coping ability? Surgery is recommended for a minority of patients with IBD, when the disease can not 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 benefit. With modern surgery and pre and post operative care, the dangers of serious complications from surgery are quite low. Some patients who have not been able to be helped by medical drug treatment or standard resections of the bowel may have to undergo an ileostomy. This form of surgery poses some additional problems of adjustment. However, the problems can be more easily coped with by most patients with the help of informed and informative physicans. Organizations, such as United Ostomy Association, 36 Executive Park, Suite 120, Irvine, CA 92714, can be very helpful resources. The various national and local Ostomy Association address these questions in their numerous publications and meetings, and can often provide very helpful counsel for the surgery patient both during the pre-operative stage and following the surgery. This counsel is usually provided through an extensive in-hospital and home visitation program. One of the major concerns expressed at the time is about acceptability by sexual partners. Experience has shown that sexual activity is improved rather than worsened, especially in patients who were acutely ill proir to surgery.

Could you list some of the attributes in patients with IBD that might contribute to a good prognosis?
Ideally the patient should accept IBD realistically, without self pity, without guilt feelings, and without blaming others for his or her illness. If possible, the patient should deal with the disease in a straight forward and matter-of-fact fashion; this will make it easier for friends and family to accept the illness as part of their relationship with the patient. The patient should go about their daily activities as much as possible, follow physicans instructions, and maintain a positive attitude and optimistic outlook upon life. The patient should have the drive to get back to life if he or she has partially withdrawn, and should not attempt to escape the realities of life by retiring to a sick bed. The patient should not use his or her illness to manipulate others in the family and should seek help from family members only when necessary. It should be emphasized that following the physician's advise with respect to clinical treatment is an important aspect of coping with illness.

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