Tag: Crohn

March 24, 2023 – Joshua Denton was diagnosed with ulcerative colitis when he was a junior in college. He not only faced anxiety around a new health diagnosis, but how it could change the rest of his life. 

His initial anxiety was from having “something that’s technically considered incurable.” Next came the challenges of living with inflammatory bowel disease (IBD) on a day-to-day basis. 

“There is just a level of worry about what your quality of life is going to look like. Will it ever be the same, will it get better or just deteriorate over time?” said Denton, now a 37-year-old aerospace project manager in Dallas.

People with IBD are reporting higher rates of anxiety, depression, and other life challenges compared to 6 years ago, a survey from the American Gastroenterological Association (AGA) of more than 1,000 people shows.

At the same time, many health care providers believe that patients’ mental health needs are being met, according to a companion survey of more than 100 health care professionals who treat Crohn’s disease and ulcerative colitis.

What’s the Connection?

There are likely two reasons to explain why anxiety and depression are more common among people with IBD, Keefer said. These conditions are increasingly known to share inflammatory pathways with the autoimmune diseases, particularly pathways that are brain-gut related. 

“The second issue is that these conditions themselves cause depression because so there’s so much to manage,” she added. “You don’t feel good when you stop going out and doing things, and for some people that really just manifests as depression.”

The risk of depression can also increase when someone’s IBD is active. Keefer said, “When you’re sick and lying in bed and not at work, and not seeing your friends, you’re going to get more and more depressed.”

The survey also reveals the impacts IBD can have beyond mental well-being – including challenges in relationships, the workplace, and when educating others about the conditions. The AGA used findings as a foundation for a new resource called My IBD Life.

Common errands can provoke anxiety as well, Denton said. “There are things that people with normally functioning bodies may take for granted. I have to think, ‘Hey can I go to the store and get groceries without worrying about having to run to the bathroom or having an accident?’ ‘Can I go on a date and eat and drink comfortably – and not eat anything that is going to trigger a flare-up?’”

There can be issues with friends and family who don’t understand the need to always be close to a bathroom and how urgently that need can come up, said Guiden, a digital marketing professional at JPA Health, a public relations and marketing agency that helped develop the My IBD Life campaign. 

Keefer, who also is an advisor on the campaign, said that “many GI conditions, not just Crohn’s and ulcerative colitis, come with a lot of unpredictability that can add to the anxiety.” The uncertainty sets IBD apart from many other chronic diseases.

That’s another way the My IBD Life website can help. If someone is uncomfortable talking about the details or IBD, those affected can refer others to this resource. That way, Denton said, people can take their time and learn as much as they want to about life with Crohn’s disease or ulcerative colitis. The personal stories shared on the site really “humanize” IBD. 

Keefer agreed. “The campaign really breaks down common emotional concerns that patients have, provides them with real tips and tricks based on real patients and providers. It’s very evidence-based guidance but it’s also very practical, tangible information for patients.” 

The patient survey with responses from 1,026 people ages 18 to 59 with IBD was conducted June 27-July 5, 2022. The provider survey with responses from 117 gastroenterologists was conducted at the same time.

IBD and Inequality

The survey also revealed that different communities can experience the challenges of IBD in different ways. For example, one question asked respondents to rate on a scale of 0 to 10, with 0 being does not apply and 10 being applies very well to my experience, the following: “My IBD journey has been impacted by my race, ethnicity, culture, sexual orientation, gender identity and/or age.”

The average rating for all 1,026 respondents was 3.57. However, people of color rated this statement a 4.5 and Black patients gave it a 4.7. 

“I won’t try to speak for those that were behind the survey, but I’ll speak through the lens of myself being an IBD patient and also a part of a nonprofit called Color of Crohn’s and Colitis Foundation, a nonprofit that focuses on increasing medical access and equitable treatment with respect to resources for black and brown IDB patients,” Denton said. 

“Unfortunately, it’s rooted in a little bit of systemic discrimination” and relates to the historic treatment of black and brown patients, he added. The issues include equitable access to care and treatment and participation in clinical trials that are more representative of the United States population. “Certain things have very little to do with who we are as actual individuals and have much more to do with the structure of the medical environment.”

Feb. 9, 2023 – For people living with inflammatory bowel disease or chronic digestive problems, eating can be tricky. Some people avoid certain foods when they cook at home, for example, for fear they could trigger troublesome GI symptoms. At the same time, like everyone else, people with Crohn’s disease or ulcerative colitis can benefit from a well-balanced, nutritious diet. 

One possible solution is a free online tool with more than 500 recipes designed especially for people with IBD. The Crohn’s & Colitis Foundation, in conjunction with Nestlé Health Sciences, launched the Gut Friendly Recipes site Jan. 31 to help people create meals without missing out on nutrition. 

“This is a terrific new resource … but it’s important to make sure patients and their care providers understand that these diets and recipes are not meant to be a substitute for managing the inflammatory disease with their doctors and health care teams,” says David T. Rubin, MD, chair of the National Scientific Advisory Committee for the Crohn’s & Colitis Foundation.

Just Avoiding Some Foods Can Be a Problem

People with IBD usually find that there are certain foods that trigger a flare. Some people may not tolerate raw vegetables, while others can tolerate some fresh produce. Others find that they have specific food sensitivities that cause inflammation and trigger a flare, says Sonya Angelone, a registered dietitian and consulting nutritionist in San Rafael, CA, who was not affiliated with Gut Friendly Recipes. 

“Some people back themselves into a corner with a very limited food intake, which leads to nutrient deficiencies. They are afraid to eat and have a flare, so they eat very few foods,” Angelone says. 

A proper elimination diet can help identify food triggers, but the process can be challenging and frustrating for the unfamiliar, Angelone says. Instead, she suggests people work with a registered dietitian nutritionist to determine the foods that are problematic. 

Many patients struggle with knowing what to eat and restrict their diet for different reasons, says Haller. “In clinic we spend a lot of time working with patients on diet liberalization and find foods/meals that work well for them.”

In addition to preventing or correcting malnutrition and nutrient deficiencies, maintaining lean body mass, promoting healing of mucous membranes in the intestines, minimizing gut symptoms, supporting a good relationship with food, and improving a person’s food-related quality of life are among the additional goals of nutrition for people with IBD, Haller says.

The recipes could evolve over time as the science advances. “There is outstanding ongoing research occurring to better understand how diet and food are related to IBD, some of which is funded by the Crohn’s & Colitis Foundation,” Rubin said. “And we are making very good progress in understanding the complex relationship between food and the immune system in our bowels.”

Gut Friendly Recipes is available online at www.gutfriendlyrecipes.org. 

Most people with Crohn’s disease know all too well what a flare feels like. Symptoms like diarrhea, abdominal pain, nausea, and exhaustion can be uncomfortable and embarrassing. So it’s a relief when they disappear. But if you don’t have any symptoms, does that mean you’re in remission? 

The answer is more complicated than you might imagine. There are several types of remission. And “remission” tends to mean something different to patients than to their doctors, says Ariela Holmer, MD, a gastroenterologist with the NYU Langone Inflammatory Bowel Disease Center.

“Patients focus on symptoms, because those are what cause decreased quality of life and disability and why they come to see us in the first place,” she says.

But to doctors, remission means that your small and large intestines are healthy so you can avoid complications, she says. There can be a disconnect between symptoms and what’s going on in your digestive tract.

“You can be walking around feeling fine and still have active disease that’s visible when we do an endoscopy or MRI,” she says.

What Are the Types of Remission?

The definition of remission in Crohn’s disease has changed over the past few years. Most inflammatory bowel disease (IBD) experts use at least four different terms to describe the various types of remission.

Clinical remission. This is something you can identify on your own. It simply means that you don’t have any noticeable symptoms. 

Biochemical remission. This means you’re in remission according to lab tests, specifically blood tests and stool tests. Your gastroenterologist should do blood tests to monitor your level of C-reactive protein, an inflammatory substance, plus stool tests to check your level of another inflammatory substance called calprotectin. Ideally, both markers should be low for you to be in biochemical remission.

Endoscopic remission. Endoscopic remission means that when you get a lower endoscopy (a colonoscopy or sigmoidoscopy) your doctor sees no signs of inflammation, ulcers, or bleeding. That’s a very good sign that your disease is under control.

The International Organization for the Study of IBD recommends that doctors use endoscopic remission as the long-term treatment target for Crohn’s disease. In other words, the fact that you feel better isn’t enough. Doctors should keep tweaking your treatment until your intestines show proof that you really are better.

During your endoscopy, your doctor will probably also take small samples (biopsies) of your intestinal tissue to be analyzed. If no inflammation can be seen under a microscope, you’re said to be in histologic remission. (Histology refers to the microscopic examination of tissue.)

Deep remission. If you meet the definitions for both endoscopic and clinical remission, congratulations.  You’re in deep remission. Research has found that people with Crohn’s who reach deep remission soon after being diagnosed and stay there for at least a year are less likely to have advanced disease and complications later on.

How to Avoid Relapses

There’s no cure for Crohn’s disease. People who have it tend to go through periods of remission with  flares from time to time. Reaching deep remission should increase the chances that you’ll stay in remission longer — perhaps for many years. But other things also affect what your future with Crohn’s might look like, Holmer says.

Those include how old you were when were diagnosed. People diagnosed after age 30 usually fare better than those who’ve had Crohn’s since childhood. It also matters how much of your intestines has been affected by Crohn’s (less is better).

It also makes a difference whether you’ve had complications like ulcers, strictures, or fistulas. If you’ve had them before, you’re apt to have more complications in the future.

There’s no way to guarantee you’ll stay in remission. But you can tip the odds in your favor. Take your medications as your doctor directs. And see your gastroenterologist regularly — even if you feel fine.

“You should always stay in touch with your doctor and continue having your disease monitored with biochemical and endoscopic tests,” Holmer says.

“Some patients think, ‘OK, I’ve been in remission for 5 years, so I can stop seeing my doctor.’ Those are the ones that end up relapsing.”

By Sarah Keitt, as told to Hallie Levine

I’ve lived with inflammatory bowel disease since 1990, when I was diagnosed with ulcerative colitis. Thankfully, my symptoms resolved with surgery, but about 6 years ago I began to experience a recurrence of frequent abdominal pain and diarrhea. I suffered for years, until this past December, when I was finally diagnosed with Crohn’s.

While I’ve started to get my life back, it hasn’t been easy, especially when it comes to my relationships.

Coping With Isolation

My Crohn’s symptoms started right around the time my kids were about to enter middle school. I had spent years being involved in everything from their classrooms to their sports games. But all that ended when I got sick.

I couldn’t go to my kids’ soccer matches, or meet other moms for coffee, because I couldn’t be away from a bathroom for that long. I developed severe anemia due to bleeding in my GI tract. I became so weak I could barely walk. All of a sudden, I found myself homebound, barely able to walk up and down stairs.

Still, I didn’t feel comfortable confiding in anyone except Geordie, my husband. Bloody diarrhea isn’t exactly cocktail-hour conversation. My family and close friends knew I was anemic, but I always tried to put my best face forward when I talked to them.

I have other chronic health conditions, including ulcerative colitis and multiple sclerosis, but I’d never thought of myself as disabled before. Now I did, and it was so depressing. It took so much energy and strength just to get through the day, while other mothers around me lived normal lives. I felt so lonely.

I wasn’t the only one who put on a brave face. It was agonizingly hard on my two kids, Lucy, now 17, and Theo, now 15.

My children had a lot of worries that they didn’t always vocalize. Over the next several years, I was in and out of the hospital for blood transfusions and surgeries, and it was very scary for them. They never asked a lot of questions. It was always just, “Mom’s not feeling well,” or “Mom’s tired.” They knew to run upstairs when I needed something, because it was hard for me to navigate stairs.

It really impacted our ability to do things as a family. We took them to an amusement park once and I couldn’t walk because I was so weak. We got a wheelchair, and I could tell from their faces how hard it was for them to see me in it. They were older by then, too — in middle school and high school. I don’t know what I would have done if they were younger.

Finding Support Is Key

In my case, it’s my husband, Geordie. When we met, he knew I had both multiple sclerosis and ulcerative colitis, even though I appeared perfectly healthy on the outside. But he realized there was always a chance both of these diseases could flare up, and he was prepared for that.

Neither of us expected the Crohn’s disease. But he has been a rock. He spends every day trying to make sure I have everything I need and that I get the right care. I know it’s been a drain on him, but he’s never once complained.

This past December, I had a surgery known as an ileostomy, where they removed my colon and replaced it with an ostomy bag, a pouch worn on the outside of my body to collect waste. It’s hard not to be self-conscious, but Geordie has been incredibly supportive. He always reassures me that he still finds me attractive and that he’s so grateful for it, because it’s allowed me to get my life back. I wouldn’t trade my husband for the world.

Why It’s Important to Be Open

My ileostomy has allowed me to begin to return to normality. I feel a lot stronger, and have a lot more energy. I ran for local office, something I could not have done 6 years ago. I look forward to going to my kids’ soccer games and rock climbing meets, something I couldn’t do just a couple years ago.

But I’ll be honest. Walking around with an ostomy bag does a number on your self-confidence. I cover it under clothing, but it still is a small bulge under a sweater or dress. When I talk to people sometimes, I wonder if they look at it and are confused about what it is.

The hardest part of an ostomy bag is when I have to change it in public. When you open it, it smells, and there’s no way to spray that odor away. Occasionally, it’s leaked onto my clothing when I’m out, and I’ve had to stop whatever I’m doing to make an emergency trip to Walmart for a new shirt.

But whenever I feel embarrassed, I remind myself that the bag gives me back my freedom. I can eat what I want now, and be present for my husband and kids, because of it. Sure, no one wants to talk about bathroom habits, but if I let people know that I have to wear an ostomy bag because I have Crohn’s disease, I help give the condition more visibility. That doesn’t just help me — it helps everyone who lives with this condition.

By Sarah Shafer, as told to Stephanie Watson

I began having Crohn’s disease symptoms of as far back as age 13 or 14. At the time, I tried to hide my condition. The teenage years are already awkward. The last thing I wanted was for my friends and family to know how often I ran to the bathroom and how urgently I had to go.

I did eventually tell my family and I saw a doctor about my symptoms. The doctor thought it was stress-related. He assumed that I had ulcers.

When I was 25, I developed abdominal pain so severe that I almost passed out at work. It turned out to be an abscess. My doctor told me that it wasn’t normal for a 25 year old to have an abscess. That discovery led to further testing, which led to me being diagnosed with moderate to severe Crohn’s disease.

Keeping My Crohn’s Under Control

I’ve been on a couple of different biologic drugs to manage my Crohn’s disease. It took a few tries to get my treatment right. One involved a 4-hour infusion, which interfered with my job. I had to take a day off of work once every 5 or 6 weeks. The one I’m on now turned out to be easier because it’s an injection I give myself.

My doctor, Raymond Cross, MD, at the University of Maryland, has helped me figure out which combination of medications works best for me. He kept up with the research and gave me references to read. I feel like our partnership has made a big difference because it has kept me engaged in my own care.

By monitoring my symptoms and staying up to date on the latest research, I’ve learned how to control my Crohn’s flare-ups. Today I know how to stick with my treatment plan and manage my triggers.

Fine-Tuning My Diet

About 8 years ago, I started to read research on the link between food sensitivities and Crohn’s disease. For 3 months, I cut out dairy and gluten to see if that helped my symptoms. Then I slowly reintroduced these foods, a little at a time.

I came to realize that dairy is OK for me in limited quantities, but gluten is a consistent trigger. I cut gluten out of my diet, and I’ve avoided it for about 10 years.

Stress Management

My disease is under pretty good control, but whenever I get stressed, the frequent urge to go to the restroom comes right back. So I try to keep my stress in check.

I find that running is one of the best stress relievers, but it can also be a problem for me. It isn’t always easy to get to a bathroom when you’re on a jogging trail.

I’ve run seven marathons, but I have had to get creative. I either find trails that have restrooms along the way, or I run on a treadmill so I can stop and go the bathroom whenever I need to go.

Medication Management

Sticking to my medication regimen is also key to managing my symptoms. I take a pill every morning.

I also give myself an injection of the biologic once every 10 days. At first, I played around with the frequency of the injections. I started with one injection every 14 days. When that wasn’t enough, I went down to once every 12 days, and now I space the doses 10 days apart.

I can tell when I need my injection. As the day gets closer, I become more sensitive to dairy foods and the frequency of my bathroom visits increase. So I don’t mess around with the timing.

I have to be careful with my medication when I travel. Because the medicine has to be kept chilled, I keep my schedule in mind when planning a trip. I either have to bring a cooler pack with me or make sure that I have somewhere to keep the medicine cool until I reach my destination.

A Good Support System

Managing Crohn’s flare-ups is easier when you’ve got a strong support system. Having someone you can talk to about how you feel is really important. All those years when I was too embarrassed to discuss my symptoms with anybody was tough on me emotionally, as well as physically.

My husband has been extremely supportive. Not everyone you meet will be willing to change their diet and lifestyle to accommodate your needs, but he has.

It makes a big difference when the people in your life are supportive and they don’t make you feel like you’re impeding on their lives by having to make accommodations, like avoiding certain foods or stopping multiple times to use the bathroom during a road trip. When the people around you are supportive, it can make a big difference in how you feel and how well you manage your Crohn’s disease.

By Kalee Eichelberger, as told to Stephanie Watson

At one point in my life, I wanted to go to medical school and become a doctor. But because of my struggle with Crohn’s disease, I changed career paths entirely. The challenge of adjusting my diet to my disease led me to become a dietitian.

My health issues started early. I had health issues all through middle school and high school — GI symptoms like abdominal pain, loose stools, nausea, and vomiting.

It took a little bit of time to put the pieces together and get diagnosed. I finally learned that I had Crohn’s disease in 2012, when I was 17 years old.

The next challenge was finding a treatment that worked for me. My insurance company made me go through step therapy, where I had to try cheaper medications and fail on them before getting to try more expensive ones. Eventually I started on a biologic drug, which suppresses the part of my immune system that is triggering inflammatory bowel disease (IBD) symptoms. That has worked for me.

Underweight and Malnourished

Early in my disease, I had a very hard time maintaining my nutritional status. The combination of symptoms like abdominal pain, nausea, and vomiting made it difficult to eat and keep food in me. And really, who wants to eat when it triggers pain and discomfort?

On top of that, my GI tract was so inflamed that it wasn’t properly absorbing nutrients. As a result, I was very underweight. I just couldn’t keep the weight on.

It was really challenging for me to find foods and a diet plan that worked for me and didn’t aggravate my symptoms. After what felt like endless attempts at changing my diet, I ended up so malnourished that I needed a feeding tube for a couple of years, plus a central line for IV fluids so I wouldn’t get dehydrated.

For a while I was being fed solely through a tube to give my inflamed GI tract a rest. But I was gradually able to wean myself off of it.

My saving grace was getting connected to a phenomenal dietitian who showed me the link between medicine and nutrition and helped me create a diet plan that worked for me and my disease. When I realized what an asset a dietitian can be to people with IBD, I decided to go back to school and get a second degree in dietetics.

Fine-Tuning My Diet

My dietitian had me walk through my diet in very specific detail, asking me to record a food log of what I ate and how I felt throughout the day. He helped me figure out which foods were triggering my symptoms and helped me pinpoint my specific nutritional needs.

Through the process of trial and error, I learned which foods weren’t working for me. One was high-fiber foods. Certain whole grains, nuts, and tough-to-chew fruits and vegetables with intact skins and seeds give me cramping and upset stomach. The lactose in dairy foods is also a problem for me, leaving me feeling bloated and uncomfortable.

I don’t necessarily have to cut these foods entirely, but I do have to be more careful with them. I can have dairy and some fiber, as long as I watch the quantity. It’s all about eating these foods in moderation and being aware of what else I’m eating throughout the day.

I’ve had to take supplements to fill in the nutritional gaps from cutting these foods from my diet and from my other disease-induced vitamin deficiencies. For example, I wasn’t getting enough vitamin D  when I cut back on dairy foods, so my gastroenterologist suggested I take a calcium/vitamin D supplement.

What I’ve Learned

Living with Crohn’s disease has given me a lot of empathy toward the people I work with. Eating is such a social component of everyday life, and it can become so stressful when you have IBD as there is no one-size-fits-all approach. Diet is very individualistic. I try to be patient as we work to find the diet that’s right for them.

Having been on the receiving end of a feeding tube, I understand what a challenge it is to maintain nutritional status and what a big task it is to need nutritional support. I remember how much my dietitian at the time empowered me to take control over my health and nutrition. If I could be that advocate for just one of my patients, I can honestly say that I’m grateful for my IBD and for the journey it has  brought me on.

Thankfully, I’m in remission today. I feel very healthy. I’m really empowered by what I’ve learned throughout the years, both from working with a dietitian and being a dietitian.

It was a journey to get to where I am today, and I hope that more people can get to the same point. I’ve learned how important it is to do your research as someone with Crohn’s disease. There’s so much conflicting information on the internet about IBD and diet.

It’s always important to work with trained specialists like a gastroenterologist and dietitian. Rely on the them, but don’t be afraid to advocate for yourself. No one knows your body better than you do.

By Tina Aswani Omprakash, as told to Stephanie Watson

In 2005, I was fresh out of college and had just landed a prime job on Wall Street. My life should have been peaking. But inside, I felt decades older than my 21 years.

I’d had strange symptoms since I was about 8 years old — joint pain and eye issues that had no obvious cause. Now I was also getting bouts of digestive symptoms. I had acid reflux, and I bounced back and forth between constipation and diarrhea.

I went to my primary care doctor, who sent me a GI specialist. In June 2006, I was diagnosed with ulcerative colitis. Because the disease was only in one part of my colon, it didn’t meet the criteria for Crohn’s disease, which can occupy any part of the GI tract.

Working Myself Sick

I was working a high-pressure job with pretty extreme hours. The stress of my job was making me sicker and sicker.

I had constant diarrhea. I was bleeding. The only way I could eat was through a PICC line in my arm. By early 2008, I was down to just 85 pounds.

My disease had progressed to the point where I needed surgery. Without it, there was a good chance I’d die. I had emergency surgery to remove my colon on July 4, 2008, which left me with an ostomy bag on the outside of my body to collect waste.

It was a rough few years. I started to develop hard growths called nodules on my skin. I had eye issues and joint pain. Everything in my body hurt. At the end of 2011, I developed my first fistula — an abnormal tunnel between my rectum and vagina that was caused by inflammation.

My doctor told me they thought I actually had Crohn’s disease, not ulcerative colitis. For the next four years, I was in and out of surgery. I developed several more fistulas. One was so close to my spine that it threatened to paralyze me.

In the spring of 2015, my doctor put me into a clinical trial for a new biologic drug. It took several months to work, but it closed up my last fistula and put me into remission for the first time in 10 years.

Managing Crohn’s Disease on the Road

In 2016, I started volunteering with the Crohn’s & Colitis Foundation, co-facilitating their Women’s Support Group. That’s how I became an advocate. Over the years, I’ve learned a lot about my disease and how to manage it.

One of the hardest things about living with Crohn’s is the constant urge to have bowel movements. My doctors prescribed anti-diarrhea medicines, but I also discovered a few tricks on my own.

I found that sitting on a heating pad or in a warm sitz bath prevents the muscle contractions that give me that urgent need to go. When I ride in a car, I sit on a cushion to prevent the urge.

Another thing that has helped is deep breathing and meditation. I’ve had to do a lot of that to calm myself down. I find that constantly thinking about my disease makes it worse. Focusing on something else helps.

For a long time, I had such severe bathroom anxiety that I wouldn’t leave the house. I discovered that I could get out as long as I packed a bag in case of accidents. I wear a diaper and bring along extra diapers and underwear. I also carry baby wipes and cream to prevent irritation. And I locate the nearest bathroom at my destination and rest stops along the way before I leave.

Getting My Health Back

Twenty surgeries and a few near-death experiences later, I’ve finally been able to get some semblance of my life back. I’m working toward my Master of Public Health degree.

My Crohn’s disease seems to be in remission. Although my health still isn’t perfect, it’s much better than it was. Over the last 15 years, I’ve learned a lot from having IBD. Most of all, I’ve learned that you can’t take a day of life — or a day of health — for granted.

By Christina Gentile, PsyD, as told to Barbara Brody

First things first: Stress does not cause Crohn’s disease. But physical ailments often overlap with mental ones. And Crohn’s is hardly the exception. Research suggests that people with inflammatory bowel disease (such as Crohn’s and ulcerative colitis) are two to three times more likely than members of the general population to struggle with anxiety or depression.

Even if you don’t meet the official criteria for an anxiety disorder or major depression, living with Crohn’s disease might make you feel stressed, frustrated, upset, or scared. Navigating a new diagnosis, having debilitating symptoms, and adjusting to changes in treatment can be very challenging. 

Whether your mental health problems tend to be mild or more serious, don’t be surprised if they get worse when your Crohn’s is flaring. During a flare, you might feel anxious about having urgent, bloody diarrhea or flatulence. You may worry about whether you’ll be able to find a bathroom in time. You could feel embarrassed about your symptoms. You may develop body image issues, which might prompt you to withdraw from social situations.

The Gut-Brain Connection

One reason Crohn’s disease is so closely connected to anxiety and depression is that your brain and your gut are linked through your vagus nerve. Signals run in both directions along this pathway.

Although Crohn’s is an autoimmune disease that causes inflammation in your GI tract, what’s going on in your mind can certainly affect your digestive health. Research has shown that people with inflammatory bowel disease who also have anxiety or depression are more likely to get frequent flares and tend to have a lower quality of life.

As a clinical health psychologist who specializes in digestive diseases, I try to understand how Crohn’s disease affects my patients’ daily lives. I’ll come up with a treatment plan that uses skills-based training to help them better manage flare-ups and improve their quality of life. When I meet with a patient, I teach them how to reduce stress and manage it better. I also help them deal with negative thinking patterns that may keep them from coping well with their Crohn’s disease.

Learning how to manage stress and anxiety related to their symptoms can reduce their risk of flares. It can also help them cope with symptoms when they do occur.

Treatment Options

Several different mental health treatment options may be helpful for people with Crohn’s who are having anxiety, depression, or trouble coping with their diagnosis.

The best-known treatment is cognitive behavioral therapy (CBT). It aims to identify and challenge negative thought patterns and behaviors that can increase stress, lead to worsening mood or anxiety over GI symptoms, or interfere with managing Crohn’s disease. 

Another approach is acceptance and commitment therapy (ACT). This has a slightly different focus. It emphasizes accepting what you can’t change (your Crohn’s disease and the discomfort that might come with it). It involves becoming more mindful of your thoughts, emotions, and gut sensations. It also teaches you skills to improve your quality of life, even in the face of your symptoms.

Many people with Crohn’s also benefit from gut-directed hypnosis. This involves deep relaxation techniques combined with soothing images and verbal suggestions, aimed at calming your digestive system and managing pain.

Getting the Right Help

If you’re struggling emotionally because of Crohn’s disease, your first step should be to talk to your gastroenterologist, who may refer you to a mental health provider. Ideally, you’ll work with someone who has special training in gastropsychology, a discipline within clinical health psychology that focuses on digestive diseases. You can also try searching for an expert near you at the Rome Foundation’s gastropsych registry.

If you can’t find this type of specialist in your area, look for a mental health professional who has experience with chronic health conditions, stress, and anxiety disorders. You doctor may be able to recommend someone. Or check with your local hospital or health center.

Assuming that your mental health issues are mostly related to having Crohn’s (and not part of a broader anxiety or depressive disorder), you’ll probably benefit fairly quickly from a skills-based treatment approach.

When you find a provider, be as direct as possible about what you hope to get out of the experience. Maybe you want to focus on how your anxieties over Crohn’s are keeping you from getting restful sleep. Or maybe you need to learn to cope with discomfort and pain without getting stressed about it. Setting a clear and specific goal will help you make the most of therapy so you can feel better faster.