Expert Q&A

A: Thank you for this question on a sensitive and important topic, intimacy and sex in IBD. I appreciate that you are asking what YOU can do. It’s a good place to start. Expressing how you feel about the current state of your relationship in a compassionate way may open the door to learning how your girlfriend is feeling. Perhaps she is struggling with symptoms that she feels embarrassed by? Maybe due to medication or disease activity she has low energy, fatigue, pain, low sex drive or body image concerns? She may feel sad, depressed, worried or frustrated? All of which can dramatically impact how one wants to engage with their partner. Your girlfriend may desire to be intimate with you, but her physical or emotional symptoms may be a major factor. By opening the door of communication, together you can discuss what your next steps are as a couple. Establishing care with a therapist who understands the nuances of chronic health issues may be helpful for you. Therapy goals might include having a safe place to express your feelings, learning communication strategies and developing ideas for different types of intimacy that may aid in strengthening your relationship. If your partner believes that her disease is contributing to her intimacy concerns, talking with her medical team is important. Talking with a gastroenterologist about sex might seem uncomfortable, but this is an important conversation. They need to know many of the most personal aspects of your life because they may be able to help. The doctor may run labs, assess disease activity and/or have some suggestions to aid in stabilizing health which may with time boost mood and sexual desire. If pain or discomfort contributes to the lack of sexual interactions, her doctor may recommend working with a pelvic floor physical therapist. Your girlfriend may also benefit from a mental health provider to discuss the various stressors/complexities associated with having IBD. hide answer

A: I am sorry you are not feeling well and commend you for being aware of how your physical health can impact your mood and emotional health. Ensure that you are discussing both physical and emotional symptoms with your gastroenterologist. They may need to run labs (iron deficiency anemia, Vitamin D, B-12, TSH, etc) to see if there are deficiencies that are also contributing to your fatigue, healing and mood symptoms. By treating the deficiencies physical and emotional symptoms may see improvement. There are different types of medication that can be prescribed to aid with mood stabilization that you can speak with your physician about. However, working with a mental health professional to discuss your depression, learn ways to cope with emotions related to the complexities of IBD and over time gain confidence to manage emotions and stress related to disease management. Sometimes therapy is enough to get you feeling well again, other times a combination of medication and therapy is best. Be open with your physician; ask if they have a referral recommendation for a mental health provider. If you and your team think medication is a next step for your treatment plan, consider consultation with a psychiatrist. You can check www.romegipsych.org to see if there is a mental health provider who specializes in working with people who have gastrointestinal conditions. hide answer

A: Having a child with medical issues can create many obstacles that sometimes we just need help to navigate. Communication with your son’s gastroenterologist or pediatrician is a great place to start. Discuss your concerns, what you have tried and how this is impacting the family. They will likely be able to provide some suggestions or direct you to a specialist who can help. To address the dietary aspects, ask if there is a pediatric dietitian who specializes in IBD or feeding issues. This person may be able to create a tailored diet plan taking into consideration your child’s age, diagnosis, medication, and medical recommendations. Also, a child psychologist would be a wonderful addition to your child’s team! Perhaps there are some emotions that your son is having a difficult time processing which impacts other aspects of his life (i.e. eating). The child psychologist can aid your child in working through the various aspects of having IBD in a developmentally appropriate way. The psychologist can also work with the family to aid with implementing strategies to make things less challenging at home. hide answer

A: Taking a new medication, especially one with scary, possible side effects, can be anxiety provoking. Fears related to the unknowns and uncontrollable aspects of the medication can drive that anxiety as well. If you are feeling debilitated by the anxiety and worry over this medication, seeking the support and guidance of a psychologist can be very appropriate and helpful. Look for a mental health provider who specializes in gastrointestinal disorders, chronic health issues and/or anxiety. A provider who specializes in the use of Cognitive Behavioral Therapy (CBT), a type of therapy very commonly used in medical settings and to treat anxiety. CBT is used to address your worrisome thoughts and provide you with tools to better manage them. Mental health care when managing a chronic disease, like IBD, is often just as important as your medical care. Your therapist can aid you in developing tools to better manage stress and adaptively cope with worry and fear. When you feel better about your self-management skills, you can regain focus on the enjoyable aspects of your life. hide answer

A: Sometimes having IBD can feel as though you have an invisible illness. That can make it hard for family and friends to truly understand all the ways in which IBD impacts your life. There is a great deal of education that is required to successfully navigate IBD. Asking your loved one to learn with you can be a good starting place. Also, consider outside resources for support, such as friends, the IBD community, and a mental health professional. Here are a couple suggestions to aid with building a support network: • Invite your family member to an appointment with your gastroenterologist. Ask your provider to discuss the disease, impacts on the family, treatment and potential side effects of treatment. • Ask your loved one to read this document about being diagnosed and managing IBD: http://www.crohnscolitisfoundation.org/assets/pdfs/newly-diagnosed.pdf • Invite your family member to a Crohn’s and Colitis Foundation patient education event in your area. • Join an IBD support group to talk with other people who have IBD and have had similar experiences with family and friends. • Invite your family member to sit with you and watch IBD School videos from IBD experts at the University of Michigan: http://www.med.umich.edu/ibd/school/index.html • Communicate how it makes you feel when your loved one doesn’t take your disease seriously. Let them know how they can best support you. • Consider establishing care with a mental health professional who works with people with chronic illness to learn skills to manage the many complexities of IBD. hide answer