Factsheet – Inflammatory bowel disease

Inflammatory bowel disease

This resource is part of our Disability Essentials range. You can find the other free resources that are included in this range by clicking here.

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is the term given to describe a group of chronic diseases that cause inflammation and ulceration of the digestive tract. It is estimated that it affects one in 210 people in the UK, with most diagnoses in the 15-40 age group. There are currently no cures for IBD. Existing treatments can significantly reduce symptoms as well as the frequency and duration of flare-ups for many people. The most common inflammatory bowel diseases are:

• Crohn’s disease – can affect the entire digestive tract
• ulcerative colitis – affects the large bowel.

The causes of IBD are unknown, but it is thought to be a combination of genetics and a problem with the immune system.

Triggers

While they don’t cause the disease, some common triggers can increase the risk of flare-ups. These include:

• smoking
• diet and eating habits
• lifestyle
• their surroundings and environment
• infection
• stress
• tiredness.

Inflammatory bowel disease (IBD) should not be confused with irritable bowel syndrome (IBS); they are different conditions and need different treatments.

How does IBD affect an individual?

IBD is a fluctuating condition and it affects different people differently. Some people will have frequent severe flare-ups. Others will experience mild symptoms and may have several years between minor flare-ups or fluctuate between the two extremes. IBD is unique to each individual.

Many people with IBD will manage their condition very well with minor adjustments to their diet or lifestyle.

Symptoms

The most common symptoms are:

• recurring or bloody diarrhoea
• urgent and / or frequent need to use a toilet
• weight loss
• fatigue – physical and mental tiredness
• stomach aches, bloating, and cramps.

Other symptoms that can be associated with IBD include:

• high fever
• vomiting
• anaemia
• anxiety
• depression.

Inflammatory bowel disease is not usually fatal, but it can cause life-threatening complications.

Potential impact on work

The potential impact on a person’s ability to do their job will depend on:

• the nature of the job
• the individual
• how their IBD affects them.

Many people with IBD can manage their condition well with little or no impact on their work. Some employees may already work for you who have not shared their diagnosis as the disease is currently well-controlled. However, anyone with IBD has the potential to experience sudden flare-ups. This will be true for customers and visitors as well as employees.

The main concerns for most people with IBD at work include:

• access to suitable toilet facilities at short notice
• embarrassment about smells and sounds is a common feature of their condition, especially if they have an upset stomach
• privacy and confidentiality
• experiencing discrimination due to their IBD.

Legal duties

The Equality Act 2010

In the UK, employers have legal duties to:

• prevent discrimination, and
• provide reasonable adjustments

for their disabled employees. This means it is unlawful for employers to treat applicants, job candidates and employees unfavourably because of their disability.

The Equality Act also requires employers to make ‘reasonable adjustments’ for their disabled employees.

For more information, see our ‘Briefing – Adjustments in employment’.

Suggested adjustments

Any potential adjustments should be discussed with the employee before being implemented. The employee is best placed to know what they may need.

Access to adequate toilet facilities as and when required

A person with IBD can have a real need to access a toilet urgently to avoid having an ‘accident’. This is a genuine need, and access to suitable toilet facilities should not be underestimated or delayed.

The employee should be able to work near suitable toilet facilities and access them quickly and as often as required. An agreed system should be in place to cover for those with fixed breaks or who are in a critical role, such as a control room operator.

IBD symptoms can cause smells and sounds that can be embarrassing for the person and often cause stress. Many workplace toilets do not provide appropriate ventilation or privacy to counter and manage this. Access to an individual toilet such as an ‘accessible’ or ‘disabled’ toilet with these facilities can be beneficial.

Customers may also require these facilities, and they should be made available to them. Some people carry a ‘Can’t wait’ card and / or a RADAR key to help them access toilets when away from home. Staff should be made aware of these and similar systems and assist visitors and customers in accessing toilets without delay.

Some employees who work outside, such as on a building site or oil and gas plant, may benefit from a temporary transfer to office-based duties during flare-ups. Not only can this help with easy toilet access, but it can also help with associated fatigue management.

Flexibility

Flexible working hours can be conducive for some people. For example, many people with IBD require more frequent use of the toilet at the start of the morning. A later start time would help with this.

Shorter working hours or working from home, if this is possible, can also enable a person to continue working during flare-ups. This will reduce the impact of IBD-related fatigue on the individual.

Shift work can exacerbate symptoms for some people, including fatigue and stress. If this is the case, a transfer to the day shift on a permanent or temporary basis can be helpful. This is not the case for everyone and so should not be assumed.

Travel

There is no reason why people with IBD cannot travel for work when the IBD is under reasonable control.

Any possible adjustments should be identified in a travel risk assessment if overnight or overseas travel is required. This includes access and storage of any medication, dietary restrictions, for example. A travel clinic can advise on this.

Flexibility on the mode of transport for work travel can be helpful. For example, travelling by train may be preferable to bus or car.

Commuting to and from work can also be challenging for people with IBD. Many people find it easier and quicker to drive. Being able to park close to the worksite and toilet facilities is helpful.

People with IBD may not qualify for the Disabled Blue Badge system or official disabled parking spaces. Within the workplace, a provision that enables them to use these parking spaces is encouraged.

Dietary accommodations

Some people successfully manage their IBD by having regular meal breaks taken at regular times. It is not uncommon for people with IBD to need to eat smaller portions more regularly than their colleagues. They may also need to take prescribed medications at these times too. If regular and / or frequent meal breaks are required, they should be considered when organising meetings and training.

Some people have dietary restrictions, which may mean that they need to bring their food to work. Most workplaces provide suitable storage and catering facilities such as fridges and small kitchen areas. Where this is not the case, it may need to be provided or other appropriate arrangements made.

Dietary restrictions and timings of meals should be considered when travelling or other work events such as conferences, away days and training.

Reduce stress, anxiety and depression triggers

Stress is a normal reaction to events where we feel under increased pressure, such as interviews, tight deadlines, high workload, and presentations. If the triggers are not controlled, they can develop into clinical anxiety and depression. If a person already has challenges due to their disability, any additional stress can exacerbate their condition.

Stress reduction is the best practice for all employers. Discuss any fears an employee may have and aim to reduce them. A stress risk assessment can be a valuable tool in identifying any triggers, managing them, and measuring the results.

Absence management

People with IBD will require time off work to attend appointments related to their condition. For example, routine check-ups or treatment appointments (some people need periodic medication, which can only be given in a hospital environment).

Sometimes a person may need to take time off work due to the severity of their symptoms. IBD can be debilitating with life-threatening complications. There may be times when a person requires to be in hospital for treatment or surgery. A graded return to work and duties can be helpful in these situations.

It is best practice to have policies and procedures in place that distinguish between sickness absence taken for a reason relating to a disability and general sickness absence. Disabled employees must not be treated less favourably than their colleagues for a reason relating to their disability.

Further information

For more information on suggested adjustments, specific barriers for inflammatory bowel disease and information about the law, please see our other resources in the Knowledge Hub.

For more detailed information and advice about a specific situation, contact the Advice Service:

Tel: +44-20-7403-3020 | Textphone: +44-20-7403-0040

Email: advice@businessdisabilityforum.org.uk

Crohn’s & Colitis UK

1 Bishops Square (Helios Court)

Hatfield Business Park

Hatfield

Hertfordshire

AL10 9NE

Email: helpline@crohnsandcolitis.org.uk

Helpline Service: 0300 222 5700