Living with a long-term medical condition can pose many challenges. Emotional issues frequently arise. However, with the support of family, friends and health professionals these can be tackled. Dealing with the disease in a straightforward and open manner is the best approach, but it’s not always easy. Some people become emotionally distressed on hearing a diagnosis and it takes a lot of effort and determination to adopt and maintain a positive attitude and take control.

There is a misconception that tension or anxiety cause Crohn’s disease. This is not the case. Both Crohn’s and colitis are biological disorders. However, tension and anxiety can have an impact on how a person copes with their condition. It is also thought that severe stress can make inflammation worse. Also, when people experience physical or emotional strain, this can lead to symptoms flaring up.

Common emotional responses

A chronic disease affects physical well-being and quality of life. People suffer pain and discomfort and symptoms that may require bed rest or even hospitalisation. There can be a high level of uncertainly about how well an individual is likely to feel tomorrow, next week or next month. This makes it difficult to plan ahead.

Common emotional responses to chronic disease include anxiety, depression, dependence on other people or even social isolation and withdrawal from regular activity. The embarrassing nature of the symptoms of a bowel disorder may lead people to shy away from social activity.

These reactions are quite normal. Talking things through with close friends or family may be helpful. A support group like the Irish Society for Colitis and Crohn’s Disease www.iscc.ie may be useful. Discussing common problems with others in the same situation can be very helpful. For more, visit the Discussions channel on this site.

However, if psychological problems or distress grow to the extent that they greatly interfere with normal life, it may be time to seek professional advice from a doctor or a counsellor. Your GP is a good place to have an initial discussion, and he or she will refer you for specialist help if appropriate.

Crohn's disease and sex

Even at the best of times, sex and sexuality is a challenge for many people. When it comes to Crohn’s disease, its symptoms and very nature are going to be an issue. Sexual relationships may be affected when anxiety about disease, body image, symptoms, medications and surgery come to the fore.

Abdominal and rectal pain may occur during sex. There may be a sensation that a bowel movement is imminent, and that can naturally cause anxiety. For women there may be pain in the area between the vagina and rectum due to a fistula or abscess.

Steroids can affect sexual drive and function. They can also lead to weight gain, which can have an added impact on body image.

Apart from the barriers to sex caused by symptoms, people may simply not be in the mood. They may not be physically well and may be feeling down. This in turn can place great strain on relationships, where the spouse or partner may feel rejected  as a result of a decline in sexual intimacy in the relationship.

Openness, honestly and a little imagination can help. If you are uneasy about a particular sexual position, try something different. If you have concerns or anxiety about penetrative  sex, why not explore other options, such as oral sex or mutual masturbation. Whatever  you choose, the most important thing is that you and your partner are relaxed and comfortable with your choice.

Physically, there may specific problems to overcome in cases where treatment has not worked and surgery is necessary. Even after post-surgery recovery, people may find that their confidence is shaken. When the bowel is removed, an opening is left in the abdomen called a stoma. A pouch is worn into which waste is emptied. This can lead people to struggle with a poor body image initially. It may take a while to come to terms with such a change in bodily function and to learn how to manage this in practical terms.

On the positive side, people may feel a new sense of wellbeing and a more positive outlook after surgery, having suffered severe symptoms for many years. This may greatly improve sexual relationships.

If you have concerns about emotional issues, anxiety, depression or sex, it is important to discuss these with friends, a support group or a health professional. Dealing with these issues rather than bottling them up is vital to taking control of your illness, improving quality of life and maintaining relationships.