Covid-19: Returning to the office

[Mouse2212]

I have IBS-D and am currently fortunate enough to be able to work from home but am finding talk of returning to the office very stressful. It’s clear that because of social distancing, toilet access will be more limited than previously and I am very worried that there won’t be a toilet available when I need one. I am reluctant to raise it with my employer as I’m embarrassed and would be interested to know if and how others have been able to raise this issue.

[xjrs]

Your employer has a duty of care towards you and needs to make any reasonable adjustments and allowances for any conditions that you have. Have the discussion with your boss in confidence or call them prior to returning to work to discuss your fears - just make sure that you say that the info is not to go anywhere else (most bosses don't need to be told this, but I've had the odd unprofessional one that does need to be told). Failing this you could speak to someone in your HR department if you have one. Some larger companies even have wellbeing programmes and have internal support groups for specific conditions. Also, whilst you feel your condition isn't under control, can you not continue to work from home if you have managed to successfully so far and use your condition as the excuse? More employers are likely to be happier with home working now - plus it saves them a ton of money on office space and bills.

The next very important point is what help you are receiving to control your IBS so that you feel more confident to be out of the house or in the work place? Here is some general advice I have shared with others in this group:

IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce your anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.

There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as pain or disordered bowel movements. This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app it will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.

If you are also suffering from pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:

iffgd.org/lower-gi-disorder...

It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & Alflorex have helped me with this intestinal pain.

You may also find assistance with anti-spasmodic medication such as mebeverine (Colofac) or enteric coated peppermint.

You can find some info on self management here:

theibsnetwork.org/the-self-...

[IBSNetwork Partner IBS Network]

Have you spoken to your boss about your IBS and how it affects your daily life? Your employer does have a duty of care , but if they don't know about your condition and how it affects you , how can they help and make reasonable adjustments?

Take a look at the info on our website about IBS and work in general theibsnetwork.org/ibs-and-w...

Also tell them to take a look at our website IBS and the information from medical professions as this will give them a better understanding and how they can help you and any other staff that may be living with IBS. theibsnetwork.org/have-i-go...

[Linley]

Xjrs is right employers have a duty of care. Write dowm what you want to say to them, keep it short but politely to the point. Has your company got a disabled toilet facility you can use?