How does IBS affect people at work?

The IBS Network reports that around 10-20% of the UK population is currently living with IBS and Britain's businesses lose almost £3 billion every year through sick days related to gut health.

The debilitating effects of IBS frequently cause those struggling to take days off, arrive to work late or finish early.

In some cases, if IBS limits someone's ability to complete their daily activities, they can be classed as disabled under the Equality Act 2010.

While employers have a duty to make reasonable adjustments to accommodate their employees at work, these alterations aren't always enough for people with IBS. Even if changes are made, severe symptoms of IBS can still be difficult to manage when someone feels humiliated by needing to use the toilet or their stress levels are high.

How can IBS interfere with someone's working day?

Dr Maryam Behnam from Chelsea Pharmacy Medical Clinic says IBS can affect people at work by causing abdominal pain, discomfort, frequent visits to the toilet, a gurgling abdomen and bloating.

These symptoms can lead to low mood and cause both physical and mental distress while at work and home.

45-year-old *Michelle was diagnosed with IBS in 2004. She worked as a front-facing advisor for the local government before losing her job as a consequence of taking too many sick days with her IBS. Bosses pressured her to increase her attendance, which she said was impossible because of her long-term health condition. At this point IBS was not recognised as a disability as it is today, so employers weren't as aware of how to support someone with the condition.

Michelle found working with the public in a fast-paced environment with few breaks and opportunities to use the toilet worsened her IBS: she was constantly panicking about needing the toilet urgently and couldn't focus on doing her job properly. She severely restricted her food intake in an attempt to manage her symptoms. This led to rapid weight loss, loss of energy, skin problems and low self-esteem.

She had numerous 'close calls' where she wasn't able to reach the toilet on time.

In addition, her relationships with her colleagues suffered because only close friends realised how severe her IBS was. Other co-workers mocked her and assumed she was taking advantage and having time off for no reason. This created a hostile work environment.

Should you tell your employer if you have IBS?

Michelle's IBS was always on her HR record, but she never brought it to anyone's attention out of embarrassment, which is common. Even when her illness made her unable to get into the office, Michelle lied to her employer about what the problem was out of shame. Only when her condition worsened and she took more time off was she forced to admit to how much she was really struggling.

The IBS network encourages employees to be open with their managers about their IBS, as well as understanding how humiliating this can be. They say these conversations may help alleviate some of your anxiety if you explain your condition with somebody you trust.

"Your colleagues cannot support you if they do not know," they stress.

How does IBS cause stress and anxiety?

IBS and anxiety are both known to trigger each other, says Dr Behnam.

"IBS symptoms such as abdominal pain, bloating, diarrhoea or constipation can impact one's mental health severely and leave the person depressed, anxious or sleep-deprived.

Stress and anxiety in return make the IBS worse through several mechanisms such as an overactivity of the immune system, dysbiosis (imbalance of gut bacteria) and overactivity of bowels."

Michelle found having a high-stress job on top of IBS meant her mental well-being took a real hit and, many years later, she is still struggling with the lasting damage caused by anxiety and depression. Even when applying for jobs today, she has lied to employers, not declaring her IBS out of fear of not being successful.

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How can employees manage IBS at work?

The IBS Network offers tips for people struggling to manage their IBS and ease their worries while working, such as:

• Keeping a supply of any IBS medication you use with you.

• Keeping other essentials, such as wipes and spare underwear, together in a bag in your car or in your drawer at work.

• Getting up early enough before work to allow plenty of time for breakfast and to go to the toilet.

• Taking a proper lunch break and avoiding eating meals on the run.

• Preparing your own food so you know what it contains and the portion sizes.

• Aiming to drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks, to avoid dehydration and constipation.

What can employers do to accommodate staff with IBS?

The IBS Network encourages employers to make themselves aware of IBS and its debilitating effects on those who have the condition.

"Understanding ways in which you can help your staff who have IBS will allow them to continue working to their full capacity. Be aware that stress is often an important factor in those with IBS. If they feel unable to approach you, it might make their condition worse. Although you may find it a little uncomfortable at first, talk to your employee about what you can do to support them."

Michelle says that her workplace was initially very supportive when they learned of the severity of her condition. They offered reduced hours with later starts and two additional breaks. They also gave her an extra allowance on sick leave. However, after a month or so, they withdrew these measures, assuming symptoms would have eased. This, in fact, caused more stress.

The IBS Network has suggestions for alterations that can be made by employers to ensure the well-being of their staff with IBS, such as:

• Offering flexible working.

• Providing easy access to toilets.

• Allowing employees to take regular work breaks.

• Ensuring effective monitoring and management of workload.

They also highlight that, where IBS impacts someone's life to the point where it is deemed to amount to a disability, employers are obliged to offer alternative ways of working and obtain medical information from the employee if unsure on how to assist them by making the necessary adjustments to the workplace.

As someone with lived experience, Michelle suggests workplaces relax rules regarding sick days, as they rarely take into account long-term conditions. Even if special measures are put into place at a later date, it is often not mentioned at the beginning of employment that adjustments can be made, leaving employees to panic about taking too much time off.

She also highlights that employers need to be more considerate towards invisible disabilities and understanding of how these can reduce someone's quality of life.

Is IBS a lifelong condition and can it be managed?

Michelle developed IBS in 2002 after the birth of her first child, following the pressures of being a new mum, working full-time and managing the stresses of everyday life.

Now 45, she still finds IBS restricts everyday life, but she has learnt to manage it. These methods include adapting her diet and finding medication that works for her, after trying several kinds of prescription drugs and over-the-counter medication. She takes maximum doses of medication on days when she has plans or needs to go out. However, this has a knock-on effect as it can cause constipation.

There is no single cure for IBS. Dr Behnam says it can be a lifelong condition. However, in most people IBS improves in later life and symptoms can often be managed by making adjustments so a person's lifestyle is less stressful.

She says that stress reduction, along with a healthy diet and adequate sleep are the three main factors in the management of IBS.

When should you contact a doctor about IBS?

Dr Behnam reminds people to not self-diagnose IBS, as other causes of IBS symptoms may need to be excluded before a diagnosis is made. Let your doctor diagnose it after running a few tests, and report any new symptoms or changes in bowel movements to your GP.

The IBS Network reminds people to seek support from their doctor if they are worried about IBS, keeping in mind that any embarrassment is only temporary, but ignoring a problem could lead to larger and more painful issues.

*names changed