Crohn’s disease is a condition which affects the digestive system and causes it to become inflamed. It is a type of inflammatory bowel disease. It is a lifelong condition but symptoms can flare up and subside over the course of months and years. It is estimated that one in every 650 people in the UK has Crohn’s disease.
What are the signs and symptoms of Crohn’s disease?
Crohn’s disease can flare up and then subside (called remission) but symptoms typically include:
- Stomach cramps
- Blood in stools
- Weight loss.
Other symptoms may include joint pain, nausea, sore eyes, mouth ulcers and swollen or reddened skin, often on the legs.
How is Crohn’s disease diagnosed and treated?
Someone is advised to go to their GP if they are experiencing unexplained weight loss, have had diarrhoea for seven days, or if they notice blood in their stools – which may be a sign of cancer.
A doctor will enquire about the regularity and types of symptoms that the person with potential Crohn’s disease is experiencing to determine whether they do have Crohn’s disease. Tests can indicate a diagnosis, such as urine and stool sampling.
A referral to a gastroenterologist (specialist of the bowel) can perform further examinations to confirm the diagnosis. These include a colonoscopy, a biopsy of small parts of the bowel to look for inflammation, or an MRI scan to look at the bowel.
There is no treatment for Crohn’s disease, but someone can manage their symptoms through a number of approaches.
Steroids can be prescribed to reduce gut inflammation, but they are not usually taken long-term as they increase susceptibility to infection and can cause indigestion, sleeping difficulties and other problems.
Another shorter-term solution to the inflammation is a special liquid diet which contains the correct nutrients for a balanced diet but can reduce the pressure on the digestive system.
A longer-term treatment is immunosuppressants, as they can help prevent flare-ups, but they do increase the likelihood of infection.
Surgery may be an option if other treatments are not working. This often involves removing a section of an unhealthy bowel. Some people may need an ileostomy bag after surgery while their bowel heals (this is when bowel movements empty into a pouch on the stomach).
There are a few ways to confirm what sort of reasonable adjustments should be made for an employee with Crohn’s disease:
An employee may not disclose their Crohn’s disease upfront, but if they do, questions regarding the nature of an employee’s Crohn’s disease and what extra support they may need can be broached sensitively. For example:
- Have they required adjustments in the past? For example, permission to work from home during a period of particularly severe symptoms.
- Encouraging the employee to express their strengths and interests and which tasks they might enjoy doing is a positive way of adapting to their needs and empowering them, in spite of their Crohn’s disease.
- Even if the employee does not wish to disclose their Crohn’s disease – or they have not even received a precise diagnosis – an employer can focus on making reasonable adjustments, rather than seeking to determine the precise disability their employee has.
What reasonable adjustments are possible for employees with Crohn’s disease?
Employers have a legal duty to make reasonable adjustments for employees with Crohn’s disease if they know, are aware of, or could ‘reasonably be expected to know’ that the employee has Crohn’s disease. Most employees will tell their employer what reasonable adjustments they need. They often involve simple changes in the way an employer might usually do things.
If the employee does not disclose a health issue or disability which may affect their performance upfront, an employer should broach the subject sensitively if they suspect that there may be a disability behind the employee’s reduced performance. Reasonable adjustments can then be made in accordance with the employee’s needs, including, in the case of Crohn’s disease:
- Flexible working hours to accommodate medical appointments and periods of increased absence or decreased productivity following a flare-up in symptoms.
- Additional breaks, such as to empty an ileostomy bag post-surgery or to take painkillers for painful joints or to manage stomach cramps (although ibuprofen can exacerbate symptoms, which is something to be aware of).
- Adjustments to duties depending on the severity of their symptoms, which may be variable and improve or deteriorate from one week to the next.
- Relocation of workstation, for example, to allow the employee more convenient access to a bathroom.
- Raising awareness so that colleagues understand the employee’s Crohn’s disease and can help ensure the employee feels comfortable at work, for example, when taking additional breaks or using a hot water bottle to relieve stomach cramps.
Crohn’s disease Signposting
Crohn’s and Colitis UK – charity which provides information on symptoms, getting diagnosed and treatment for inflammatory bowel conditions, including Crohn’s, both for people with the conditions and medical professionals (0300 222 5700).
Guts UK – charity campaigning to increase the volume of medical research into digestive conditions, such as Crohn’s disease, as well as public awareness and support for those living with digestive conditions (020 7486 0341).