Should You Tell Your Boss You Have IBD? Plus More Tips for Coping at the Office

As the human resources director for family Destinations Guide, a website that offers kid-friendly vacation ideas, Bonnie Whitfield always makes sure employees feel comfortable disclosing their medical conditions so the company can provide accommodations. For Whitfield, it’s not just professional—it’s personal, because she has inflammatory bowel disease (IBD).

“Since I have IBD myself, and I’ve been through a few flare-ups at work, I know what it’s like to be in that situation,” she says. Employees are often trying to navigate not just the symptoms of a chronic illness, but also anxiety over questions like: Should I tell my employer and coworkers? Will people feel like they can’t count on me? What if I’m embarrassed to talk about it?

These are all common concerns, says Whitfield, and unfortunately, worrying about such issues can actually put you at higher risk for an IBD flare that could affect your work.

IBD encompasses two conditions—Crohn’s disease and ulcerative colitis—that are characterized by inflammation of the gastrointestinal tract, leading to symptoms like diarrhea, abdominal cramping, fatigue, and sudden weight loss. Treatment options help many people go into remission so their condition becomes a non-issue, but even on medication, symptoms may return in a flare-up that can range from mild to debilitating and might last days or weeks. The unpredictability of the disease is another source of potential anxiety when considering how it will affect work performance, Whitfield says.

“Sometimes, pushing yourself can make your flare worse,” she adds. “Having a plan in place beforehand can go a long way toward keeping you productive while still taking care of yourself. It’s important to remember that being sick shouldn’t mean you can’t be an effective employee.”

Here are some tips to consider when balancing your health and your workplace, even if your IBD is in remission right now.

Let your employer know—and put it in writing

Although the symptoms of IBD—like frequent trips to the bathroom, gassiness, and bloating—can feel embarrassing, it’s important to recognize you have a chronic illness and that it should be handled as such, Whitfield advises.

She suggests telling your direct supervisor and HR director not just about your condition, but also what you need in terms of accommodation and why that will help you function better in the workplace. For example, many people with IBD benefit from having an office or cubicle closer to the bathroom, which can shorten the amount of time spent going back and forth during a flare. Also, simply being closer might reduce worry about the issue, and in itself that could tamp down some symptoms. Having to use a wheelchair may also come into play, since side effects used to treat ulcerative colitis can lead to mobility challenges, so letting an employer know that could be a possibility—and ensuring you have access to all the areas you need—is crucial for planning ahead.

There may be multiple doctor visits as well, especially when flares are more dominant, and treatment could include options like surgery in the future. Preparing an employer for that possibility should be part of the conversation about your condition.

Whitfield says putting information like this into writing is the best approach, since it provides the most clarity about what you need. Plus, it ensures that all parties are receiving the same information.

“Explain how IBD affects your work performance and how you can still do your job effectively while keeping up with treatment regimens and any other responsibilities required by the company, such as working overtime,” she adds. “The more specific you can be about what accommodations would help keep you healthy and productive, the better equipped your employer will be to develop a plan that works for both of you.”

Another benefit to writing it down: It may feel easier than saying everything in a meeting, particularly with multiple people or those you don’t know well. For instance, when Los Angeles-based Span Chen was working as a cashier, every day felt like a battle due to pain and the inability to leave a line of customers. Treatment helped reduce flare-ups, but also led to more fatigue. He felt hesitant to bring up his struggles.

“What helped was writing a letter to my boss explaining what was going on, and that I needed to take time off in order to heal fully,” says Chen. “Because I wrote it down, I didn’t forget key points, like saying that being able to have more time away from work would allow me to return in full health.”

Read More: How to Maintain Your Social Life When You Have IBD

Establish some code words and contingency plans

Even just having a key phrase can be useful, says Cassie Mahon, who leads client meetings for her employer in Columbia, Missouri. She informed her boss about her IBD, and together they formulated a plan of action about what to do if Mahon had to leave suddenly.

“If I say that it’s time for a short break, she understands what’s going on and we don’t have to tell everyone else in the room what’s happening,” she says, adding that sometimes her boss will step in to continue a presentation if necessary. That might seem like a minor tweak to the process, but Mahon says it provides much-needed reassurance that her work can continue with minimal disruption.

Stick to your routine

Although IBD might not be predictable, your work schedule still can be, if you have the option of being flexible about location. That means making sure you’re able to work from home occasionally and that there’s a plan in place for those days, including having a home office setup and access to online company resources.

“Stay true to your usual routine as much as possible, which can help take some of the stress out of an IBD flare,” Whitfield says. “This can keep your life feeling normal while also giving your body time to recover.”

Of course, not everyone has the option of working from home, but if it’s a possibility for you and can alleviate some of the worry around being in the office, it’s helpful to incorporate at-home time when you can. If it’s not possible, Whitfield says that creating a more flexible work schedule could be another beneficial strategy. For instance, if being around so many coworkers makes you anxious about flares, you might swap one weekday for working on a weekend day so you’re in the office with fewer people.

Keep supplies on hand

Another part of preparation is knowing what you need so you have items at the ready, no matter what.

For Boston-based Keyla Caba, being anywhere that’s not home can be difficult with her IBD, particularly because she wears an ileostomy pouch—a special bag that collects waste from the colon—which must be emptied regularly. After years of fretting over the distance between her desk and restroom, she decided to make it a priority to make her experience more comfortable, and address her fears about not making it to the bathroom in time.

That has meant always having spare clothes at the office, as well as some sort of deodorizing spray, and a sign she would hang on her desk to let colleagues know she was having a flare and needed extra time away.

“This was the start of how I transformed the office bathroom into a peaceful experience for myself, and relieved my restroom anxiety,” Caba says. “Knowing that I have what I need on hand can reduce my fears about flares.”

Know your rights

Even if company management and HR are happy to accommodate your needs as someone with IBD, it’s still essential to know your rights as an employee, says Kia Roberts, principal and founder of Brooklyn, New York-based Triangle Investigations, which handles assessments of workplace misconduct. For example, she recently worked on a harassment case for a person with Crohn’s disease who wasn’t given accommodations by her manager.

“Most workplaces today understand the importance of not discriminating against employees based on protected characteristics like race, sexuality, gender, and ethnicity, but many employers do not understand the importance of having a policy on how employees with health issues should be treated within the workplace,” says Roberts. “If an employee feels they are being singled out for different treatment based on their health issues, that could represent discrimination on the part of the employer.”

Another important aspect of your rights: If your IBD is disabling, it’s protected under the Americans with Disabilities Act, which means your employer must make reasonable accommodations. You may also be covered under the Family and Medical Leave Act, which entitles eligible employees to take unpaid, job-protected leave for medical reasons—up to 12 weeks of leave within a 12-month time period.

Focus on gut-healthy lifestyle habits

Part of being more productive at work comes from what you do outside of the office, and that means implementing the right lifestyle behaviors, according to Dr. Ashkan Farhadi, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif. In addition to making sure you follow treatment protocols like medication you may be prescribed, you can lower risk of flares by focusing on gut health, he says.

“Diet will, of course, play a major role in your IBD management, but equally important are other habits that improve your gut microbiome,” Farhadi says. “The three most prominent are sleep, stress reduction, and exercise, because if you get those on track along with your diet, it can significantly reduce the frequency and severity of flares.”

For example, there’s a strong association between sleep difficulties and gut function, which can lead to more than just daytime sleepiness or flares at work. A 2018 study in the journal Frontiers in Psychiatry found that insomnia has been linked to poor immune function, difficulty absorbing certain nutrients, and depression.

Read More: These Environmental Factors Increase the Risk of IBD

Stay aware of potential overwhelm

Stress is another big challenge when it comes to avoiding flares, adds Dr. Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, Calif.

“Chronic stress has a ripple effect on your gut microbiome, which means it can impair your gastrointestinal system and keep it from functioning well,” he says. “When you have IBD, that means it could make your flares more intense, or could cause flares even if they’ve been well managed in the past.”

A significant part of better stress control comes from evaluating all aspects of your everyday activity, and that includes work. If you’re feeling frazzled, that’s another conversation to start with your supervisor and HR. “When someone has a chronic illness like IBD, remember that it should be a team effort in terms of management,” Whitfield says. “The more that people around you understand what’s going on, the more it will benefit you, your company, and your coworkers.”