We’ve invited health psychologist Dr Megan Arroll and author of “Irritable Bowel Syndrome: Navigate Your Way to Recovery” to give advice on how you can manage your return to work in these uncertain times.
Return to work anxiety and IBS – how to cope and prevent symptom flare-ups
COVID-19 has had a huge impact not only on our health directly, but on the way we live and work. Now that we are being encouraged back into the office, many people are experiencing heightened anxiety – particularly those with underlying gastrointestinal disorders such as Irritable Bowel Syndrome. The thought of getting on busy commuter trains, not being able to access a toilet due to social distancing and the overarching uncertainty of the pandemic can all lead to IBS symptom flare-ups.
For many, just the fear of uncontrollable symptoms in the ‘new normal’ world can lead to sleepless nights. So if you’re preparing for a return to work, here are some psychological techniques to manage anxiety and practical tips to cope with the post-lockdown environment.
Why does anxiety make IBS worse?
The brain and gut are connected by a super-highway called the brain-gut axis – you may have noticed that during very stressful times your symptoms spike, which frustratingly can lead to feeling even more stressed! Therefore, it’s important to integrate stress management techniques into an overall IBS treatment plan – the relationship between our minds and bodies is very real, with one affecting the other.
This is why taking a multifaceted approach of practical, psychological and physical remedies is useful when dealing with a potentially stress-inducing transition such as going back to work.
Planning and preparing for a return to work
- If you haven’t had one already, ask your employer for a COVID-19 risk assessment. Although IBS is not a listed risk factor for COVID-19, you may have other underlying conditions or risk factors that should be taken into account such as age, weight and/or pregnancy which need to be considered in your return to work plan.
- At this time, mention any concerns you have about coming back into the workplace. You might be worried about some reports of ‘one in, one out’ toilet facilities so this is a good opportunity to clarify the social distancing policy at your place of work.
- Ask what adjustments can be made (if any) for your return to work – it may be that your office can dedicate certain facilities for employees with GI issues. Having this conversation with your line manager will help them to put into place what you need for a smooth return.
- If there are limited occupational adjustments that can be made, visit the IBS Network and order a Can’t Wait Card to help gain access to toilet facilities when you need them most (https://www.theibsnetwork.org/cant-wait-card/).
- View the government’s guidelines to working safely during COVID-19 for your particular type of workplace as these differ between sectors (https://www.gov.uk/guidance/working-safely-during-coronavirus-COVID-19).
Products and return-to-work kit
- Even with all the planning in the world, flare-ups can happen so pack your own personal IBS kit to help you feel more comfortable about being out of the home, travelling or in different environments. What’s in it depends on your unique constellation of symptoms, but as a good starting point you might want to pack flushable wet wipes, scented spray, a change of underwear with sealable plastic bag and acute symptom relief medications. Most of the time, simply having this kit acts as a comfort blanket to reduce the fear of symptom flares – so you may never use it but it’s good to have just in case.
- Before heading back into the workplace, soothe the gut with a product such as Silicol®gel. As our mind and gut interact, getting stomach irritation under control before stressful times can help control severe symptoms. Silicol®gel contains silicic acid which coats the lining of the stomach and intestines by physically attracting and adsorbing most irritants, toxins and pathogens without removing nutrients or ‘good’ bacteria.
Psychological techniques to calm back-to-work anxiety
In addition to soothing the gut physically, we can calm the GI system with our minds. Psychological techniques such as gut-directed hypnotherapy, guided imagery, relaxation exercises and cognitive behavioural therapy are all science-backed approaches for the management of IBS symptoms.
Like all skills, the more you practice these types of techniques, the more effective they will be so start using an exercise such as below before a stressful event occurs – this way you’ll be in good mental shape when returning to work.
- Sit or lie down comfortably and place your right hand on your belly and your left hand on your upper chest.
- Breathe in for a count of three, and out for a count of four. You should feel your right hand lift and dip in step with your breathing, while your left hand should be still. If your left hand is moving, this is indicative of stress breathing so concentrate on pulling the breath through your abdomen.
- Take a few moments to ground yourself just through your breath.
- Now, imagine a landscape that represents your gut when it’s at its worst – for some this may be a white-water river, for others a racing car that’s out of control. Bring to mind what’s meaningful to you.
- Next, turn your attention to your right hand feel its warmth radiate through your stomach.
- Now use the power of your mind to imagine this warmth helping the river waters slowly still, or the racing car’s speed coming under control, as you breathe deeply through your belly.
- Once you see your landscape as quiet, controlled and calm, inhale and exhale for another few moments and re-enter the present.
Travel tips for commuters
- Check trains and bus timetables even if it’s a route you’ve taken for years as these may have been updated since lockdown. If you’re based in London, the Travel for London has a handy Journey Planner (https://tfl.gov.uk/) and for those across the UK, National Rail Enquiries gives best routes from stations or postcodes (https://ojp.nationalrail.co.uk/service/planjourney/search). You can also switch on travel alerts so if your train is delayed or cancelled, you’ll be notified as soon as possible, which can make disruption easier to deal with.
- Face coverings are required on public transport unless you are exempt, for instance due to illness or disability (https://www.gov.uk/government/publications/staying-safe-outside-your-home/staying-safe-outside-your-home#face-coverings). Pack your face coverings ahead of time to avoid last minute panic when you’re leaving home. If you don’t have these yet, you can make your own cloth face coverings (https://www.gov.uk/government/publications/how-to-wear-and-make-a-cloth-face-covering/how-to-wear-and-make-a-cloth-face-covering).
- On your first few days back at work, leave early so that you can adjust to travelling again. This will allow you to cope with any unforeseen travel issues or give you extra time in case you do need to stop for the loo on your way.
- Download the Toilet Finder app on your phone just in case you need to locate a public toilet on your journey (https://apps.apple.com/au/app/toilet-finder/id311896604).
Further help and free online resources
- NHS Every Mind Matters gives a free personalised ‘Mind Plan’, recently updated for the coronavirus (COVID-19) outbreak: https://www.nhs.uk/oneyou/every-mind-matters/your-mind-plan-quiz/?WT.tsrc=Search&WT.mc_id=Brand&gclid=CjwKCAjwsMzzBRACEiwAx4lLG77CGG7TXfFR9ywf9CL8ydy8HokuCAfzvDUNyWoOfVKs79EenhVVUBoCDz0QAvD_BwE
- Talkspace offers a free Coronavirus Resource Hub which includes features, videos, and tips from therapists and experts on how to cope with the stress of COVID-19: https://www.talkspace.com/blog/coronavirus/
- The mindfulness app Headspace has free meditations on its website including a 3-minute anti-panicking mediation: https://www.headspace.com/COVID-19?utm_campaign=later-linkinbio-headspace&utm_content=later-5911238&utm_medium=social&utm_source=instagram