Stress in one's life and the way you cope with it will affect illness. Opinions have changed on the role of stress in IBD over the years. Initially, there was an unfortunate belief that Crohn's disease and ulcerative colitis were "psychosomatic diseases," meaning that they are caused by psychological factors. When it became clear that this was not true, there was a backlash against the stigma that had been caused by the psychosomatic theory. The unfortunate result of the backlash was to silence those who still felt that there was some connection between stress and their disease.

Most people with IBD, but certainly not all, believe that there is some link between stress or other psychological factors and the course of their illness. Lately, research findings have backed up this belief. Research at Mount Sinai is investigating the possibility that ulcerative colitis comes in different varieties — a type that is stress sensitive and a type which stress does not affect. We may be able to better understand how stress is translated into physical changes in the immune system that affect the course of IBD.

Coping with Inflammatory Bowel Disease, or dealing with the stress of surgery means dealing with a variety of problems including: suffering, uncertainty and fear about the future, limitation in physical ability, pain, changes in social relationship roles, doubt about physical attractiveness or competence, negotiating and communicating with a complex medical system that can be confusing, and frightening. The following discussion on stress and coping will hopefully allow you to recognize if you are suffering from stress and gain some insight into how to effectively handle stress.

How do I know if I am suffering from stress?

Each person handles stress differently. Some people actually seek out situations which may appear stressful to others. A major life decision, such as changing careers or buying a house, might be overwhelming for some people, while others may welcome the change. Some find sitting in traffic too much to tolerate, while others take it in stride. The key is determining your personal tolerance levels for stressful situations.

Stress can cause physical, emotional and behavioural disorders which can affect your health, vitality, peace-of-mind, as well as personal and professional relationships. Too much stress can cause relatively minor illnesses like insomnia, backaches, or headaches, and can contribute to potentially life-threatening diseases like high blood pressure and heart disease.

What are the Signs of Stress?

• The most common signs of stress for most people are:

• Tiredness / exhaustion

• Muscle tension

• Irritability / anger

• Upset stomach

• Nervousness / trembling

• Sleeplessness

• Cold, sweaty hands

• Loss of or increase in appetite

• Grinding teeth / clenching jaws

• General body complaints (weakness, dizziness, headaches or pain in the back or muscles)

Tips for Reducing or Controlling Stress

• Be realistic. If you feel overwhelmed by some activities (yours and/or family's), learn to say no! Eliminate an activity that is not absolutely necessary. You may be taking on more responsibility than you can or should handle. If you meet resistance, give reasons why you're making the changes. Be willing to listen to other's suggestions and be ready to compromise.

• Shed the "superman/superwoman" urge. No one is perfect, so don't expect perfection from you or others. Ask yourself, "What really needs to be done?" How much can I do? Is the deadline realistic? What adjustments can I make?" Don't hesitate to ask for help if you need it.

• Meditate. Just 10 to 20 minutes of quiet reflection may bring relief from chronic stress as well as increase your tolerance to it. Use the time to listen to music, relax and try to think of pleasant things or nothing.

• Visualize. Use your imagination and picture how you can manage a stressful situation more successfully. Whether it's a business presentation or moving to a new place, many people feel visual rehearsals boost self-confidence and enable them to take a more positive approach to a difficult task.

• Take one thing at a time. For people under tension or stress, an ordinary workload can sometimes seem unbearable. The best way to cope with this feeling of being overwhelmed is to take one task at a time. Pick one urgent task and work on it. Once you accomplish that task, choose the next one. The positive feeling of "checking off" tasks is very satisfying. It will motivate you to keep going.

• Exercise. Regular exercise is a popular way to relieve stress, 20 to 30 minutes of physical activity benefits both the body and the mind.

• Hobbies. Take a break from your worries by doing something you enjoy. Whether it's gardening or painting, schedule time to indulge your interest.

• Healthy lifestyle. Good nutrition makes a difference. Limit intake of caffeine and alcohol (alcohol actually disturbs regular sleep patterns), get adequate rest, exercise, and balance work and play.

• Share your feelings. A conversation with a friend lets you know that you are not the only one having a bad day, caring for a sick child or working in a busy office. Stay in touch with friends and family. Let them provide love, support and guidance. Don't try to cope alone.

• Give in occasionally. Be flexible! If you find you're meeting constant opposition in either your personal or professional life, rethink your position or strategy. Arguing only intensifies stressful feelings. If you know you are right, stand your ground, but do so calmly and rationally. Make allowances for other's opinion and be prepared to compromise. If you are willing to give in, others may meet you halfway. Not only will you reduce your stress, you may find better solutions to your problems.

• Go easy with criticism. You may expect too much of yourself and others. Try not to feel frustrated, let down, disappointed or even"trapped" when another person does not measure up. The "other person" may be a wife, a husband or child whom you are trying to change to suit you. Remember that everyone is unique, and has his or her own virtues, shortcomings, and right to develop as an individual.

Where to Get Help?

Help may be as close as a friend or spouse. But if you think that you or someone you know may be under more stress than just dealing with a passing difficulty, it may be helpful to talk with your doctor, spiritual advisor, or employee assistance professionals. They may suggest you visit with a psychiatrist, psychologist, social worker, or other qualified counsellor.

The section "How do I know if I am suffering from stress?" was adapted from the National Mental Health Association (www.nmha.org) fact sheet"Stress - Coping With Everyday Problems".