IBD and College: Do the two play nicely?

Inflammatory bowel disease and collegeCollege students across the country are well into their second semester, bunkered into dorms and libraries and riding out the winter weather. Hopefully, especially for those first-year students, the challenges of navigating school and managing priorities seem a little less daunting. After all, adjusting well to college life is critical for success in school and is closely tied to graduation rates. So, it should come as no surprise when I say that successful college adjustment has lifelong implications for career opportunities, earning potential and future successes.

While this transition is difficult for all students, students with inflammatory bowel diseases (IBD) — like Crohn’s disease and ulcerative colitis — can attest to added challenges, such as maintaining their treatment regimen, avoiding common infections, and adjusting to shared bathrooms.

Recently, my colleagues and I surveyed college students from across the country — including students with and without IBD — to find out more on how IBD affects adjustment to college. Our results were published in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association (AGA).

We found that students with IBD don’t adjust as well to college as healthy students without IBD, and students with more active IBD did even worse.

For those IBD students out there, I offer the following tips to help you stay well while at college.

Take your medications. Figure out a way that will work for you to remember to take your medications every day. Try setting a recurring reminder on your phone. Get pill boxes that you can fill up a week at a time. Put your medications near your toothbrush or someplace you will routinely see them. Taking your medications is one of the most important ways to stay healthy, so do whatever it takes to remember. After all, medications don’t work if you don’t take them.

Check out student health services and the office of student disabilities. All colleges have student health services and most have an office or person who helps students with disabilities. While you may not be disabled or feel disabled, the office of disabilities can often help with important issues that can arise while at college. They may be able to arrange for you to have restroom access during classes and exams, or they may be able to arrange for untimed exams. In some schools, they can arrange for dorm rooms with private restrooms. Know what health services are available. Know what to do if you get sick. Can the student health service take care of your IBD? Most student health services cannot offer specialty care, but they may be able to help with other health issues, like arranging laboratory testing. Is there a local gastroenterologist office that can help? Take some time before classes start to find out the answer to these questions.

Get enough sleep. College students are notorious for pulling all-nighters. It is important for everyone to get enough sleep. This is especially important with IBD. Poor sleep can be caused by IBD, and poor sleep can make symptoms worse and make it more difficult to cope with health issues.

About alcohol. Alcohol may be readily available at college. It is important to know if this interacts with your medications. Two common IBD medications that can be problematic with alcohol are methotrexate (Trexall®) and metronidazole (Flagyl®). Other medicines can also be affected by alcohol. Alcohol can affect your liver, and can cause or aggravate many gastrointestinal symptoms. It is also always important not to drink and drive and not to drive with someone who has been drinking. Consider being the designated driver.

About caffeine and other stimulants. Caffeine may be seen as a necessity to get through college. While caffeine has not been linked to flares of IBD, caffeine use can cause loose stools or diarrhea, even in people without IBD. So be aware of your symptoms. Loose stools do not always mean you’re having a flare. There are many other herbal products that are marketed as stimulants. While these do not have any known advantages over caffeine, they may be problematic. Some may interact with IBD medications, and there have been reports of tainted herbal supplements. Ask your doctor if you are considering taking herbal or other products.

Infections. It is important to stay well and don’t let infections stand in your way. Most infections come from physical contact or sharing drinks or food. Use common sense. Wash your hands before eating, and don’t share drinks from the same bottle or cup. Some infections, such as influenza and chicken pox, are airborne. It is important be up to date with all your vaccinations. Influenza (flu) vaccine is recommended every year for all college students, especially if you are on immune-suppressing medications.

Sexually transmitted infections. Sexually transmitted infections (STIs) are unpleasant for anyone. Since many people with IBD are on immune suppressing medications, it is extra important to be careful and protect yourself against STIs. Consult with your doctor or with student health services for further advice on preventing STIs and for prompt evaluation and treatment if you think you may have been exposed to or may have an STI.

Plan for success. It’s import to remember to have fun at college. This is an important time for making friends and for new life experiences. Stay well so your illness doesn’t interfere with having a good time, and so you do well in school and have the best chance at a successful career after college.

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Jeremy Adler, MD, Pediatric GastroenterologyJeremy Adler, MD, MSc, is an Assistant Professor of Pediatrics and Director of Pediatric Inflammatory Bowel Disease Program at C.S. Mott Children’s Hospital. Dr. Adler’s clinical interests include childhood inflammatory bowel disease and successful transition from pediatrics to adulthood.  You can find him on Twitter at @JeremyAdlerMD.



best children's hospitalsUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.