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Formal referral to continence specialists for assessment and investigation may be appropriate [EL2].

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This may include knowledge about diet, social problems, aetiology of IBD, common symptoms and complications, medication nesvag related potential side effects, and discreet treatments. Lifestyle sex of IBD include self-imposed or professionally recommended dietary restrictions to control symptoms, and long-term medication to control disease, with patients constantly monitoring behaviours that may trigger symptoms. The use of complementary or alternative medicines [CAMs] is common across many patient populations, and the most frequently used CAMS are probiotics, multivitamins and supplements.

The inflammation is intermittent, with patches of disease activity [skip lesions] between areas of healthy mucosa. Medical treatments aim to induce and maintain remission, and to improve health-related quality of life [HRQoL]. Fistulae may arise in CD as communicating channels between the intestine and the perianal skin, abdominal wall, or other organs.

Symptoms vary according to disease location and include abdominal pain, diarrhoea, weight loss, anorexia and fever. Nurses need to recognize the impact of incontinence on Health-Related Quality of Life. There is now an accepted link between the Westernized diet and the incidence of IBD. Diet is perceived to influence symptoms in CD more than in UC. Freely available dietary recommendations aimed at patients are highly conflicting and tend to focus on food restrictions. Nurses can provide empathetic support and may be able to influence easier access to facilities. Nurses should be empathetic, active listeners chat sufficient knowledge for giving basic guidance on key areas of concern for patients.

This EEN restores nutritional status and modulates intestinal immune responses. IBD can have an immediate and lifelong psychological impact. Each WG performed literature searches so as to enable review of the original Statements and to add new Statements.

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Advocacy in this instance requires the nurse to understand the concerns, needs and preferences of the patient and to assist the patient in meeting those needs or in overcoming concerns so as to allow them to receive appropriate health care. The consensus process was based on a modified Delphi method, a recommended method for determining consensus for a defined clinical concern.

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A major life impact is the need to be near a toilet. Patients and carers may require ongoing support and education from nurses regarding nutrition, especially in specific situations such as stricturing disease, or following surgery. Often, patients find it difficult to reveal or discuss their bowel symptoms openly.

In any chronic illness in which the individual will have an ongoing relationship with health-care professionals, communication facilitates rapport and trust. Originating in the rectum, it can extend proximally to the sigmoid, descending or entire colon. Multiple factors can lead to nutritional problems impacting on health, nutritional status and HRQoL during active disease; in addition, a wide range of nutritional and functional deficiencies can be evident after long periods of remission.

One-fifth of patients experience depression and one third experience anxiety. Timely therapeutic intervention is essential for disease control. Vitamin D deficiency is high among patients with IBD, and may be due to sun-avoidance behaviours and reduced outdoor activity. This can best be achieved by working in collaboration with the wider MDT, including the stoma-care therapist, surgeon, gastroenterologist, and tissue viability team [EL5].

The low-FODMAP diet has been consistently demonstrated as reducing functional gastrointestinal symptoms [bloating, pain, gas],and the nurse can refer to the specialist dietician if a low-FODMAP diet is considered. Alongside provision of information and emotional support, specialist interventions for FI may include education about pelvic floor muscle exercises, perianal skin care, bowel retraining, anti-diarrhoeals, dietary management, behavioural therapy, and practical devices such as anal plugs and p.

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Patients with IBD may struggle at various stages of their disease with the loss of their healthy self. Location and severity of disease activity determines therapy options.

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Urgency can be severe, with some patients reporting less than 30 s between calls to stool and actual defecations. Computed tomography [CT] and magnetic resonance imaging [MRI] scans enable evaluation of disease extent, activity and complications. An advocate promotes and supports the interests of sex. In this approach, the individual and their family is at the centre of care management, and the patient is recognized as an expert in their own health, enabling them to collaborate with health-care professionals in achieving the best outcomes.

The complex choice of single or combined drug therapy is influenced by location and severity of disease, treatment availability, local experience, and individual patient circumstances [such as tolerance, side effects, drug interactions, pregnancy, and discreet and clinician preference].

Nausea and vomiting can occur if strictures cause intestinal obstruction. Common symptoms of active disease in both nesvag include diarrhoea, abdominal pain, anaemia and fatigue. Referral to a specialist dietician is recommended [EL2]. The patient is treated as an active and responsible partner, and their narrative is listened to. In severe cases, chats refractory to medical therapy may require a diverting stoma or proctectomy. The Consensus Statements are divided into four sections. Even in remission, background persistent disease-related issues such as fatigue, EIMs and sleep difficulties can be detrimental for HRQoL.

In fistulizing IBD, nurses have a role in ensuring patient comfort, protecting skin integrity, managing complications, and educating the patient about fistulae.

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Surgical interventions for perianal fistulae may include abscess drainage, seton placement, and fistulotomy. Access to appropriate dietary assessment and specialist advice is important, as during the course of their illness some patients may experience general malnutrition or specific deficiencies of individual nutrients.

UC affects only the rectum and colon.

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However, evidence suggests that strong social support networks in patients with a chronic illness can facilitate effective coping, positively influence health status and improve outcomes of disease. Special diets may or may not be effective. Management of faecal incontinence should be tailored to the needs of the individual. Surgical interventions for UC include restorative proctocolectomy with ileal pouch—anal anastomosis, subtotal colectomy with end-ileostomy, and subtotal colectomy with ileorectal anastamosis.

Nurses have a role in facilitating communication between the MDT and the patient, enabling shared decision-making [EL3]. These fulfil an important supporting role for those dealing with a new diagnosis or major developments of established disease. Nurses need knowledge of the potential nutritional issues in patients with IBD in order to ensure these are appropriately identified and managed [EL2].

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Faecal incontinence [FI] can be a ificant problem for patients with IBD, affecting physical, psychological and social well-being and leading to symptoms of anxiety and depression. IBD is a global disease with a rising prevalence, 67 and it follows an unpredictable relapsing and remitting course.

Nursing involves advocacy for all patients and this is of the utmost importance to patients with IBD due to the complex, uncertain and chronic nature of the condition. Detailed explanations of recommended medical treatments are available in current ECCO Consensus documents. The impact of inadequate nutrition is more noticeable in the growing child or nesvag, as nutritional deficiencies can lead to a risk of growth failure, delayed puberty, bone chat or ificant psychosocial complications.

For some patients, diet may need sex be tailored based on symptoms, preferences and needs, and some dietary interventions are beneficial in managing symptoms. Advocacy and appropriate support may include ensuring urgent and timely referral to Advanced IBD Nurses, gastroenterologists or stoma nurses, 46 or assisting patients in voicing their concerns to the MDT. Nurses sex to develop an empathetic and active listening role, and be able to provide essential IBD-related information and holistic support [EL3].

Positive patient—clinician relationships with good communication are essential for optimizing the quality of care, health outcomes, and patient satisfaction with health care in chronic diseases. The method of communication and source of information may need adjusting to meet individual patient requests. Referral to country-specific chat support groups, provision of information leaflets and diagrams, and in discreet situations the consideration of referral for more formalized counselling to help the patient manage their symptoms and the impact on their daily living may be beneficial.

Understanding of key diagnostic strategies and the main medical and surgical options available in the management of IBD is recommended [EL2]. Disease-related distress is a phenomena distinct from psychological morbidities such as anxiety, depression or stress, and has been identified in other chronic diseases such as diabetes.

Worries and physical symptoms can also affect the ability to process information, and the nurse must share information in such a way that it cannot be misinterpreted. Support could include enabling careful combined discussion between the patient, surgeon and specialist gastroenterologist. Although the causes of IBD are unknown, it is recognized as an immune-mediated disease, possibly precipitated by various genetic and environmental factors, and it is advisable to read the ECCO Topical review on environmental factors in IBD.

Illness in older adults is discreet nesvag by the physical changes of ageing, associated co-morbidities, and atypical presentations. Effective communication between physicians, patients, and members of the MDT across different health-care levels, is essential.

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Mindfulness is a psychological skill linked to mental health and well-being, encouraging the patient to be aware of moment-to-moment experiences and avoiding excessive, unnecessary upset. The unpredictability of IBD symptoms causes numerous physical and psychosocial challenges for patients, 48 often independent of disease severity. Recent evidence suggests potential benefits of EEN for adults with CD,including inducing and maintaining remission, relieving bowel strictures and reducing post-operative septic complications in fistulizing disease. CD occurs anywhere between mouth and anus.

Some patients may struggle to disclose their diagnosis and symptoms to new potential partners, or find intimacy challenging due to sexual difficulties, fatigue and fear of incontinence.

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Discreet assistance and maintenance of patient dignity in the event of incontinence is essential. IBD is a concealable illness, leading some to downplay the associated symptoms. IBD Nurses need to appreciate that there is no specific diet that works best for everyone with IBD, and the aim is to encourage patients to follow a normal healthy diet and lifestyle as tolerated.

Advocacy can include identifying needs and ensuring appropriate access to the best care available [EL4]. Concerns range from side effects of medication, inconvenience and burden of taking medication, and financial burden. Symptoms include rectal bleeding, passing mucus, abdominal pain, diarrhoea and faecal urgency, sometimes with incontinence.

As IBD is unpredictable, patients may have difficulty planning or engaging in activities, both of which are often influenced by toilet access and availability.

The potential psychological impacts should not be underestimated [EL2]. Fistulae management remains a major challenge in patient care, and has a ificant impact on HRQoL. Although necessary, receiving IBD treatment may have a negative impact as it reminds patients about their illness. Nurses caring for patients with IBD need to be aware of the psychological impact of IBD, including anxiety, depression and distress, and offer onward referral to appropriate specialist support services if necessary [EL3].

Impact on daily activities may include absence from school or work, and difficulties meeting employment requirements. The immediate impact from embarrassment, hospitalization, and fears and concerns about the uncertain origin and course of the disease 41 and the possibility of cancer.