Sick leave with IBS: What is applicable?


Many people who suffer from IBS experience that the symptoms affect their everyday life negatively and sometimes to such an extent that it is difficult to cope with work. But what really applies to taking sick leave with IBS ?

What does the National Board of Health and Welfare say about sick leave with IBS?

As part of (as they themselves put it) creating a uniform and legally secure sick leave process, the National Board of Health and Welfare issued a so-called insurance medical decision support in 2007. The decision support was issued in two parts, one of which deals with more general principles for sick leave, while the other contains recommendations on assessment of work ability and appropriate sick leave periods for different diagnoses.

Sedan 2007 har man vid något tillfälle även gjort mindre justeringar i rekommendationerna. I en tidigare version av riktlinjerna för just IBS från 20100615 som vi har tillgång till (du hittar en kopia av denna i referenserna nedan) fanns bland annat kortfattade skrivelser som…”Colon irritabile ger sällan så intensiva besvär att arbetsförmågan påverkas” “…och efter eventuell medicinering i form av bulkmedel brukar besvären avklinga inom några dagar.” “…kan återkomma mer eller mindre ofta bland annat beroende på patientens stresskänslighet och förändringar i livssituationen” “överrepresenterat bland patienter med samtidiga psykiska besvär”. Många med IBS besvär känner inte igen sig alls i detta och som tur är har man delvis lyckats utveckla denna skrivelse sedan 2010.

Bedömning av arbetsförmåga

För IBS (diagnoskod K58) finns idag istället följande rekommendation för bedömning av arbetsförmåga.

Since 2007, minor adjustments have also been made to the recommendations. In an earlier version of the guidelines for IBS from 20100615 that we have access to (you will find a copy of this in the references below) there were, among other things, brief letters such as … “Irritable bowel syndrome rarely causes such intense discomfort that work ability is affected” “. ..and after any medication in the form of bulking agents, the symptoms usually subside within a few days. ” “… may recur more or less often due to the patient’s sensitivity to stress and changes in the life situation” “overrepresented among patients with concomitant mental disorders”. Many people with IBS problems do not recognize themselves at all in this and fortunately they have partly managed to develop this letter since 2010.

Assessment of work ability

For IBS (diagnostic code K58), there is today the following recommendation for assessment of work ability.
“- Patients with IBS usually do not have a reduced ability to work. If the patient feels that the symptoms hinder work, reasons related to current tasks or to movement between home and work need to be analyzed.

During periods / relapses with extra pronounced symptoms , the ability to work may be reduced for one or a few days within the framework for personal sick leave.

A combination of factors , e.g. extra severe and long-lasting IBS symptoms, comorbidity, pronounced mental disorders, lack of coping strategies, concerns about other serious diagnoses, etc. may be the cause of longer sick leave needs . In that case, it should be clarified that it is the combination that together forms the basis for treatment and possible sick leave. “From The National Board of Health and Welfare’s website 20121011

The substrate

The basis for this assessment has been prepared by the following four experts in the field: Pontus Karling, Med dr, Chief Physician, Medicincentrum, Norrlands Universitetssjukhus, Umeå, Magnus Simrén, Professor, Chief Physician, Medicinkliniken, Sahlgrenska Universitetssjukhuset / Sahlgrenska, Göteborg, Hans Törnblom, Chief Physician, Med dr, Gastrocentrum Medicin, Karolinska University Hospital, Solna and Susanna Walter, Med dr, Specialist doctor, Endocrine-Gastrointestinal Medical Clinic, University Hospital, Linköping.

In the documentation you can read about definitions of symptoms
“IBS is a so-called functional gastrointestinal disease – a combination of abdominal pain / abdominal discomfort and stool disorders that lasts for more than 6 months. Other common symptoms are fatigue, sleep disorders, headaches, back pain or palpitations. “Chronic pelvic pain is also relatively common.”
forecast ….
“The prognosis is generally good and the diagnosis is not linked to an increased risk of death. In 5 years’ time, approximately 20-30% of the patients are judged to have such reduced symptoms that the diagnosis is not relevant.”
and treatment
“The most important measure is a clear diagnosis with information about what it means. Any treatment is chosen based on dominant symptoms (abdominal pain, gas, constipation, and diarrhea). The number of pharmacological treatment interventions should be limited to one at a time and the effect should be adjusted according to agreed intervals. For some patients with extra severe IBS symptoms, comorbidities or mental symptoms, psychological treatments may be appropriate. ”

IBS symptoms come in flares

There is also a section on so-called “Expected consequence for operating conditions”. This describes how the problems with IBS can actually affect the work situation. Since IBS problems usually come and go during periods (so-called relapses), it is especially during these that it can be difficult to cope with the work. However, the relapses can vary both in how long they last (one day to a week) and how often they return (from a few times a year to each month).

What can lead to difficulties in managing work during these relapses is the pronounced abdominal pain or difficult-to-control bowel movements, i.e. you have to rush to the toilet. Furthermore, the problems can cause mental strain and fatigue, which in turn, among other things can lead to difficulty in concentrating and decreased endurance. It is easy to imagine what problems this can cause for, example, a bus or taxi driver who is not sitting next to a toilet. For doctors and others who assess sick leave with IBS, it is important to make an individual assessment together with the patient about how long it is reasonable for one to take off before they can return to work.

Short-term problems

It is also described that the relapses in IBS are normally short-lived and very rarely last more than a week. As the problems become more long-lasting, the importance of various efforts to reduce the problems is emphasized. It is then considered not least that mental symptoms should then be paid attention to and treated. If the complaints should lead to a long-term sick leave with IBS, referral to a gastroenterologist for investigation of available treatment measures should take place.

In the links below, you can read about the recommendations in their original form and also take part in the data from the Swedish Gastroenterological Association that forms the basis for the insurance medical decision in support for IBS.