An invitation to lunch should be a small decision. Do we have time? Do we like the café? For someone whose day is organised around bowel symptoms, the decision may begin with a different set of questions. Where is the toilet? Will it be available? Can I manage the hygiene routine there? What happens if I need to go again before we leave?

Those questions belong in an occupational therapy assessment. They describe the effort required to participate in something ordinary. As clinicians working with housing and equipment, we need to understand that effort before deciding what to change.

Crohn’s disease, ulcerative colitis, irritable bowel syndrome and diverticulitis have different clinical mechanisms and management needs. The practical difficulties a person describes can nevertheless overlap. Pain, repeated toilet visits, urgency or fatigue may affect clothing management, transfers, cleansing and the ability to return to whatever they were doing. A diagnosis gives us clinical context. The person’s account tells us where to focus in the assessment.

What ‘independent’ can conceal

A person may transfer without assistance and still find the whole toileting routine exhausting. They may complete personal hygiene only through painful reaching, repeated attempts or a period of recovery afterwards. They may cope at home because everything is arranged within reach, then struggle in a workplace bathroom where the tissue dispenser is located behind them.

If we record only that the person is ‘safe and independent’, these issues are not accounted for.  The observation is accurate but incomplete. We have described the outcome without describing the cost.

The phone on low battery is a useful analogy. It still works, but every decision takes account of what remains. We close applications and save enough power for the journey home. A person managing fatigue may make a comparable set of choices about their day. The analogy opens a conversation; it cannot measure their energy or explain the cause of fatigue.

Crohn’s & Colitis UK estimates that fatigue affects around seven in ten people with Crohn’s or ulcerative colitis during a flare-up and four in ten during remission. These are approximate group figures, not a prediction for an individual. They remind us to ask about sustained function even when someone describes their disease as settled (Crohn’s & Colitis UK, 2025).

The bathroom in use

A bathroom can look accessible in a photograph while requiring function that is difficult for its user. The purposeful assessment begins when we consider the person carrying out the routine.

Where does the walking aid go while clothing is lowered? Can the person reach what they need without twisting or losing support? Does a rail assist one movement but obstruct another? Is there space for help when it is wanted and privacy when it is not? Each answer has consequences for specification.

Height is a good example. Raising a toilet can alter the effort involved in standing, but we must also consider sitting stability, foot support and the person’s method of transferring. A higher seat is not a complete clinical rationale. We need to describe the movement it supports and what happens to the rest of the task.

The same thinking applies outside the room. A short route can become unusable if the toilet is locked and the key is elsewhere. For a teacher who needs someone to take over a class, the barrier may be the availability of cover. An environmental intervention can involve changing a routine or an agreement between colleagues.

A question before an equipment choice

Consider Maya, a fictional example case. She has Crohn’s disease and works in a small office. She can get on and off the toilet independently, but reports fatigue and painful reaching during cleansing. After repeated visits, she sometimes finishes her working morning at home and misses lunch with colleagues. Her employer has asked for an occupational health assessment.

As occupational therapists we may first ask about her existing clinical advice, pain and barriers. Then we would then explore the hygiene routine, how it changes through the morning and the differences between home and work. Her goal is to complete her working morning and stay for lunch. A recommendation confined to her home bathroom might leave the difficulty at work unresolved.

A wash-and-dry toilet could be one option to assess if water-based cleansing is appropriate and it addresses the movement she finds difficult. The assessment question should be: Can Maya achieve comfortable, effective cleansing and drying with less painful reaching? We should compare relevant alternatives and hear her preference. A product demonstration alone cannot answer the question.

The assessment must include a review of operating the controls, positioning, clothing and getting up afterwards. We also need to consider cleaning, maintenance and what she would do if the equipment were unavailable.

Clinical care and occupational care

Occupational therapy environmental intervention works alongside medical care. Crohn’s and Colitis involve inflammation; IBS is a disorder of gut–brain interaction; diverticulitis involves inflamed diverticula and can require urgent treatment. New or worsening symptoms need appropriate clinical review. We should not assume that a familiar diagnosis explains every change, or expect equipment to solve a problem that needs medical assessment.

The occupational therapist’s contribution is to identify how symptoms and surroundings affect everyday activity. That may lead to a small change in positioning, a different hygiene method, temporary transfer support or a more substantial adaptation. It may also lead to a conversation with the person’s wider team before any recommendation is made.

Returning to the occupation

When reviewing, the first question is whether the intervention addressed the difficult step. The next is what that changed in the person’s life. For Maya, we would ask about her experience of toileting and whether she can remain for the lunch she values. We would record changes in treatment and working arrangements as well, so that an improvement is not automatically attributed to a single item of equipment.

This is the part of housing and equipment practice that reaches beyond a plan drawing or a specification. In this example, we are trying to make a work environment usable for someone with a particular body, routine and purpose. The question after “Can you manage?” should be: “What does managing cost you, and what would you like to do afterwards?”

Sources

Crohn’s & Colitis UK (2025) Fatigue. Available at: https:/​/​www.crohnsandcolitis.org.uk/​info-​support/​information-​about-​crohns-​and-​colitis/​all-​information-​about-​crohns-​and-​colitis/​symptoms/​fatigue (Accessed: 14 September 2026).

NHS (2025a) Crohn’s disease. Available at: https:/​/​www.nhs.uk/​conditions/​crohns-​disease/​ (Accessed: 14 September 2026).

National Institute of Diabetes and Digestive and Kidney Diseases (2017) Definition & facts for irritable bowel syndrome. Available at: https:/​/​www.niddk.nih.gov/​health-​information/​digestive-​diseases/​irritable-​bowel-​syndrome/​definition-​facts (Accessed: 11 September 2026).

NHS (2023) Diverticular disease and diverticulitis. Available at: https:/​/​www.nhs.uk/​conditions/​diverticular-​disease-​and-​diverticulitis/​ (Accessed: 14 September 2026).