Recently, a creator went live and dropped the “perseverance mask” that so many men with chronic illness wear until they break. He shared this raw, unfiltered reality:
“All right, let’s talk about right now. I’m really struggling right now... a lot of you know I have ulcerative colitis, but none of you really understand what my life is like whenever I’m in a flare... I’ve been in a flare for the last [while]... s** my pants multiple times a week. Yesterday, my pants three times. It’s diarrhea. I can’t control it. I don’t know when it’s going to happen... It’s embarrassing. I have to come upstairs, clean myself up, and go about my day like everything’s fine, but it’s fed. I’m using the bathroom with bloody diarrhea anywhere from 8 to 15 times a day... I can’t show up as me right now. I show all the highs and I show all the good stuff and show myself trying to persevere through this, but this is the reality... and no one fing gets it. How could you? ... I’m trying to show up for my clients and build my business and post content and show people that I persevere despite this, but right now, I’m getting my fing ass kicked. I’m getting beat up right now. That’s fing hard. So hard, man... I feel like as a man, I always put the mask on and persevere and push forward... but it’s not all sunshine and rainbows. It’s very isolating. It’s hard to feel like no one gets it. I’ve already failed two medications in just over a year... I just wanted to drop the mask for the day.”*
When you are a man dealing with a severe chronic illness like Ulcerative Colitis (UC), the battle isn’t just physical. It is a psychological warfare that attacks your dignity, your autonomy, and your identity as a provider, business owner, or partner. Yet, even in the midst of these invisible battles, it takes tremendous strength to keep showing up day after day. It is important to remember that support exists, healing is possible, and hope can be rebuilt, even when things feel at their hardest. If you are struggling right now, take one small step: reach out to a friend, family member, or a support group, just send a quick message or share a few honest words with someone you trust. You might consider online forums such as the Crohn’s & Colitis UK Forums, Men’s Health Forum communities, Reddit groups like r/IBD or r/ChronicIllness, or local men’s support groups focused on chronic illness. Even a single text, post, or conversation can be the first crack that lets some light back in.
How does chronic illness impact men’s mental health and masculinity?
When you are a man dealing with a severe chronic illness like Ulcerative Colitis or Crohn’s disease, the battle is never purely physical. This psychological warfare can unfold just as powerfully for men living with other long-term health conditions, such as multiple sclerosis, rheumatoid arthritis, diabetes, or chronic pain. No matter the diagnosis, a chronic illness directly attacks your dignity, your autonomy, and your foundational identity as a provider, business owner, or partner. Society teaches men that their value is fundamentally tied to their productivity, physical strength, and unyielding emotional resilience. A severe chronic illness violently disrupts this life script, leaving a man to navigate a profound identity crisis in complete isolation.
If you are feeling this way, try one small action today: as I said already, reach out to a trusted peer or write down a few honest thoughts about your experience. Even a single text or short journal entry can be the first step to breaking that sense of isolation. There are other manageable ways to reconnect with yourself, too: consider joining a low-pressure online chat or forum, or explore guided journaling prompts specifically designed for people living with chronic illness. Practicing basic self-compassion, such as simply acknowledging how hard things truly are, can be a powerful first step toward self-acceptance and healing.
The trauma of losing basic bodily autonomy triggers an intense, cyclical psychological shame. Coming upstairs to clean yourself up after an accident and then immediately logging onto a business call requires a staggering level of compartmentalisation. Over time, this forces men to wear a psychological mask of wellness. They hide the blood, the weight loss, and the absolute exhaustion just to keep the people around them comfortable or to protect their professional reputation.
This constant masking leads to a state of hyper-reflexivity, where you are trapped in a loop of monitoring your body for the next urgent symptom while simultaneously burning through your remaining energy to project an image of perfect health. Furthermore, failing multiple advanced medications in a short period induces a form of medical trauma and learned helplessness. Every failed treatment feels like a personal failure of the will, even though it is completely out of your control. Again, society teaches men that value is tied to productivity, physical strength, and stoicism (”push forward, persevere”). A severe chronic illness violently disrupts this script.
The Trauma of Autonomy Loss
For a man, losing control over his own bodily functions (e.g., ruining his clothes multiple times a week) triggers intense psychological shame. This isn’t just discomfort; it is a recurring, unpredictable trauma. Coming upstairs to clean yourself up and then walking back down to a business call or a client meeting requires an exhausting level of compartmentalisation.
The Identity Crisis and “The Mask”
When he says, “I can’t show up as me right now,” he is describing a severe Script Disruption (Transactional Analysis). His internal script is to be the successful business owner who perseveres. The reality is that his body is “beating him up.” To cope, men put on a mask of wellness, hiding the fact that they are bleeding, losing weight, and exhausted. This creates profound Hyper-Reflexivity, constantly monitoring your body, terrified of the next urgent symptom, while pretending to be perfectly fine to the outside world.
Medical Trauma and “Failing” Treatments
When you “fail” multiple biologic or immunosuppressant medications in a short period, it induces a sense of learned helplessness. The psychological weight of pinning your hopes on a new drug, waiting months, and having your body reject it feels like a personal failure, even though it is completely out of your control.
How Counselling Can Help Men with Chronic Illness
Processing the Trauma of the “Accident” (Desensitisation)
Therapy provides a safe, completely non-judgmental space to say the words: “I pooped my pants three times yesterday.” Therapists use modalities like Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to separate your core identity from your symptoms. We help de-escalate the catastrophic shame associated with accidents, retraining your nervous system so that a flare doesn’t send you into a panic-induced fight-or-flight spiral.
What does a typical first session look like? In your initial meeting, the therapist will invite you to share only as much as you feel comfortable. You may start by simply describing what brings you to therapy and the physical and emotional challenges you are facing. The focus will be on creating a sense of safety. Your therapist might ask about your current daily routine, your support systems, and how your symptoms affect your work and relationships. There is no expectation to share everything right away, often it is about building enough trust to acknowledge the reality of your situation and realising that there is no judgment in the room. You can take a break if you need to step away, and you set the pace for the discussion. By the end of the first session, you will likely feel a sense of relief, having said things out loud you may never have told anyone, and a clearer idea of how therapy can help you move forward.
Retiring the “All-or-Nothing” Masculine Mask
In therapy, we address the exhausting cycle of showing “only the highs.” We work to dismantle the toxic belief that showing vulnerability or admitting your body is failing you makes you “weak.” True resilience isn’t pretending you aren’t bleeding 15 times a day; it is having the courage to drop the mask so your support system can actually see you and reduce your isolation.
Processing Grief and Medication Failure
Every time a medication fails, there is a bereavement period. A therapist helps you process the anger, grief, and fear that come with a chronic, unpredictable disease. We move you from a state of fighting your own body to a state of radical acceptance, which doesn’t mean giving up, but means stopping wasting precious energy wishing things were different and instead dealing effectively with what is.
Reasonable Adjustments: Restructuring Work and Life
Navigating a career or building a business while fighting a chronic illness also requires implementing aggressive, strategic lifestyle adjustments. Because a standard professional blueprint does not account for a body in crisis, you must restructure how you work to protect your remaining energy. This means moving away from rigid schedules and utilising asynchronous blocking, such as scheduling client meetings and high-cognitive tasks strictly in the afternoons when morning flares have typically subsided. Other helpful strategies include setting task reminders to manage brain fog, delegating administrative work or daily errands when possible, and batching emails or messages to reduce cognitive overload. Using shared calendars or project management apps can also help you keep track of priorities and communicate availability without constant check-ins, making it easier to adapt your workload around unpredictable health needs. Even small adjustments, like scheduling brief rest periods between calls or letting colleagues know when you might be offline for medical reasons, can make a major difference in sustaining your energy and mental health throughout the workday.
A common concern for many men with chronic illness is whether or how to disclose their condition at work. Deciding what to share, and with whom, is a highly personal decision that often involves weighing privacy against the potential for understanding and practical support. You may choose to share only the basics of your health needs with specific supervisors or HR, or you might decide to confide more openly in trusted colleagues. If you are not sure how to start, here are a few sample phrases you could use to begin the conversation:
“I have a chronic health condition that sometimes affects my energy and needs during the workday. There may be times when I need flexibility or short breaks, and I wanted to let you know in case unexpected absences occur.”
“I wanted to share that I live with a medical condition that is mostly invisible but sometimes requires doctor’s appointments or changes to my regular schedule. If I ever need to adjust my work hours or work remotely on short notice, I will do my best to communicate in advance.”
“There may be days when I am managing symptoms that impact my concentration or ability to be present in meetings. I’d appreciate your understanding if I occasionally need to step away or reschedule.”
It is helpful to consider what reasonable adjustments you need in order to perform your job safely and effectively, and to communicate those needs clearly without feeling pressured to share more personal details than you are comfortable with. Having even one or two people at work who understand your situation can reduce stress and help create a more supportive environment when unpredictable symptoms or medical absences occur.
Additionally, managing the anxiety of leaving the house requires practical environmental control. Keeping a discreet emergency go-bag in your office or vehicle containing a full change of clothes, wet wipes, and necessary medications lowers your baseline anxiety, which ironically reduces stress-induced physical flares.
Finally, managing nutrition during a flare requires letting go of the guilt of survival eating. Even simple options, like sipping on clear broths, eating plain white rice, or snacking on peeled bananas and rice cakes, can help calm your gut and provide some energy without overwhelming your system. Prepping easy-to-digest snacks in advance, such as portioning out applesauce, plain crackers, or lactose-free yoghurt, can make eating feel less daunting when your appetite is low. Consider preparing small containers of cooked soft vegetables, peeled fruit, or overnight oats, so you have nourishing options on hand without extra effort on difficult days. For times when cooking feels impossible, relying on meal delivery services that offer plain, gut-friendly meals, or keeping a stash of shelf-stable options like rice pouches and canned soups, can relieve pressure and ensure you have something to eat. Working with a GI-specific dietitian to incorporate high-calorie, low-residue elemental formulas can also help you maintain your weight and take the pressure off meal preparation when your appetite is entirely gone. Dropping the mask is not an act of defeat, but a necessary step to stop fighting against your own body and finally begin navigating life on your own terms.
What to Ask and What to Expect From Your Counsellor
If you are a man dealing with a severe, active flare of an illness like Ulcerative Colitis, taking the step to find a counsellor can feel daunting. Many people feel anxious, unsure, or even embarrassed about starting therapy, and that is completely normal. It is common to worry about the logistics of sitting through a session, or to fear that a therapist won’t understand the physical reality of what you are going through. Acknowledging these feelings can actually be an important first step. To help make the search more manageable, you might explore therapist directories such as Psychology Today, Therapy Directory, or GoodTherapy. There are also chronic illness-focused networks like the Chronic Illness Therapist Network, the National Association for Chronic Illness Support, or online forums that maintain lists of recommended professionals. Some disease-specific organizations, such as Crohn’s & Colitis UK or the Crohn’s & Colitis Foundation, also offer support lines or referrals to therapists with experience in gastrointestinal and chronic conditions. Using these resources can help you feel less overwhelmed and more empowered to find a therapist who understands your unique situation.
If you feel stuck or overwhelmed, try taking one simple action to begin: search online for therapists in your area who mention experience with chronic illness or gastrointestinal conditions, or prepare a short email introducing your situation and asking if they have worked with similar clients. You could also jot down a few questions or concerns you have about therapy. Even small steps like these can help lower the inertia and put you in control of the process. Knowing what to look for and what questions to ask can help you find a professional who will adapt to your needs, rather than forcing you to adapt to theirs.
What to Ask a Potential Counsellor Before You Start
When you are reaching out to a therapist, you have the right to interview them to ensure they are a safe fit for your condition. If a therapist does not have direct experience with chronic illness or gastrointestinal conditions, you can ask about their willingness to learn about your needs or adapt their approach. It is also helpful to seek recommendations from peers or support groups who have found understanding professionals. You can send these questions in an initial email or bring them up during a brief consultation call:
- “Do you have experience working with clients who have chronic illness or gastrointestinal conditions like IBD?”
- “If I have an unpredictable physical flare-up or an accident, what is your cancellation policy, and can we pivot to a shorter phone session at the last minute?”
- “For face-to-face sessions, how close is your office to the nearest private restroom, and is it easily accessible during our time?”
- “Are you comfortable with me stepping away abruptly mid-session if I have a medical urgency, without me needing to apologise or stop the session entirely?”
- “Can we structure our sessions flexibly, such as doing shorter, twenty-five-minute check-ins if I am too exhausted or sick to sit through a full hour?”
What to Expect in Face-to-Face Appointments
In a traditional office setting, a qualified counsellor will proactively structure the environment to lower your baseline anxiety. You should expect an open-door restroom policy, meaning the therapist will explicitly establish on day one that you have standing permission to leave the room whenever necessary.
The physical setup of the room should also honour your comfort. Your chair should give you a clear, unobstructed path to the exit so you never feel trapped or awkward as you leave the room. Furthermore, a supportive therapist will welcome you to bring comfort items into the space, such as a heating pad for abdominal cramping, a water bottle, or your emergency go-bag, ensuring the room feels like a safe sanctuary rather than a rigid clinical trial.
What to Expect in Online or Telehealth Appointments
Virtual therapy eliminates the stress of a commute, but it requires a therapist who understands physical stamina and screen fatigue. You should expect your counsellor to offer camera flexibility, meaning you are completely welcome to turn your video off, mute your microphone, or step away entirely if an urgent physical need arises while they hold the virtual space for you.
You should also expect a complete release from traditional corporate or academic postures. A counsellor who understands chronic illness will explicitly invite you to lie down in bed, prop yourself up with pillows, or change positions throughout the call to manage fatigue, pain, or weight loss. Finally, if looking at a screen becomes too taxing due to a heavy flare or a lack of sleep, you can expect your therapist to seamlessly switch the appointment to a traditional audio phone call so you can still receive support without the physical strain.
Reasonable Adjustments: How Counsellors Can Adapt Online and Face-to-Face Therapy
When working with male clients navigating a severe, active flare of a condition like Ulcerative Colitis, the traditional therapeutic structure must be adapted to reduce anxiety and honour their physical reality. Therapists cannot expect a client to sit through a rigid, unyielding fifty-minute session when they are actively experiencing panic over bowel urgency. By making practical, empathetic adjustments in both face-to-face and virtual settings, counsellors can create a truly safe container that reduces shame and allows the client to show up authentically.
Adjustments for Face-to-Face Appointments
In a traditional office setting, the primary source of anxiety for a client with a gastrointestinal illness is the physical environment. Counsellors can significantly lower this baseline stress by proactively addressing logistics before the client even arrives.
The “Open Door” Restroom Policy: At the very beginning of the therapeutic relationship, the counsellor should explicitly state that the client has a standing, unconditional permission to interrupt the session at any moment to use the restroom, without needing to explain or apologise.
Strategic Room Selection: The therapy room should be located as close to a restroom as possible. If the clinic has multiple bathrooms, guiding the client to the most private or single-occupancy restroom can dramatically reduce social anxiety and shame.
Flexible Seating and Comfort Elements: The seating arrangement should allow the client easy, direct access to the exit without having to awkwardly squeeze past the therapist. Additionally, keeping the room at a comfortable temperature or offering a heating pad can help soothe abdominal cramping during intense conversations.
Adjustments for Online/Telehealth Appointments
While virtual therapy eliminates the stress of commuting, it introduces unique challenges regarding stamina, posture, and screen fatigue during a physical crisis. Online adjustments allow the client to engage in deep psychological work from the safety of their home without exacerbating physical pain.
Camera-Flexibility and “Off-Screen” Breaks: The counsellor should establish a rule that the client is welcome to turn off their camera or step away from the screen immediately if an urgent physical need arises. The session does not need to terminate; the therapist can simply hold the space until the client returns.
Supportive Posture and Formatting: Traditional therapy assumes the client is sitting upright facing a camera. For a client dealing with severe fatigue, cramping, or weight loss, sitting upright for an hour can be agonising. Counsellors should explicitly welcome the client to lie down, propped up with pillows, or use a laptop in bed.
Session Length Modulation: If a client is in a severe flare, bleeding heavily, or mentally exhausted from sleep deprivation, a standard fifty-minute session might be physically impossible. Therapists can offer split sessions, such as two 25-minute check-ins a week, or switch to an audio-only phone call if looking at a screen becomes too taxing.
Looking for Counselling for Chronic Illness, Medical Trauma or Men’s Mental Health in Reading?
Living with a chronic illness can affect far more than your physical health. Conditions such as Ulcerative Colitis, Crohn’s disease, Irritable Bowel Syndrome (IBS), Multiple Sclerosis (MS), Rheumatoid Arthritis, Chronic Fatigue Syndrome (ME/CFS), Fibromyalgia, diabetes, chronic pain, long COVID, autoimmune conditions, and other long-term health problems can have a profound impact on confidence, relationships, work, identity, anxiety, depression, and overall mental wellbeing.
As a counsellor based in Reading, Berkshire, I provide therapy for men and adults living with chronic illness, invisible illness, disability, medical trauma, health anxiety, burnout, grief, emotional overwhelm, workplace stress, relationship difficulties, and the psychological impact of long-term health conditions.
Many people search online for counselling for chronic illness in Reading, therapy for Ulcerative Colitis, Crohn’s disease counselling, medical trauma therapy, health anxiety counselling Reading, IBD mental health support, therapy for chronic pain, counselling for autoimmune disease, support for men with chronic illness, therapy for invisible illness, psychotherapy for long COVID, counselling for MS, therapy after serious illness, or BACP counsellor Reading. If these experiences resonate with you, therapy can provide a confidential, compassionate space to process what you are living through without having to put on a brave face.
I work with clients across Reading, Caversham, Tilehurst, Earley, Lower Earley, Woodley, Shinfield, Calcot, Purley on Thames, Theale, Pangbourne, Sonning, Twyford, Wokingham, Bracknell, Henley-on-Thames, Newbury, Thatcham, Burghfield Common, Mortimer, Winnersh, Maidenhead, Basingstoke, Didcot, Wallingford, Abingdon, Oxford, Slough, and throughout Berkshire, with secure online counselling available across the UK.
Whether you are struggling with the emotional impact of a recent diagnosis, repeated hospital admissions, medication failures, surgery, medical uncertainty, or the daily exhaustion of living with a chronic condition, you do not have to face it alone. Therapy can help you process medical trauma, reduce shame and isolation, manage anxiety and depression, rebuild confidence, strengthen relationships, adapt to life with a long-term condition, and develop healthier ways of living that work with your body rather than constantly fighting against it.