Transitioning to college with Inflammatory Bowel Disease is both an academic and healthcare milestone. IBD is an unpredictable, relapsing condition. A person managing urgency, fatigue, medication side effects, or active inflammation is already navigating challenges their peers are not. IBD may shape certain logistics along the way, but it does not have to define your entire college experience.

As someone who was diagnosed with Crohn’s disease at age 21, two months after graduating from Marquette University, I did not require these accommodations, but looking back at that part of my life (20+ years ago), I would have needed and really benefited from this information had I been diagnosed younger.

This week on Lights, Camera, Crohn’s we hear from Amanda Vispo, MSW, LCSW, a Clinical Social Worker from the IBD Center at Boston Children’s Hospital about tips for overcoming challenges during this chapter of life and knowing what accommodations provide the best equity and access for everyone in our community.

The shift from high school to college

Ideally, families should begin considering accommodations during junior year of high school, even if a teen is feeling well.

“I often describe accommodations as an insurance policy. We are not anticipating decline. However, if a flare occurs, we want patients focused on recovery rather than scrambling to put supports in place,” Amanda advises. “A pattern I frequently see is patients in remission during campus visits underestimating what they might need during a flare. Sharing a bathroom with an entire floor can feel very different during active symptoms. Mid-year housing changes are not always possible.”

In appointments, Amanda asks patients to think about a particularly difficult flare day. Not to alarm them, but to encourage honest reflection. What did they need? How often were they in the bathroom? How fatigued were they? What helped at home?

“We then discuss how to replicate those supports in a college setting. Planning early preserves flexibility, waiting can limit options.”

College marks a meaningful shift in responsibility. In high school, accommodations are proactive and team driven. Parents are automatically involved, and systems monitor progress closely.

“In college, students must self-identify and initiate contact with disability services. Once accommodations are approved, the student becomes the primary communicator with professors, says Amanda. “Understanding this shift early makes the transition smoother. Transition planning is not only about documentation, but also about building confidence and developing self-advocacy skills that extend well beyond college.”

What steps can high school patients take now to make the transition smoother?

Preparation happens gradually. Students can begin with:

• Practicing how to clearly describe the functional impact of their symptoms
• Learning their medication schedule and treatment basics
• Communicating directly with providers
• Thinking intentionally about housing needs and daily symptom patterns

Small steps toward autonomy build lasting confidence.

Reframing accommodations as tools

Accommodations do not lower academic standards; they remove barriers created by symptoms outside a patient’s control. Equity means recognizing that not everyone starts from the same physical baseline.

Amanda says, “Adjusting the environment through flexible attendance, housing, or testing supports ensures patients have a fair opportunity to demonstrate their ability. That is not special treatment. It is equitable access.”

Flares can occur without warning, and their duration and severity are difficult to predict. Accommodations can provide predictability within that uncertainty.

“When patients know they can leave class without penalty, take stop-the-clock exam breaks, or rely on stable housing, it reduces anticipatory anxiety. That reduction in stress matters because heightened stress can worsen GI symptoms and complicate disease management.”

Having established accommodations allows students with IBD to focus on healing during flares instead of managing academic logistics.

Knowing how to communicate with disability services

When preparing patients for conversations with disability services, Amanda reminds them they are not navigating this process alone. GI teams play an important role in advocacy.

“We provide detailed letters outlining the diagnosis, treatment plan, the relapsing nature of the condition, and recommended accommodations. Many colleges also require medical verification forms, which providers complete to ensure disability services has clear documentation,” says Amanda.

The patient’s role is not to prove their illness, but to explain how symptoms affect their academic experience. Amanda encourages her patients to focus on functional impact rather than diagnosis alone.

For example, a patient might explain:

• During flares, I may need urgent restroom access multiple times per class.
• I receive infusions every six to eight weeks that require travel and recovery.
• Fatigue affects my ability to attend early morning classes.
• There are periods when I can complete coursework but may not tolerate being physically present.

Clear, specific descriptions help disability services understand how symptoms translate into academic impact. When paired with medical documentation, this creates a complete picture.

Accommodations to seek out

One support Amanda strongly encourages her patients to consider is priority or early course registration.

IBD symptoms often follow patterns. Some patients struggle more in the mornings. Others experience worsening symptoms later in the day. Many travel home periodically for infusions or follow-up care. Priority registration allows patients to:

• Choose class times that align with when they function best
• Avoid stacking multiple demanding courses back-to-back
• Build in buffer days for medical appointments

This is not about lowering expectations. It is about working with the body rather than constantly pushing against it. Other helpful accommodations may include:

• Housing assignments best suited to medical needs
• Flexible attendance policies for medically excused absences
• Access to lecture recordings
• Modified deadlines during acute flares
• Permission to bring necessary food or drinks into class

Housing and medical stability

Urgency and frequency are hallmark symptoms of IBD, particularly during flares. Sharing a hallway bathroom with many peers can increase anxiety and reduce privacy. Because stress can exacerbate GI symptoms, reducing that stress supports disease management. Additionally:

• Some people require rectally administered medications that necessitate privacy
• Patients on immunosuppressive therapies may benefit from reduced exposure in shared spaces
• Fatigue is common, and stable sleep supports disease control

Private rooms, single-occupancy or lower-trafficked bathrooms, or suite-style housing with a lower patient-to-bathroom ratio can meaningfully reduce stress and preserve dignity. These are practical components of symptom management.

Managing the stress and guilt students often feel

Amanda says she hears this all the time. Patients will say, “I don’t want special treatment,” or “I should be able to handle it.” Managing a chronic illness already requires resilience. Those with IBD are navigating inflammation, fatigue, medication effects, and unpredictability, often invisibly.

Amanda wants those with IBD to know, “Accommodations ensure those with chronic illnesses are not penalized for something outside their control. Anticipating needs and putting support in place reflects responsibility, not weakness. There is no shame in using tools that allow full participation.”

Final Thoughts

College should be a time of exploration, independence, and possibility, not a test of how much suffering someone can quietly endure. Living with IBD means carrying an unpredictable disease into a setting built for predictability, but with the right supports in place, students can thrive both academically and medically.

Proactive accommodations are not a backup plan for when things go wrong; they are a foundation that allows students to fully engage when things go right. Planning ahead, practicing self-advocacy, and partnering with a GI care team transforms college from a period of constant vigilance into one of growth, confidence, and opportunity. IBD may shape the path, but it does not need to limit the destination.