Please select the eligibility criteria that correspond to the clinical trial below.
Title: Improving Continence in People With Inflammatory Bowel Disease: Active Case Finding and a Randomised Controlled Trial
Brief Summary: Inflammatory Bowel Disease (IBD) affects 250,000 adults in the United Kingdom (UK) and causes bouts of diarrhoea which are hard to control. Over a quarter of patients experience extremely distressing faecal incontinence (FI). Even when the disease is in remission, the majority of patients live in fear of not finding a toilet in time. This curtails their activities and quality of life. The National Institute for Clinical Excellence (NICE 2007) has issued national guidance on actively asking patients about FI and a step-wise care plan for managing FI. However, this has not been evaluated in people with IBD, the vast majority of whom do not ask for help, even when they have frequent FI.

Across six expert centres in the UK, the investigators will perform 3 linked studies: \[1\] The investigators will screen people with IBD, offering the opportunity to obtain help with bowel control. The investigators will compare uptake of a postal approach versus response to a proactive face-to-face asking approach at a physical or telephone clinical appointment. \[2\] The investigators will conduct a randomised controlled trial (RCT) comparing two different approaches (IBD nurse specialist plus self-help booklet versus self-help booklet alone) to see which one produces the best results in terms of reductions in FI, other symptoms, costs and quality of life at 6 months after intervention. Booklet group participants may access the nurse intervention at 6 months if they wish, when the RCT is finished. \[3\] Interviews will be performed at the end of the intervention, gathering patient views and preferences and staff perspectives via Qualitative interviews and free text questionnaire comments, to enable a rich understanding and interpretation of our results.

The investigators will disseminate the results widely to people with IBD and health professionals and take active steps to embed successful interventions in NHS services, having gained sound evidence on how many people want help, whether intervention is effective in improving FI, and patient and staff views on interventions.


Options:
A: Inclusion Criteria:

* diagnosis of ulcerative colitis
* able to provide informed consent
* admission to hospital with flare of underlying ulcerative colitis

Exclusion Criteria:

* Crohn's disease
* inability to provide informed consent
* readmission during study period (intervention would only be used on the initial admission during the study period)
B: For active case-finding: diagnosis of IBD,between 18 and 80 years of age; diagnosis of IBD confirmed with endoscopy / colonoscopy; no stoma.

For RCT and patient interviews: Patients with IBD who experience FI, are interested in interventions, and meet the following:

Inclusion criteria:

* Endoscopically confirmed IBD diagnosis
* Between 18 and 80 years of age
* No current flare-up of disease (self-report of usual symptoms when not in active flare)
* Reporting FI at least once in the past year
* With or without ileo-anal pouch plus:

Exclusion criteria:

* Under 18 or over 80
* Current disease flare-up (self-report of usual symptoms indicative of active flare)
* Course of specialist FI treatment in past year
* Previous major anal fistula surgery (surgical lay-open) or current perianal fistula
* Current stoma
* Current participation in another trial
* Inability to give informed consent (for example, due to reduced mental capacity)
* Inability to read or speak sufficient English to understand study documents, procedures and requirements
C: Inclusion Criteria:

* Age \>18 years,
* Internet or Smartphone access
* Ability to complete a Tablet or web-based questionnaire in English language.

Exclusion Criteria:

* Presence of short bowel syndrome, stoma or pouch.
* Presence of a condition or disease that, in the opinion of the investigators, may make it exceedingly difficult for the patient to use HealthPROMISE App, including, but not limited to, advanced dementia.
D: Inclusion Criteria:

* Confirmed diagnosis of Crohn's disease, ulcerative colitis or indeterminate colitis

Exclusion Criteria:

* Cannot comprehend simple instructions in English
* Inability to comply with the study protocol (i.e., active drug or alcohol abuse or history of nonadherence to medical visits and/or medications)
* Presence of an ileostomy, colostomy, ileoanal j pouch anastomosis or ileorectal anastomosis
* Imminent surgery
* History of short bowel syndrome
* No flares of disease in last two years
* Uncontrolled medical or psychiatric disease Degenerative neurologic condition Unstable angina Class III/IV congestive heart failure Severe asthma or chronic obstructive pulmonary disease Symptomatic peripheral vascular disease Chronic renal insufficiency (creatinine \> 2.0) Malignancy within the last 5 years (excluding squamous or basal cell cancers of the skin) Poorly controlled depression, mania, and schizophrenia Active infection Acquired immunodeficiency syndrome
* Pregnancy
* Age less than 18 years.

Answer: B