Darren Fletcher fighting for his football career
Darren Fletcher is facing a battle to save his top-flight career after being placed on an extended break by Manchester United due to the debilitating effects of the bowel condition, ulcerative colitis.
Having fought against what United initially described as a virus for the past nine months, the club finally confirmed on Tuesday that the 27-year-old, absent from the United first-team since scoring in the 2-2 Champions League draw at home to Benfica on November 22, has, in fact, been suffering from a condition which can, according to medical experts, lead to severe complications and potential steroid treatment which could contravene football's drug-testing policy.
Fletcher's absence following medical advice, which is expected to see him miss the rest of this season, has added to United's alarming manpower shortage just days after captain Nemanja Vidic was ruled out for nine months with a ruptured cruciate ligament.
But while manager Alex Ferguson is now likely to recruit in January to help stem the injury crisis which has been exacerbated by Fletcher's illness, the immediate concern at Old Trafford is for the Scotland midfielder's well-being and it is understood that the club is determined to ensure the best possible treatment for the player.
Following increasing speculation about Fletcher's condition, however, the club issued a statement on his behalf in order to clarify the worrying situation.
The United statement said: "On behalf of Darren Fletcher, Manchester United wishes to announce that he is taking an extended break from football for health reasons.
"Over the past year, he has had several absence periods which we have attributed to a viral illness in order to respect his right to medical confidentiality.
"Darren has, in fact, been suffering from ulcerative colitis (a chronic inflammatory bowel condition) for some time preceding this.
"Whilst he was able to maintain remission of symptoms for a considerable period, this has proved more difficult recently and Darren's continued desire to play, and his loyalty to both his club and country, has probably compromised the chances of optimising his own health and fitness.
"He has therefore accepted medical advice to take an extended break from the demands of training and playing in order to afford the best chance possible of achieving full remission once again.
"We request that his privacy is respected and hope that the removal of the additional stress associated with speculation regarding his health will also aid his recovery."
While no timescale has been placed on Fletcher's potential recovery by the club, medical experts familiar with the condition have warned that the player's career, certainly at Premier League level, could be compromised by the illness.
Professor Chris Probert, a consultant gastroenterologist at the Royal Liverpool Hospital, said: "I would be very surprised if he could perform at the same level with this condition.
"He must have been extremely fit to have been able to play for as long as he has with the symptoms of the condition.
It seems inconceivable that he would not have had his performance impaired somehow by the condition and it's no surprise that he's been forced to take short breaks from time to time.
"The consensus is that stress can aggravate these conditions, so that might apply to someone with a high-intensity job such as a professional footballer."
Fletcher was forced to miss 12 first-team fixtures between March and May of last season following the initial outbreak of the condition, but he returned to take a place on the substitutes' bench for the Champions League final defeat against Barcelona at Wembley.
He then missed United's pre-season tour of the United States after suffering a setback, but was fit enough to return to action for Scotland's Euro 2012 qualifiers against Czech Republic and Lithuania in September before making 10 first-team appearances for United, culminating in the Benfica outing last month.
Fletcher admitted in September that his health problems were "scary," but felt that he had sufficiently overcome the condition to continue with his career. He said at the time: "It was scary and it knocked me back. I am hardly a person who can afford to lose weight, but I did. Now, though, I am fully on the mend."
With United and Fletcher now realising the need for time away from the game, however, Ferguson is likely to reconsider his stance last week that he would be unlikely to bolster his squad in January. Aside from Fletcher, United are also without fellow midfielders Tom Cleverley and Anderson to long-term injuries, while Paul Scholes, John O'Shea and Owen Hargreaves -- all of whom left Old Trafford in the summer -- have not been replaced.
Although Scholes remains on the staff at United as a coach, it is understood that there is no likelihood of the 37-year-old being asked to return to action having retired at the end of last season. Darron Gibson, the Republic of Ireland midfielder, is likely to be retained next month having been made available for transfer in the summer, but with youngsters such as Paul Pogba and Ravel Morrison regarded as not yet ready for Premier League duty, Ferguson is set to assess his transfer market options.
Everton midfielder Jack Rodwell has rarely strayed from United's radar and could emerge as a January target, with Newcastle duo Cheik Tiote and Yohan Cabaye also potential targets.
Darren Fletcher is unlucky -- about one in 10,000 people develop ulcerative colitis each year, writes Jeremy Laurance.
It is a chronic condition causing inflammation of the bowel with symptoms, typically, of abdominal pain, bloody diarrhoea and a frequent need to go to the toilet .
In many cases the symptoms are mild and do not interfere with normal life. But the stress of playing Premier League football will not have helped. The condition is unpredictable and symptoms may flare up and then disappear for months or years.
It tends to run in families, with about one in six cases having a relative with the condition. Diet is an important trigger and sufferers have to learn which foods make their symptoms worse. Fatty foods and carbohydrates, the mainstay of the western diet, tend to aggravate the condition. The incidence is lower among Asians, who eat more pulses and vegetables.
Eating little and often is the best defence -- five or six small meals are better than three large ones. Sufferers should drink plenty to avoid becoming dehydrated as a result of the diarrhoea. Relaxation techniques such as meditation and yoga may also help.
If modifying the diet does not control the condition, treatment with drugs is the best option, including steroids. In more severe cases immunosuppressants may be used; one theory about the condition is that the gut reacts to a viral infection by becoming inflamed and then fails to switch off the immune response when the threat recedes.
In the worst cases surgery may be required to remove a part of the bowel. Fans must hope Fletcher's absence from the field will be enough to return him to health.