Few couples hearing the term “in sickness and in health” at their wedding have thoughts of chronic illness enter their mind.

But the reality is, with almost half of the American population dealing with some type of chronic illness, this should be something all couples consider.

Relationships, while they can be incredible, can also have their share of ups and downs — it’s only natural when you bring two people together who have different life experiences, lifestyles, personalities, etc. Add a chronic illness into the mix, and your relationship may feel a little crowded.

So how can couples — married or not — build a solid foundation and work together to make the most out of life despite illness? Well, I don’t have all the answers, but my husband and I have learned some things along the way that I want to share with you.

First, I want to share a quick story with you. My husband entered into our relationship 14 years ago knowing I had lupus. Sadly, some people warned him not to marry a “sick girl.” I’m grateful he didn’t listen to them, but my feelings were hurt when he confided these comments to me years later.

It seems they were worried that he would have to take care of me for the rest of his life and that I couldn’t give him children. His response was along the lines of: “Marrying the healthiest person in the world doesn’t remove the possibility that she could become sick or be in a horrible accident and need someone to care for her — people are in accidents or diagnosed with illnesses every day.” It warmed my heart that he stuck up for our relationship in the face of those who felt I would be a burden to him.

But the opposition didn’t stop there. If you are like me — you have a chronic illness and are in a relationship — there will undoubtedly be challenging times. To help you face these challenges and keep your partnership strong, here are a few pieces of advice that have worked for my husband and me:

-Therapy can be an incredible tool: Communication in a relationship can present its own challenges. Working with a neutral party (your therapist) can help you and your partner learn how to work together to communicate well. Therapy helped our bond strengthen as we realized we are on the same team and need to face life’s challenges together, as life can throw us “doozies.” Individual therapy can also be an option; for instance, if your partner is having a difficult time adjusting to a life with a chronic illness, it can be very helpful for them to have a person to whom they can express their feelings and concerns.

-Accept help from those who offer it: One of the biggest mistakes my husband and I recognized (too late) was not letting our family and friends know when I was in a flare or in the hospital. I was embarrassed at being sick for many years. We didn’t let these people knowing how badly and desperately we needed help, and they thought we were aloof and “too busy” for them (the complete opposite of the truth). We learned to share our burdens with those who love us and accept their offers of help. I can’t tell you how many of our burdens have been lifted by people who brought us meals, drove me to appointments, dropped off medicine from the pharmacy, or just sat with us when I was too sick to get out of bed. If there are people in your life who are willing to help, be specific and vocal about your needs. It can help lift an enormous amount of stress.

-Value intimacy: One of the greatest bonds between two people can sometimes get overlooked because of issues with chronic illness. Scheduling intimacy time or taking advantage of the moments you feel OK are crucial. And sex doesn’t always have to be in the cards. It can be a bubble bath with your partner, a massage, or cuddling on the couch and just talking.

Even after 14 years together, my husband and I do not have it all together; sometimes lupus (and a few other chronic illnesses) have brought the stress level in our marriage to a high, and we did not react in a kind or loving manner toward one another. Over time, however, we’ve found a rhythm, and have built a strong, beautiful partnership.