Illness-related fatigue is extreme tiredness or lack of energy that is not relieved after rest. It is not something that goes away after a good night’s sleep or a nap. It can be physical, mental, or a combination of both. You may feel a lack of motivation or alertness, along with a lack of energy or strength. Your body feels heavy and sluggish.
This unrelenting exhaustion is far more than ordinary or usual tiredness. With ordinary tiredness, you are able to get out of bed. Your day-to-day activities are not impaired much. Doing things that you love doing or taking a nap may perk you up.
Illness-related fatigue is the most common symptom of depression and underlying conditions requiring treatment. Over 3/4 of people with Crohn’s Disease and Ulcerative Colitis, both forms of Inflammatory Bowel Disease (IBD), experience fatigue. Fatigue is a common and under-recognized symptom with IBD. Because there is unpredictability in the occurrence of fatigue in people with IBD, it can affect socializing, planning, travel, or participating in other activities you enjoy doing.
Although fatigue can occur in people of all ages and both sexes, some studies suggest a greater effect on women who have IBD.
What are contributing factors for causing fatigue in IBD?
The combinations of factors causing fatigue in people with inflammatory bowel disease include:
Pain
Abdominal pain caused by inflammation, blockages, and bloating can be draining. Other extraintestinal symptoms, such as joint pain and back pain, can contribute to fatigue. Pain also may contribute to fatigue through emotional and psychological distress or poor quality of sleep.
Inflammation and flare-ups
Inflammation and flare-ups release chemical signals that act on the brain, causing tiredness and lack of motivation. Multiple studies have shown that fatigue is associated with the severity of the disease.
Fatigue may continue in some people while in remission (their symptoms are under control). It is thought that inflammation remaining in the gut may be the cause.
Nutritional deficiencies
Various nutritional deficiencies may occur due to decreased food intake, disrupted food absorption, increased energy expenditure, and/or increased loss of muscle or bone.
Anemia is a common complication seen in inflammatory bowel disease. Lack of healthy red blood cells affects the body’s ability to transport oxygen throughout the body, causing exhaustion. Potential contributors of anemia in people with IBD are iron deficiency, vitamin B12 or folate deficiency, chronic inflammation, and side effects of medications, such as Sulfasalazine, Methotrexate, Azathioprine, and 6-Mercaptopurine.
Iron deficiency is the most common cause of anemia in IBD. It can be the result of lower nutritional intake, chronic gastrointestinal bleeding due to ongoing inflammation, or mucosal ulcers.
Other than contributing to bone loss and immune system dysregulation, vitamin D deficiency may also contribute to fatigue. Vitamin D deficiency can be due to several factors. These include improper absorption and anorexia with IBD, steroid medications (Prednisone, Prednisolone, Budesonide) used to treat IBD, diet, and sun exposure.
Micronutrient deficiencies, such as zinc, calcium, vitamin A due to malabsorption, and self-imposed dietary restriction, can also contribute to fatigue.
Emotional stress
Anxiety and depression are common comorbidities with any chronic condition due to negative emotions and reduced quality of life. Along with the lack of motivation often experienced with psychological disorders, stress can trigger inflammation and pain in people with Crohn’s disease and colitis, contributing to fatigue.
Medications
Azathioprine, 6-Mercaptopurine, and steroids used to treat inflammatory bowel disease have been linked with fatigue.
Poor sleep quality
Poor sleep has been linked to worsening symptoms, especially fatigue in people with IBD. Factors that cause poor sleep include pain, ongoing active disease, nocturnal symptoms, and depression.
Additional factors that might contribute to the cause of fatigue are feeling lack of support, body image issues, alcohol and diet, and weather extremes.
Why is it important to talk about fatigue?
Most of the time, people are hesitant to discuss feeling fatigue with healthcare providers or loved ones for fear of being seen as lazy or experiencing it as a personal failing. However, science can explain why fatigue occurs with chronic conditions.
It is important for you to talk openly about your fatigue, especially with your doctor and/or your care team, so that they can provide you with support and proper care. This may include:
- Doing blood tests to check for nutrient deficiencies or how active the disease is. Collaborating with an experienced dietician to correct any nutrient deficiencies and ensure a nutritionally replete diet, can improve fatigue and other symptoms.
- Reviewing your medications and adjusting dosage or type of medication can help. Doctors may consider removing medications that are associated with fatigue.
- Receiving support from a specialist who can address psychological issues or disorders. Anxiety and/or depression can be addressed through counseling, talking therapy and/or cognitive behavioral therapy.
- Obtaining proper treatment for pain, if pain is contributing to your fatigue. Pain management can include medication, exercise or physical therapy, and counseling.
- Getting educated on sleep hygiene, identifying risk factors for sleep impairment, and receiving appropriate treatment.
What other things can I do to reduce my fatigue?
Actions to reduce fatigue may vary from person to person. What works for others may not work for you. You know your body better than anyone else. Learn what triggers cause you fatigue and work towards reducing those. Areas to consider to reduce fatigue include:
- Stress reduction
- Meditation and yoga
- Some forms of exercise and physiotherapy
- Frequent breaks from work, or flexible working hours
- Quality sleep
- Stop smoking
- Eating smaller meals with frequent healthy snacks, rather than larger meals
Illness-related fatigue can have a major impact on daily life, work, and quality of life. Overcoming fatigue can be challenging. Surround yourself with people you can talk with. Also, communicate regularly with your doctor regarding all the symptoms you are experiencing and how they affect your daily life.
