Fatigue and IBD

It is common for people with IBD to report feelings of fatigue. These feelings can include both physical fatigue (e.g., feelings of weakness or lack of energy) and mental fatigue (e.g., difficulty maintaining concentration/alertness). Fatigue can also reduce our participation in healthy activities, such as exercising and spending time with friends, as well as impacting performance at work or school.

Research has found

• Higher rates of fatigue in those with IBD than the general populations
• Fatigue is generally associated with disease activity. If your IBD becomes active or increases in severity you are more likely to experience fatigue. Conversely, as your IBD improves, feelings of fatigue generally do too
• Fatigue does not necessarily disappear when you are well –fatigue commonly reported by patients in remission
• Fatigue may be slightly more common in Crohn’s disease then ulcerative colitis.

There are several potential causes of fatigue in people with IBD. One explanation that has been put forth is that fatigue is triggered as part of a defence mechanism (i.e., sickness behaviours) intended to encourage rest and recovery after a period of illness (e.g., inflammation, infection). Other potential causes include

• The experience of pain can cause fatigue through sleep disturbances and prolonged psychological distress
• Nutritional deficiencies such as a lack of iron can cause anaemia (deficiency of oxygen-carrying red blood cells)
• Some IBD medications have been associated with feelings of fatigue (e.g., azathioprine, methotrexate).
• Comorbid psychological disorders such as depression and anxiety are common in IBD. These mental states are often associated with feelings of fatigue
• Active IBD can involve frequent middle-of-the-night trips to the toilet, which disrupt the quality of sleep and cause fatigue during waking hours

What can you do?

• If you are ‘well’, raise the issue of fatigue with your doctor –you may be flaring up without yet knowing it. Getting on top of disease activity can often improve fatigue.
• Get blood tests taken to check for nutritional deficiencies. These are more common during times of active illness but can occur in remission as well.
• Assess your mental health. IBD can be highly stressful and is often associated with symptoms of anxiety and depression. Prolonged psychological distress can cause fatigue.
• Consider modifying your work or study schedule to allow accommodate regular rest breaks.