Dealing with fatigue in IBD

Over three quarters of people who suffer from IBD also suffer from fatigue during disease flares. It can take weeks, or even months, after a flare to get back to normal energy levels.

Fatigue may also be a prominent feature of the underlying illness, regardless of state of disease activity.

It’s important to find out why you might be feeling exhausted, and ways you can manage it. This serves to limit the impact that fatigue has on your quality of life.

What causes fatigue?

There are many things that can contribute to you feeling fatigued.

Stress, depression and anxiety

The emotions of living with a chronic disease can feel overwhelming.

Poor sleep

Whether it’s trouble getting to sleep due to cramps or pain, or trouble staying asleep due to nocturnal bowel movements, or even due to anxiety about disease state, sometimes it can be hard to get a good night’s sleep.

Poor nutrition

One of the side effects of Crohn’s is loss of appetite and nausea. Taking in fewer calories than required can contribute to feeling tired all the time. You may also have trouble absorbing key nutrients in the food you do eat, making it even harder.

Inflammation

Chemical signals produced during inflammation can cause tiredness and lack of energy. This may be why fatigue is more pronounced during a flare.

Medication side effects

Steroids can affect your ability to sleep, due to their association with an increase in energy. Antidepressants and narcotics can cause lethargy. Immunomodulators, that turn down your immune system, can directly cause fatigue.

Anaemia

Slow continuous blood loss through lesions in the intestines can lead to anaemia. You may also struggle to properly absorb iron, B12 and other important nutrients.

The following may also contribute to feelings of fatigue:

• alcohol intake,
• other health problems,
• weather extremes,
• lack of support, and
• being overweight or underweight.

How does fatigue affect people with IBD?

Fatigue can affect every part of your life, and sometimes make it difficult to function.

Social activities

If you’re not sure when you’ll be feeling good, it’s hard to make plans in advance. This could be making holiday plans, socialising with friends, or even taking part in hobbies.

Relationships

With an invisible illness, it’s easy for people to think you’re ok when you’re really not. This can have a negative effect on relationships with friends, family or even a significant other, because they may not appreciated how exhausted you feel. It’s important to learn to speak up about your fatigue, so that they understand what you’re going through.

Memory and concentration

Fatigue can lead to ‘brain fog’, where you are so tired you feel like you can’t even speak properly. You may also have trouble thinking logically.

Physical activity

It can be hard to undertake physical activity when all you want to do is rest. Sometimes, you need to listen to your body and take that rest. Things become problematic when you struggle to complete everyday tasks such as housework, collecting the kids from school, or even walking from one room to another.

Work and school

Working or studying full time may be too much for some people suffering from IBD related fatigue. In these cases, going part time, or even giving up for a period, may be the only option.

Emotions

It’s normal to feel frustrated and angry if your fatigue is affecting your ability to do all the things you want to do. It can also be isolating when it’s difficult to get out and socialise with friends and family.

Managing fatigue in IBD

Treating and managing fatigue can sometimes be challenging.

Treat flares

Your best line of defence is to ensure you avoid and treat your IBD flares. Take your medication according to instructions, and be honest with your doctor about your symptoms and medication side effects.

Eat well

Even if you’re not always feeling hungry, try to eat three nutritious meals a day. Smaller meals may be better tolerated, and avoid great foods, insoluble fibre, or triggering foods. An IBD specialised dietitian provide you with personalised advice.

Get enough sleep (when possible!)

Remember good sleep hygiene, to avoid other factors affecting your sleep. Don’t drink caffeine before bedtime, avoid screens for an hour before bedtime, have a good wind down routine, stay away from long, daytime times.

Manage stress

Stress in and of itself can cause fatigue. Do what you can to keep your stress at bay: taking time for yourself, resting, a nice warm bath, talking to friends or family, or even talking to a professional.

Exercise

Exercising may help you sleep better, by physically tiring you out. Start off slow, and talk to your doctor before undertaking any new exercise. Research is new, but suggests that regular exercise can have anti-inflammatory effects.

Manage your time

You’ve only got so much time and so much energy to get things done. Priortise your tasks, daily or weekly, and set realistic goals for what you can achieve. Most importantly, listen to your body and rest when it’s telling you to.

Rule out other causes of fatigue

If you’re in remission and still extremely fatigued, talk to your doctor to run some tests. It may be that you don’t have any symptoms (clinical remission), but still suffering from inflammation. Also get other blood tests run, such as iron, vitamin B12 and vitamin D.

Manage symptom multipliers

Reduce things can make symptoms worse, such as stress, smoking, caffeine and alcohol.

Learn your triggers

Everyone may have different triggers, so it’s important to understand what wears you out. Manage your life in a way that works for you.

Ask for help

Don’t be afraid to tell friends and family how you feel, and ask for help with tasks such as cooking or housework. There are also many support groups (online and in-person) where you can talk to people going through the same thing as you; sometimes just feeling heard can help.

It may also help to try:

• taking frequent breaks (during housework, work or other activities),
• alternative therapies such as acupuncture, yoga or remedial massage,
• planning ahead to reduce stress,
• getting quality sleep, and
• flexible working hours.

Talking about IBD

It’s important to talk to your health care team about how you’re feeling. Sometimes things that you don’t think relate to your condition do, and your team can help navigate the issues.

Trying to get the people in your life (friends, family, co-workers) to understand how you’re feeling can sometimes be difficult. The following terms may help in describing how you feel:

• zombie mode
• wiped out
• brain fog
• feeling woozy or fuzzy

Unfortunately, sometimes there is no explanation for why you’re feeling fatigued no matter what you do. If this happens, be kind to yourself. A warm cup of your favourite drink, a hug from a friend or family member, or curling up on the couch to binge watch Netflix may be all you need to feel a little better.

Contributed by Dr Arvind Rajagopalan