The Reasons Why IBD Causes Fatigue

Understanding Crohn's Disease & Ulcerative Colitis Symptoms

Fatigue is a non-specific symptom of many diseases and conditions. Feeling tired could be the result of not getting enough sleep, or not getting enough quality sleep. In the U.S., we are constantly shortchanging ourselves on sleep, and most children and adults do not get enough. Fatigue, however, is more than being tired and it can't necessarily be overcome by getting some sleep. Fatigue is a symptom often associated with inflammatory bowel disease (IBD) and tends to be one that is brought up frequently as being most problematic in lowering quality of life.

Chronic fatigue can lead to a host of other problems, including poor performance at work and school, drowsy driving, and feelings of depression. Figuring out that fatigue is a problem is not difficult, but determining what is causing it — and what to do about it — is no easy task. The reasons people with IBD may feel fatigued include medication side effects, sleep disturbances, related conditions such as anemia, and a flare-up.

Medication Side Effects

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Some medications that are used to treat IBD can cause fatigue either directly or indirectly by negatively affecting your sleep. Corticosteroids, such as prednisone, tend to give people the feeling of being "wired," which makes it difficult to get rest. Other medications may cause drowsiness or fatigue. When these side effects occur, they should always be discussed with the prescribing physician.

IBD & Poor Sleep

Sleeping Boy
Not sleeping like a baby at night? Your IBD could be to blame for your fatigue. Photo © Michael Falk

When fatigued, it would seem as though falling asleep quickly and  staying asleep longer would be easier. However, when IBD is flaring, sleep may be interrupted by other signs and symptoms, such as trips to the bathroom or night sweats. The best way to get the midnight trips to the bathroom and waking in a pool of sweat to stop is to treat the flare-up, but that can take some time

In the meantime, try practicing good sleep hygiene in order to give the best chance at a restful night's sleep. For waking because of having to use the bathroom, one idea is to consider scheduling the last meal of the day several hours before bedtime. Night sweats are more difficult to prevent, but coping with them can include sleeping on a towel or two and keeping a change of clothes and another pillow or pillowcase close to the side of the bed. This way, cleaning up can go quickly and it may be possible to get back to sleep without getting out of bed or turning on a light.

IBD Flare-Up

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When your IBD is flaring, it could lead to extreme fatigue. Photo © Miguel Saavedra

IBD causes inflammation in the digestive tract, most commonly in the small intestine and/or the colon. The body fights this inflammation in various ways, with one of the end results being fatigue. The long-term goal is to treat the flare-up, because this will ultimately help with the fatigue. Sticking with a treatment plan and getting proper sleep may be helpful in the near-term.

Pain is another common symptom of an IBD flare-up that can cause fatigue or interrupted sleep. Treating pain associated with IBD can be complicated, but pain that is impairing the ability to function needs treatment. Discuss pain in-depth with a gastroenterologist, and seek a referral to a pain specialist if necessary.

IBD & Related Conditions

Taking Blood
A blood test can provide useful information about your health. Photo © Wojciech Wolak

One common reason for fatigue is anemia. People with IBD may be anemic either due to frank blood loss from the intestine (more common in ulcerative colitis than in Crohn's disease), or from an iron deficiency. Malabsorption of vitamins and minerals is common in IBD, and without enough iron, folic acid, and vitamin B12, the body can't make more red blood cells. Treating the cause of the anemia, be it stopping the bleeding or supplementing with iron or B vitamins, would be the best course of action to treat anemia associated with IBD.

Arthritis is the most common extra-intestinal complication of IBD. Another type of auto-immune disease, arthritis, comes with its own causes of fatigue, such as pain and inflammation. Some forms of arthritis will improve when IBD is under control, and other forms are independent of the status of the IBD. If arthritis is a suspected cause of fatigue, the best course of action would be to treat both the IBD and the arthritis.

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