Fatigue is more than ordinary tiredness. It is an overwhelming lack of energy that does not go away with a good night’s sleep, and it can make work, family life and even simple daily tasks hard. Many people with Crohn’s disease (CD) or ulcerative colitis (UC) say it is the symptom that affects them most. It is very common when the disease is active, and many people continue to feel fatigued even when their disease is in remission.
Because fatigue cannot be seen, family, friends and employers may not understand it. It is a real symptom, and it is worth telling your IBD team about it.
What causes it?
There is often more than one cause, and some of them are easily treated.
- Active inflammation. The chemicals released during inflammation cause tiredness, as anyone who has had flu will know. Settling the inflammation often improves fatigue.
- Anaemia. A low blood count is common in IBD, caused by blood loss or poor absorption of iron, vitamin B12 or folic acid. It is one of the most treatable causes of fatigue. See Crohn’s disease and iron deficiency anaemia.
- Low iron without anaemia. Iron stores can be low even when the blood count is normal, and this can still cause tiredness.
- Other deficiencies, such as vitamin D, magnesium or zinc, particularly in CD of the small intestine or after surgery.
- Poor sleep, from getting up at night to open your bowels, from pain, or from steroids.
- Medicines. Some treatments can cause tiredness as a side effect.
- Low mood and anxiety, which are common in people living with a long-term condition and can both cause and be caused by fatigue.
- Not eating enough, especially if eating brings on symptoms.
- Other conditions, such as an underactive thyroid or coeliac disease.
What tests can help?
Your GP or IBD team may suggest:
- A full blood count, to look for anaemia
- Ferritin, to measure your iron stores
- Vitamin B12, folic acid and vitamin D levels
- Thyroid function and other blood tests
- Blood tests and faecal calprotectin, to see whether your IBD is active
What can be done?
Treat the cause
If your IBD is active, getting it under control is the first step. Anaemia and low iron can be corrected with iron tablets or, if these cause side effects or do not work, with iron given by drip (infusion), which works quickly. Vitamin B12 is often given by injection, particularly after surgery to the end of the small intestine.
Keep active
It may seem the last thing you want to do, but regular, gentle exercise such as walking or swimming improves energy levels over time. Start slowly and build up gradually. See Sport and Inflammatory Bowel Disease.
Pace yourself
Plan your day so that you balance activity and rest, rather than doing too much on a good day and paying for it afterwards. Break larger tasks into smaller ones and do the most important things at the time of day when you have most energy.
Sleep
Keep regular hours, avoid caffeine and alcohol late in the day, and tell your IBD team if night-time symptoms are keeping you awake, as a change of treatment may help.
Eat well
Regular meals and a nutritionally adequate diet help to keep your energy up. A dietitian can help if you are avoiding foods or losing weight.
Talk about it
Psychological approaches, such as cognitive behavioural therapy (CBT), have been shown to help with fatigue in IBD. Ask your IBD team or GP whether this is available locally. It also helps to explain fatigue to the people around you and, if it affects your work, to your employer, who may be able to make reasonable adjustments. See Working with Crohn’s Disease and Colitis.
Keeping track
Recording your tiredness each day alongside your other symptoms can help you and your IBD team to spot patterns, for example whether fatigue gets worse before a flare-up or improves after a course of iron. Our free symptom diary includes a daily tiredness score.
If your fatigue is getting worse, or you have new symptoms such as breathlessness, weight loss or a fever, see your GP or IBD team.