Fatigue is a very non-specific symptom of many diseases and disorders. Feeling tired could also simply 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. 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 one of your symptoms is not so difficult, but determining why you are tired -- and what to do about it -- is no easy task.
Fatigue is a symptom often associated with inflammatory bowel disease (IBD). The reasons people with IBD may feel tired include medication side effects, sleep disturbances, related conditions such as anemia, and a flare-up.
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.
When you are fatigued, it would seem as though you should be able to fall asleep quickly and stay asleep longer. However, when you have IBD that's flaring, your 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, you can try practicing good sleep hygiene in order to give yourself the best chance at a restful night's sleep. For waking because you have to use the bathroom, you might consider scheduling your last meal several hours before bedtime. Night sweats are more difficult to prevent, but you could try sleeping on a towel or two and keeping a change of clothes and another pillow or pillowcase close to your bedside. This way, you can clean up and get back to sleep without getting out of bed or turning on a light.
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 your ability to function needs treatment. Discuss your pain in-depth with your gastroenterologist, and seek a referral to a pain specialist if necessary.
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 your 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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Banovic I, Gilibert D, Cosnes J. "Crohn's disease and fatigue: constancy and co-variations of activity of the disease, depression, anxiety and subjective quality of life." Psychol Health Med 2010 Aug;15(4):394-405. 16 Aug 2011.