Fatigue is a symptom often associated with inflammatory bowel disease (IBD). Inflammatory Bowel Disease (IBD) is an immune-mediated chronic inflammation of your gastrointestinal tract.  There are two types of IBD, Crohn’s disease and ulcerative colitis; both manifest as chronic immune-mediated inflammation of your gastrointestinal system. While they both cause similar symptoms, they are managed differently. Crohn’s disease may affect any part of your gastrointestinal system, from your mouth to the anus. Ulcerative colitis, however, is limited to the colon, otherwise known as the large intestine.  It is estimated that 1.4 million Americans have IBD, which tends to run in families and affects males and females equally.

Both Crohn’s disease and ulcerative colitis cause similar symptoms. Both illnesses are marked by the immune system’s abnormal response, which leads to chronic inflammation of the gastrointestinal tract.

Symptoms related to inflammation of the GI tract:

• Diarrhea
• Rectal bleeding
• Urgent need to move bowels
• Abdominal cramps and pain
• Sensation of incomplete evacuation
• Constipation (can lead to bowel obstruction)

General symptoms that may also be associated with IBD:

• Fever
• Loss of appetite
• Weight loss
• Fatigue
• Night sweats
• Loss of normal menstrual cycle

Fatigue is a major complaint of many individuals with IBD and can be attributed to several causes including medication side effects, sleep disturbances, related conditions such as anemia, and a flare-up of the IBD itself.

Medication Side Effects

Some medications that are used to treat IBD can cause fatigue either directly or indirectly by negatively affecting sleep patterns. Steroids can give people the feeling of being "wired," which makes it difficult to get rest. Other medications may cause drowsiness or fatigue. The symptom of fatigue should always be brought to the attention of your managing physician..

Insomnia

Many individuals with IBD have difficulty sleeping and this can contribute to fatigue during the day. When you have IBD that's flaring, sleep may be interrupted by symptoms such night sweats or having to get up to the bathroom.

Practicing good sleep hygiene in order to give your self the best chance at a restful night's sleep can be very helpful.  Some specific tips for IBD patients include;

• Scheduling your last meal several hours before bedtime.
• Try sleeping on a towel or two and keeping a change of clothes and another pillow or pillowcase close to your bedside to help with night sweats.

General Sleep Tips 

IBD Flare-Up

The body fights active inflammation from IBD in various ways that may result in fatigue. The long-term goal is to treat the flare-up because this will ultimately help control the fatigue. Sticking with your 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 your ability to function needs treatment. Discuss your pain in-depth with your gastroenterologist, and seek a referral to a pain specialist if necessary.

Anemia

A common reason for fatigue is anemia. People with IBD may be anemic due to loss from the intestine or from an iron deficiency. Malabsorption of the necessary vitamins and minerals for red blood cell production is also common in IBD.  If you don't get enough, iron, folic acid, and vitamin B12, the body can't make sufficient red blood cells to carry oxygen to the tissues and this results in fatigue. Treating the cause of the anemia is the best course of action to treat anemia associated with IBD.

Reference:

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.

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