Wednesday, May 22, 2024

How Can Crohn’s Cause Severe Fatigue

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Make Quality Sleep A Priority


There are many reasons that you may not be getting the rest you need, and your ulcerative colitis may be one of them. In fact, those with UC appear to experience worse quality of sleep in general, even when theyre in remission, according to a study published in the Journal of Clinical Medicine. However, when it comes to reducing inflammation, good, consistent sleep is your goal. Even a single night of getting just four hours of shuteye has been shown to increase inflammation. When youre short on ZZZs, try these smart UC sleep tips to send you into slumberland.

Treatments For Extreme Tiredness And Lack Of Energy In Inflammatory Bowel Disease

Review question

What are the effects of drug and non-drug treatments on fatigue in individuals with inflammatory bowel disease compared to no treatment, placebo or active comparator ?


IBD is a life-long illness that causes inflammation and ulceration in the gut. Crohn’s disease and ulcerative colitis are the two main types of IBD. People living with IBD often experience fatigue, which can be burdensome and negatively impact on their quality of life. Different treatments, such as medications and exercise, may improve fatigue. However, it is unclear what the effects of such treatments on fatigue in IBD are. This review presents the available evidence of the effectiveness of treatments on fatigue in IBD.

Search date

Extensive searches were undertaken from inception up to July 2018. A top-up search was run in October 2019.

Study characteristics

Fourteen studies met the inclusion criteria. Nine different drug trials, four non-drug trials and one multimodular trial were included in the review. Thirty ongoing studies were also identified and five studies are awaiting classification. In only four trials was managing fatigue the aim of the intervention. In the remaining trials the interventions were aimed at managing other symptoms, including fatigue. Data on fatigue were not available for the fourteen trials, therefore, the findings of this review are based on 1344 participants in nine trials. Most studies were small in size and had low or very low quality of evidence.

Altered Gut Microbiome And Its Impact On The Gutbrain Axis

Our current strategies of microbial manipulation include antimicrobials, fecal bacteriotherapy, and probiotics. Antimicrobials have questions around their safety, specificity, and durability . A systematic review of randomized control studies of probiotics found only support for a single formulation in a narrow indication of preventing UC relapse. However, this formulation as originally studied no longer exists under that trade name, but has been rebranded as Visibiome . At this point, there are microbial changes associated with disease activity and fatigue, but currently no narrowly targeted strategy exists to manipulate the microbiome to manage fatigue.

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How Is Fatigue Evaluated

Many different scales and questionnaires are used to measure fatigue. No single standard exists.3 One questionnaire about fatigue with inflammatory bowel disease was developed and scientifically validated in the United Kingdom and is available online. You or your provider may be interested in using this questionnaire to track changes over time.1

Your health care provider may do laboratory tests. It is common to check for anemia, active inflammation, thyroid function, or pregnancy.10 Your provider may ask questions about sleep hygiene, medications, and exercise.

Treatment Of Sleep Disturbances

Crohns Disease: Symptoms, Causes, Treatment, and ...

Poor sleep quality and resulting fatigue in the IBD population have implications for practitioners. Sleep deprivation is a modifiable risk factor and thus we need to incorporate sleep assessments more routinely for the care of our patients with IBD. Here we describe a data-supported strategy to address this issue in our patients.

Through induction of remission, gastroenterologists can significantly improve quality of sleep. Considering the effect of inflammation on sleep, it is intuitive that by decreasing disease activity, significant improvement in sleep can be achieved. Patients treated with vedolizumab and anti-TNF medications showed significant improvement in sleep survey scores with reduced nocturnal diarrhea and less abdominal pain . It is also important for clinicians to identify iatrogenic risk factors for sleep impairment and modify treatment regimens. Effective interventions include cessation of steroid and narcotic use. Additionally given the association between sleep quality and psychiatric comorbidities, there is a need to screen for these conditions and refer for treatment .

When sleep quality is of concern, cognitive behavioral therapy for sleep has been shown to be effective as a first-line intervention, and may have an important role in the care of patients with IBD . Education about appropriate sleep hygiene is also important .

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Sleep Disturbance And Fatigue

Sleep disturbances have been implicated as the cause of worsening symptoms including pain and fatigue in chronic inflammatory diseases. Poor sleep has become a keen area of research interest because it is thought to be an environmental factor that is closely linked to worsening IBD symptoms, specifically fatigue . Significant fatigue has been shown to be strongly correlated with poor sleep quality and daytime sleepiness . Population-based sleep quality studies estimate that 32% of adults report poor sleep. Sleep deficiency is an even more common issue among patients with IBD with numerous authors including Graff et al. suggesting rates of problematic sleep in individuals with both active and inactive IBD to be greater than 50% .

How I Turned A Corner With My Crohns Disease

On Thanksgiving 2013, I began experiencing intense stomach and back pain. I thought I’d pulled a muscle, but then started vomiting. In the ER, imaging revealed Id developed a fistula. Fistulas are another common Crohns complication, which results in a tunnel-like hole between inflamed intestinal walls. I underwent a multi-hour surgery to remove 10 centimeters of small intestine.

Ive been in remission and off meds since. Learning how to listen to my bodys subtle changes puts me in a different relationship to my health, wellbeing and lifestyle. In 2017, I moved to Colorado, seeking a more relaxed pace. Ive worked for several digital health startups, and in early 2021 I helped launch the start-up Lin Health, an app focused on chronic pain relief.

I eat a 90% plant-based diet, eating red meat just once annually. Yoga, movement, and meditation practices help me manage stress despite a demanding job. You can’t remove all the stress from your life, but you can react differently. Or, as a favorite Jon Kabat-Zinn quote says: You cant stop the waves, but you can learn to surf.

I also realized I have to be my own advocate. What often gets recommended works for many people, but need to do what feels right to you. It’s harder to get someone to change their diet and lifestyle versus taking a pill. It can take time for new research to work itself into clinical practice, so I read new studies and relay them to my open-minded physician.

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Exercise Combats Uc Fatigue Too

We get it: Feeling tired makes the sofa all the more appealing. But dont take this lying down: Try a brisk walk around the block instead. Why? Incorporating even moderate regular physical activity into your daily routine can reduce fatigue, Dr. Ananthakrishnan says. Research backs him up: A 2020 review article in the American Journal of Gastroenterology, found that recreational exercise decreases the risk of flares and fatigue in people with IBDs. A different 2020 study reports that a 12-week personalized exercise program not only improved fatigue levels in folks with IBD, but also improved overall quality of life.

What Causes Chronic Fatigue When Diagnosed With Crohn’s Disease

CHRONIC FATIGUE SYNDROME, Causes, Signs and Symptoms, Diagnosis and Treatment.

bowel resectiongall bladder surgerydiarrheaChronic fatigueDr. Ramesh Kumarvitamin D3wellbutrinduloxetineTrazodonezolpidemantibodiesChronic fatigue Dr. Vaishalee Punj

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What Causes Chronic Fatigue When Diagnosed With Crohn’s Disease?

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How Fatigue Is Experienced And Handled By Female Outpatients With Inflammatory Bowel Disease

Anne Beck

1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark

2Education of Nurses in Aarhus, VIA University College, Aarhus, Denmark


1. Background

Inflammatory bowel disease , comprising Crohns disease and ulcerative colitis , is a chronic medical condition with unknown aetiology, but genetic and environmental factors likely have an influence on progression of the disease. The symptoms can include diarrhoea, bloody stools, abdominal pain, and extraintestinal manifestations such as fatigue. Fatigue is a well-known symptom in chronic diseases, including IBD, and it is often connected to complaints and worries among IBD patients . Despite the lack of an accepted definition of fatigue, it can be described as a persistent, overwhelming sense of tiredness, weakness, or exhaustion resulting in a decreased capacity for physical and/or mental work . Due to the lack of an accepted definition and the fact that fatigue is a subjective and unspecific symptom, it can be a challenge to adopt the right measurement tools for fatigue diagnosis and quantification . This was expressed in a review from 2010 that identified 252 different ways to measure fatigue in chronic diseases, of which 150 have only been used once .

The aim of this study was to investigate how female outpatients with IBD experience and handle fatigue.

2. Patients and Methods

2.1. Patients
Crohns disease
Patient flow.
2.2. Interviews
2.3. Analysis

3. Results

Gastrointestinal Or Abdominal Pain

Gastrointestinal pain is one of the most common symptoms of IBD, with 50-70% of patients reporting GI or abdominal pain when their IBD symptoms began and/or when their disease is active.1,2 Patients with IBD experience GI pain for any of the following reasons:

Severe inflammation in the gut

When a part of our body is inflamed, a flood of pain-related chemicals is released in our body as warning signals that something is wrong.

Strictures, or narrowing of the intestines, and adhesions

Strictures can lead to painful blockages, or bowel obstructions, when food tries to pass through that part of the intestines.


Sometimes chronic inflammation brought on by IBD causes sores, or ulcers, on the inside wall of the intestine. In some IBD patients, these ulcers create connections, almost like a tunnel, to other parts of the body such as the skin, bladder, vagina, or a different part of the bowels known as fistulas. These can lead to painful infections and drainage.

Small Intestinal Bacterial Overgrowth

When certain bacteria increase too much in the small intestines, these bacteria then release methane. The methane causes gas may lead to bloating and cramping.

Food-related issues

Poorly absorbed/digested carbohydrates commonly cause excess gas and abdominal discomfort.

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Eating And Drinking Habits

Diet can affect how tired or energetic a person feels. Maintaining a moderate and well-balanced diet can lead to better health and better sleep.

Here are some tips to try:

  • Eat small, frequent meals throughout the day.
  • Eat snacks that are low in sugar.
  • Avoid junk food and follow a well-balanced, healthful diet.
  • Consume plenty of fresh fruits and vegetables.
  • Avoid consuming caffeine in the afternoon and evening.

What Is Crohns Disease

IBD: The symptoms and treatment for Crohn

Several different conditions are the result of inflammation of the gastrointestinal tract, and Crohns disease is one of them. Other conditions often diagnosed and discussed include ulcerative colitis and inflammatory bowel disease . It is important to note that irritable bowel syndrome is not a chronic disease nor the result of inflammation of the GI tract, yet it is often mistaken for IBD. It is a non-serious, yet cumbersome, disorder that affects the muscle contractions of the bowel. It is often successfully managed with both lifestyle changes and medical treatment.

IBD is an umbrella term that covers both Crohns disease and ulcerative colitis as well as a less severe form called microscopic colitis. Patients are diagnosed with a specific form of IBD, either Crohns disease or ulcerative colitis. UC is found almost exclusively in the colon while Crohns disease can be found throughout the entire digestive tract, from the mouth to the anus, but most commonly occurs in the small intestine. While UC appears as one continuous line of inflammation, Crohns can appear in patches anywhere throughout the colon, which can make managing symptoms extremely challenging. The causes of IBD are unknown however, they are considered autoimmune disorders and research is pointing more to genetics as the precursor.

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Dont Forget To Mention How Tired You Feel

With various factors at play, youll need to try a multi-pronged approach to fight fatigue. First, dont forget to address your fatigue levels with your doctor at every appointment. With other possible symptoms to discuss it might not come upso be sure to mention your energy levels. Your doctor can then review your medications to see if any might be draining you. Some medications used to treat UC can cause fatigue either directly or indirectly by disrupting sleep. Other medications that alter the immune system have also been reported to make people feel tired, per the Arthritis Foundation.

How You Are Limited From Performing Specific Jobs

If you suffer from Crohns disease, you may not be able to work construction because of the frequent bathroom visits and the inability to stand long periods or walk significant distances.

You may not be able to work in a manufacturing facility because of the pain, inflammation, and the chronic diarrhea causing you to reposition frequently and break away to go to the restroom.

If you work in law enforcement or as a firefighter, you cannot continue with your career because of the pain impacting your mobility, your ability to lift and maneuver, and the urgency for bathroom visits.

Commercial vehicle drivers, such as truckers or bus drivers cannot maintain employment because of the need to frequently go to the bathroom and because of the pain experienced from the disease. Those who suffer from Crohns disease are also more likely to suffer blood clots, which would be too risky for a driver who sits with his or her legs not moving minimally for hours on end. Chronic diarrhea can disrupt almost any job, including cashiers, teachers, and office managers. You cant just leave your work station repeatedly for bathroom breaks and maintain a high level of performance and productivity.

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Don’t Ignore Nutritional Deficiencies

Its important to get assessed for nutritional deficiencies and then treat them if they are present, says Dr. Ananthakrishnan. Some of the most common nutritional deficiencies include iron, B12, vitamin D, vitamin K, folic acid, selenium, zinc, vitamin B6, and vitamin B1. There are many nutrient-rich foods that can help alleviate various deficiencies from UC, but flares or other complications may make it difficult to get enough nutrients from food alone. Your medical team may recommend supplementing your diet with vitamins or minerals.

Assessment Of Concurrent Symptoms

Crohns Disease Signs and Symptoms (& Why They Occur), and Complications & Deficiencies

In order to select an optimal treatment strategy, assessment of concurrent symptoms is mandatory. Many factors are known to contribute to fatigue, such as inflammation, pain, emotional distress, sleep disturbance, anaemia, alterations in nutrition and overall nutritional status, and a diminished activity level. The presence of any of these conditions should be treated in accordance with practice guidelines and with referral to other care professionals as appropriate. Furthermore, medication side effects as well as alcohol and/or drug abuse should be taken into account, as should other comorbidities.

2.2.1. Inflammation

During periods of active gut inflammation, fatigue rates understandably increase. Fatigue, on the other hand, is a highly reported symptom and a major concern in IBD patients and fatigue can be a concealed indication of active disease. Disease activity should be ascertained by the usual clinical, radiological and endoscopic assessments in order to optimize treatment.

2.2.2. Anaemia

2.2.3. Nutrition

2.2.4. Sleep disturbance

2.2.5. Emotional distress

2.2.6. Pain

2.2.7. Medication side effects

2.2.8. Activity level

2.2.9. Comorbidities

2.2.10. Substance abuse

Alcohol and/or drug abuse are associated with emotional distress, poor sleep quality and anxiety, and should always be assessed in the work-up of IBD-related fatigue.

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How To Get That Energy Back

So what can you do to help restore or improve your energy? It comes down to your specialists determining the exact cause of your exhaustion. Your doctor will likely order a variety of blood work to check for anemia, malnutrition, active inflammation, and a metabolic panel for possible problems. In the meantime, other factors that may cause fatigue should be investigated, such as recent changes in your life, new symptoms or any medication changes. Medications can easily change sleeping habits, especially steroids that are commonly used for treating Crohns flares.

Communicating with your doctors is very important so they can closely to monitor your disease and help. Hopefully, with their help and proper treatment, your energy levels will return and you can more easily catch more Zzzs.

Note: IBD News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of IBD News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to IBD.

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