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Ulcerative Colitis Weakness And Fatigue

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What Are The Most Common Ulcerative Colitis Symptoms

Ulcerative Colitis, Crohn’s Disease & Diverticulitis – Medical-Surgical (GI) | @Level Up RN

Early ulcerative colitis symptoms usually include things that could easily be overlooked. Dont be afraid to talk to a doctor if youre having any worries though, even if your symptoms seem mild. If symptoms are ongoing and start to feel more severe, like persistent pain in your abdomen or unintentional weight loss, you should seek medical treatment as soon as possible.

Here are some of the most common symptoms of ulcerative colitis to watch out for, per the NIDDK:

Okay, so this isnt the most pleasant one to start with, but it is actually the most common ulcerative colitis symptomits also a pretty good tip-off that something isnt quite right and that you should schedule an appointment with your doctor. Remember those ulcers we talked about earlier? Yeah, thats where the blood in your stool comes from, and you might also see mucus in there as well.

This is another pretty common symptom, and contrary to popular belief, those ulcers in the colon are not actually what causes the pain. Instead, its a combination of abdominal cramping and bowel distension that occurs due to the inflammation in the intestines, according to a 2013 study published in Inflammatory Bowel Diseases.1

With all thats going on in the digestive tract with ulcerative colitis, nausea can sometimes be an issue. This occurs more often when symptoms are severe, or if the inflammation affects more of the large intestine, according to the NIDDK.

Tips For Managing Your Ulcerative Colitis Fatigue

The key to easing fatigue is not to ignore it. Fatigue is a sign that something requires attention, Katkov says. Consider the following steps.

  • Get your ulcerative colitis under control with treatment. Since fatigue is often related to the symptoms and inflammation of ulcerative colitis, its more prevalent when the disease is active. When ulcerative colitis is well controlled, a patient is not expected to have fatigue, Katkov says. Work with your doctor to find the best treatment approach for your condition.
  • Rule out other causes of fatigue. Go through the full list of diagnostic possibilities, Katkov advises. For example, if your ulcerative colitis is in remission and youre still experiencing fatigue, have your healthcare provider run a blood test to check for anemia or vitamin deficiencies. You may also want to ask your doctor whether a medication or a recent stressful situation might be triggering your tiredness. Get to the root of the problem and address it, he adds.
  • Eat your vitamins. Theres no cure-all diet for ulcerative colitis or fatigue, but eating well certainly plays a role in overall health, says Katkov. He suggests that you educate yourself about a healthy, balanced diet, and reach for foods that are rich in essential nutrients but dont aggravate your digestive tract.
  • Additional reporting by Ashley Welch.

    Fatigue With Ulcerative Colitis

    For the longest time, I didnt know that fatigue could be a part of my UC. My doctors have always focused the majority of our time together on assessing the strictly physical symptoms, like bleeding, urgency, and the number of bowel movements I have per day.

    When I had a flare-up, or even when I was in clinical remission, I didnt recognize that my fatigue was anything other than a typical stressed-out graduate students level of tiredness. When I would talk to other people or tell them, Im tired, I always got a Me too, in response. I assumed fatigue was just what responsible adulthood felt like.

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    Plan A Relaxing Activity

    Whether with your partner, friend, or family, planning a relaxing activity like a couples massage, manicure/pedicure, or other spa-like treatment can work wonders on your fatigue. Or, if you prefer, plan an activity like watching a movie with a close friend. Taking time to do something relaxing and slow-paced still provides you with time to be with your friend or loved one but doesnt become too taxing for you. And your friend could probably use a relaxing activity, too!

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    How Is Fatigue Evaluated

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    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.

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    Open Up To Friends And Family

    If youre feeling too tired to go to a relatives birthday party, for example, be honest about it. Parris says she hid her fatigue from family and friends for a long time because she was embarrassed. But after I shared what I was going through, they were really supportive, she says. Plus, it made me stop looking like a flake when I couldnt go out. They understood the real reason instead of me having to try and make up an excuse.Speaking up about her ulcerative colitis allowed Parris to help her friends and relatives better understand what she was going through so that they could be more supportive.

    Ulcerative Colitis And Colorectal Cancer

    Ulcerative colitis increases the risk of colorectal cancer. Colorectal cancer often begins as small growths on the inside of the large intestine. The risk of colorectal cancer increases based on:

    • the length of time a person has had ulcerative colitis
    • how much of the colon is affected by ulcerative colitis

    People with ulcerative colitis should have more frequent tests for polyps and colorectal cancer than people at average risk. The gold standard screening test is a colonoscopy. Polyps can be removed during a colonoscopy. This reduces the risk of colorectal cancer. Ask your doctor how often you should be checked for colorectal cancer.

    Surgery to remove the entire colon eliminates the risk of colon cancer.

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    Factors Associated With The Presence And Severity Of Fatigue

    The univariate analysis indicated that the Montreal classification, disease activity, anxiety, depression, sleep disturbance and risk of nutrition were the factors associated with fatigue in ulcerative colitis patients . Further statistical analysis showed that FSS was positively correlated with HAS , HDS , PSQI and MUST .

    Fig. 2

    Correlation between FSS and HADS, PSQI and MUST score in patients with UC. A Correlation between FSS score and HADS score. Correlation between FSS score and HAS score: Pearson r=0.416, P< 0.0001 Correlation between FSS score and HDS score: Pearson r=0.395, P< 0.0001. B Correlation between FSS score and PSQI score: Pearson r=0.339, P< 0.0001. C Correlation between FSS score and MUST score: Pearson r=0.325, P< 0.0001

    Multivariate logistic regression analysis indicated that the Montreal classification , disease activity and anxiety were related to a higher risk of presence of fatigue in UC patients .

    Table 2 Factors associated with presence of fatigue in multivariate logistic regression analysis

    Multiple linear regression analysis showed that increased disease activity and anxiety were independently associated with the severity of fatigue. These factors explained 31.2% of the variance .

    Table 3 Factors associated with severity of fatigue in the linear regression analysis

    What Complications Are Associated With Ulcerative Colitis

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    Yes. There are some complications related to ulcerative colitis. Possible complications include:

    • Severe bleeding
    • Toxic megacolon

    People with ulcerative colitis are also at increased risk of developing colon cancer. The risk of colon cancer is related to the length of time since you were diagnosed and how much of your colon is affected by inflammation. However, a regular examination by your doctor and colorectal cancer screening tests can help to reduce the risk of cancer and detect problems early.

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    Dont 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.

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    Levels Of Fatigue In Ibd Patients

    The proportion of IBD patients with active disease that experienced moderate or severe fatigue according to BFI and MFI overall questionnaires was 82.9 and 80.0%, respectively. In contrast but still clinically important, 39.5 and 44.2% of the quiescent disease IBD patients experienced moderate or severe fatigue according to BFI and MFI overall questionnaires, respectively.

    Based on BFI and all MFI dimension results, 59.283.7% of active CD and 14.371.4% of remission CD patients reported moderate to severe fatigue 42.995.2% of active UC and 22.754.5% of remission UC patients reported moderate to severe fatigue .

    Fig. 2.

    Comparison of population percentages experiencing moderate and severe fatigue and severe fatigue .

    There was a large variation between the different fatigue dimensions in all patient categories, highlighting the multifactorial nature of this symptom. The most prevalent type of moderate and severe fatigue in all studied patients was General Fatigue . The least prevalent was Mental Fatigue in CD and UC active disease , and Reduced Motivation and Reduced Activity in CD and UC in remission, respectively .

    There was a larger difference between severe fatigue prevalence in disease in remission comparing to active disease than in moderate fatigue . There was little difference between Reduced Activity, Mental Fatigue and Physical Fatigue prevalence between active disease patients and patients in remission.

    Table 2.

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    Our Fatigue Is Deeper Than Tired

    However, as I got more involved in the IBD community, and started talking with others who have ulcerative colitis and Crohns, I began to realize that our version of tired is different than the typical tiredness everyone experiences now and again.

    Our tired is deeper than just needing a quick nap or a coffee before powering through the rest of the workday. I had judged myself for years for my fatigue, thinking I wasnt trying hard enough or that I was just lazy.

    Comparing My Fatigue To Others

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    I finally realized where I was going wrong. Its just not useful to compare my fatigue to someone elses, even another person with IBD. We all manage things differently, no two bodies are alike, and the last thing anyone needs is a competition for whos the most tired.

    Thats not to say its not helpful to vent to someone else or talk with someone who understands your experience. However, Ive learned that what helps me the most is something far more internal.

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    Give Yourself A Break

    The fatigue you feel because of ulcerative colitis is much more severe than the tiredness a healthy person feels after a long day. Plus, its usually accompanied by other symptoms. “If Im really tired, says Bogdan, I will also get nauseated.” Says Parris, “Going to the bathroom multiple times a day is tiring for anybody. Its basically like having the stomach flu 24/7.”

    Bogdan recommends that you listen to your body and rest when you need to. “Don’t push yourself,” she says. If you sense a flare coming on, taking a break or a nap is a good idea, especially because it might help you feel better later. “Don’t feel that you have to keep up with everyone else,” Bogdan says. “You have a chronic illness that you have to manage.

    Assessment Of Concurrent Symptoms

    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

    2.2.9. 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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    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.

    Looking After Your Mental Health

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    If youre worried about your mental health, try to speak to your GP or IBD team. Some IBD teams have psychologists attached to their team who can help. In some areas of the UK, you can also self-refer to local psychological services. They can assess you and see what support you may need. We have further information on mental health and wellbeing.

    Some talking therapies, specifically Acceptance and Commitment Therapy may help with psychological symptoms of Crohns and Colitis. There have been some small studies suggesting psychological therapies may also help improve fatigue in people with Crohns and Colitis.

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    What Causes Fatigue In Ibd Patients

    • Inflammation: The bodys response to inflammation may cause fatigue. Chemical signals produced during inflammation directly act on the brain to cause tiredness and lack of energy.
    • Anemia: IBD patients with anemia do not have enough healthy red blood cells to carry adequate oxygen to your body’s tissues which can make you feel tired and weak.
    • Nutritional deficiencies: Low iron as well as Vitamin B12 and folate deficiency can also be linked to weakness and fatigue.4 Learn more about Vitamin and Mineral Supplementation.
    • Medication side-effects: Fatigue can be a direct medication-related adverse effect . Steroids are also associated with an increase in energy and/or insomnia. Antidepressants and narcotics, commonly prescribed, can be associated with lethargy
    • Arthritis: Pain and inflammation of the joints leads to fatigue
    • Poor sleep: Sleep may be interrupted by symptoms and anxiety.
    References

    1. Jelsness-Jorgensen LP, et al. Inflamm Bowel Dis. 2011 17:1564-1572

    2. Grimstad T, et al. J Crohns Colitis. 2015 9:725-730

    3. Borren NZ, et al. Nat Rev Gastroenterol Hepatol. 2019 16:247-259

    4. Gasche C, et al. Gut. 2004 53:1190-1197.

    • Pain and Fatigue

    Eat For Maximum Energy

    Diet may play a role in causing UC fatigueespecially if youre not eating a balanced and broad diet, says Dr. Ananthakrishnan . Consuming low FODMAP foods can also help so, too, can avoiding seeds, whole wheats, and lactose foods. While there are several specialized diets that may be helpful for some, no one plan has been proven to prevent or control UC, per the Crohns & Colitis Foundation. Your medical team may recommend a particular diet based on your symptoms and what foods youre best able to tolerate.

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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% .

    Can Elimination Diets Cure It

    Medicines for ulcerative colitis

    Up to 60% of IBD patients have tried an elimination diet to relieve ulcerative colitis symptoms .

    Unfortunately, the only known cure is total surgical removal of the colon and rectum .

    There is no scientific proof that any diet can cause remission on its own. However, limited evidence suggests that certain diets can greatly improve comfort and quality of life.

    The impact of diet on inflammatory bowel disease. Click to enlarge. Image .

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    What To Eat For Acid Reflux

    Whether its a chronic condition or a newfound symptom of stressful days, heartburn happens! Avoiding spicy, acidic and fried foods as well as cutting back on alcohol and chocolate can help douse the flames and there are some foods you should gravitate towards to help reduce the discomfort. Heres what you can eat to help keep heartburn symptoms from being too upsetting.

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