By Kerry Weiss

Medically reviewed by Shannon Chang, MD

You’re likely aware of common symptoms of inflammatory bowel disease, such as abdominal pain, cramping, and diarrhea. But IBD can contribute to persistent fatigue, too.

Fatigue: A Lingering IBD Symptom

“There are many reasons for fatigue with IBD,” explains Aline Charabaty, MD (Twitter: @DCharabaty), Director of the IBD center at Johns Hopkins School of Medicine at Sibley Memorial Hospital, in Washington DC and spokesperson for the American Gastroenterological Association. This includes:

Inflammation. Fatigue may be exacerbated by a flare. “Having active inflammation is like having the flu all of the time, and it causes tremendous fatigue” explains Dr. Charabaty.

Nutrient deficiencies. “During a flare, when you have symptoms like abdominal pain and diarrhea, you’re probably not eating a healthy, varied diet, as certain foods might not appeal to you or cause more GI distress” explains Charabaty. This can contribute to calories deficiency, weight loss, which in turn can leave you feeling fatigued. You can also have malabsorption and loss nutrients from the inflamed gut, “and your metabolism is really high as a result of the inflammation.”

Vitamin deficiencies. “IBD patients often have anemia and low iron because of the chronic blood loss from the GI tract when you have inflammation,” says Charabaty. “Patients with Crohn’s of the small bowel can also have B12 deficiency, which also causes fatigue.”

Sleep disturbances. “People with IBD often don’t get good night sleep,” explains Charabaty. Symptoms like pain can be draining, but the need to get up and use the bathroom multiple times a night can contribute to a lack of quality sleep—which can all contribute to fatigue. Anxiety associated with having a chronic illness can also lead to poor sleep and insomnia.

The emotional toll of managing IBD. “It’s difficult to manage the symptoms of IBD and live with the disease—it requires a lot of testing and visits with specialists. So there’s an emotional burden added to the physical one,” explains Charabaty. What’s more, people who have IBD have an increased risk of depression or anxiety—which also contributes to fatigue.

The Link Between IBD Meds and Fatigue

Certain medications have been linked to fatigue in some people with IBD. But the exact relationship between biologics and fatigue is unclear.

“I have some patients who, after an injection or infusion, say that they feel drained—but are often fine by the next day,” says Charabaty. “But on the long-term, I don’t think biologics specifically cause fatigue—I’ve seen fatigue even in patients who are not on biologics. Fatigue is something that can be due to IBD itself, and it’s one of the symptoms that’s hardest to get rid of.”

While many people find that fatigue improves with treatment as their IBD improves, that’s not the case for everyone. “Even in patients who are in remission, the main complaint that remains is fatigue,” explains Charabaty.

Tips to Stay Energized

The good news? If you’re dealing with persistent fatigue while managing IBD, there are steps you can take to boost your energy. Start with these steps:

Practice proper sleep hygiene. Start by establishing a regular bedtime routine and going to bed and waking up at the same time every day. “Getting proper sleep can help rebalance the body in a way that can help prevent a flare and boost your energy,” says Charabaty.

Exercise regularly. “Often people who have IBD are reluctant to be physically active—they worry exercise may cause a flare, or if they’re really sick, they don’t have the energy to exercise,” says Charabaty. “But once you’re being treated and feeling better, it’s important to gradually resume physical activity.” Even getting just 10 minute of exercise each day can help you get a better night’s sleep.

Eat a well-balanced diet. “When you’re flaring, it’s difficult to eat a healthy, varied diet,” says Charabaty. “But as your inflammation is treated and you start to feel better, it’s important to re-introduce healthier foods back into your diet.” Try eating a variety of fruits, vegetables (in the form you can tolerate: raw, cooked or pureed), whole grains, lean protein, and healthy fats.
“Incorporating all of the food groups helps ensure a healthier body, more energy, and a healthier gut microbiome, too,” adds Charabaty. And make sure you’re tested for any nutritional deficiencies as well, and get treated as needed. You might want to consider meeting a nutritionist to ensure you’re eating enough calories, too.

Take care of your emotional health, too. “A big part of managing IBD is taking care of the physical disease, but taking care of the emotional part is just as important,” says Charabaty. It can help to talk to someone about what you’re going through. Reach out to support groups, friends, family, or even a professional for support.

Medical reviewer and Oshi physician-partner Shannon Chang, MD is a gastroenterologist specializing in IBD at NYU Langone Health’s Inflammatory Bowel Disease Center in New York City. Her clinical interests include J-pouches, pregnancy in IBD, and in-patient IBD management. Dr. Chang is an Assistant Professor of Medicine, as well as the Associate Program Director for the Gastroenterology Fellowship. She completed her internal medicine residency at Mount Sinai Hospital and her gastroenterology fellowship at NYU.

Oshi is a tracking tool and content resource. It does not render medical advice or services, and it is not intended to diagnose, treat, cure, or prevent any disease. You should always review this information with your healthcare professionals.