How to Manage Fatigue When Living With Crohn’s Disease

If you have Crohn’s disease,?symptoms such as abdominal pain and frequent bowel movements can prevent you from getting enough quality sleep and rest. These are just some of the reasons why fatigue is a common problem with Crohn’s.

“Fatigue is a feeling of lack of energy, weakness, or tiredness that may interrupt daily activities,” explains Pratima Dibba, MD, a board-certified gastroenterologist with Medical Offices of Manhattan in New York City.

Dealing with persistent fatigue can be frustrating. Read on to learn more about the causes, and nine ways to help manage Crohn’s disease fatigue.

There are many contributing factors to fatigue in Crohn’s disease patients, says Supriya Rao, MD, a quadruple board-certified physician in internal medicine, gastroenterology, obesity medicine, and lifestyle medicine who goes by the moniker Gutsy Girl MD.

These factors include the following:

• Poor sleep
• Inflammation
• Extraintestinal complications
• Nocturnal bowel movements
• Blood loss
• Nutrient deficiencies
• Medication side effects
• Depression and anxiety

1. Poor Sleep

2. Inflammation

While there are two types of inflammation — acute and chronic — Crohn’s disease is chronic, meaning it’s long lasting or recurring. “Chronic inflammation from Crohn’s disease can drain your body of energy, resulting in fatigue,” Dr. Rao says. “The body uses inflammation as a defense, but overactivity from the immune system can cause exhaustion.”

3. Extraintestinal Complications

EIMs also include anemia, blood loss, and poor nutrient absorption, which can worsen fatigue, Rao says.

4. Nocturnal Bowel Movements

5. Gastrointestinal Symptoms

Crohn’s disease symptoms like cramping and bloating can make it hard to fall asleep. “Sometimes it’s just a matter of trying to get comfortable enough to fall asleep and stay asleep throughout the night,” shares Rhondell Domilici, who was diagnosed with Crohn’s disease at age 12 and is now the associate vice president of national advancement and volunteer engagement at the Crohn's & Colitis Foundation.

6. Blood Loss

Slow continuous blood loss from lesions in the small or large intestine can lead to anemia, which causes fatigue, explains Cuckoo Choudhary, MD, a professor of medicine in the division of gastroenterology and hepatology at Thomas Jefferson University in Philadelphia.

7. Nutrient Deficiencies

Crohn’s disease can cause poor nutrient absorption, which can lead to numerous nutritional deficiencies, Rao explains. Deficiencies in iron, vitamin B12, and vitamin D are particularly common in Crohn’s patients and may contribute to fatigue, Rao adds.

8. Medication Side Effects

In addition to her symptom-related fatigue, Domilici remembers one particular medication that worsened the problem. “I felt like I’d been run over by a truck,” she recalls. Unable to get up for work in the mornings, she called her doctor for a switch.

If this is the case for you, your doctor may stop or switch your medications to address this problem or recommend supplements.

9. Depression and Anxiety

“Emotional stress is a contributing factor that can exacerbate fatigue,” Rao says. “There is a large overlap in patients with Crohn’s and depression and anxiety.”

Living with a chronic disease often means monitoring and tracking your symptoms, such as fatigue. This allows you to identify triggers, such as food and stress. It can also help you detect relapses early when the disease is inactive or in remission.

When Crohn’s disease fatigue is getting in the way of your daily life, here are some of the ways you can manage it:

• Rule out underlying anemia
• Take the necessary supplements as directed by your healthcare provider
• Treat flare-ups
• Switch medications
• Manage sleep
• Manage stress
• Eat well
• Exercise regularly
• Budget your energy

1. Assess Anemia

While blood transfusions improve your blood levels, you will need to take other steps to address or prevent anemia.

2. Take a Supplement

Crohn’s patients may also have low vitamins B12 and D, Rao adds. Dr. Choudhary says she often recommends that Crohn’s patients take a multivitamin and have frequent blood tests to check for nutrient deficiencies. Consider talking with a dietitian who specializes in Crohn’s disease or your doctor before taking any new supplements.

3. Treat Flare-Ups

Make sure you’re following all of the necessary steps to avoid and treat your Crohn’s flares. This means taking prescribed medication according to your doctor’s instructions in addition to maintaining a healthy lifestyle.

4. Switch Medications

5. Manage Sleep

Talk with your doctor about ways to improve life with Crohn’s so you can get some shut-eye, especially if symptoms are keeping you up at night.

Also review your entire sleep hygiene routine to make sure you’re giving yourself a chance to get enough good-quality sleep. The Crohn’s & Colitis Foundation recommends going to sleep and waking up at the same time everyday and using fewer electronics closer to bedtime.

You should also create a bedtime routine that’s conducive to quality sleep, such as creating a calming environment in your bedroom, Rao adds.

6. Manage Stress

Yes, Crohn’s is stressful. Stress in itself is tiring and can interfere with sleep.

You’ll want to identify your stressors as part of an overall strategy to reduce stress, says Rao. The Crohn’s & Colitis Foundation advises patients to take up cognitive behavioral therapy (CBT), mindfulness, and meditation to relieve emotional stress if it’s impacting your life — your gastroenterologist can refer you if this is needed. Taking a warm bath before bed or having a cup of chamomile tea can help set a relaxing mood.

7. Eat Well

There isn’t a one-size-fits-all diet for Crohn’s disease, but food can still play a role in symptom and disease management.

8. Exercise

9. Budget Your Energy

When you have limited energy, you’ll need to use it wisely. Consider the concept of treating your energy levels like money and budgeting it appropriately.

“It’s a matter of being good at prioritizing and delegating,” Domilici says. “Look at your week and have a sense of what you can manage and not manage.” If your day is overbooked, cut some of your commitments.

Crohn’s patients may even need to take time off from school or work obligations or obtain necessary accommodations from their physician as needed, Dr. Dibba says.

Crohn’s disease is a chronic, life-long disease that can cycle between periods of relapse, when the disease is active and symptoms worsen, and remission. But symptoms like fatigue may not fully disappear even during remission. “Addressing fatigue will require ongoing, consistent care,” Rao says.

When you are feeling fatigued, you may have to lean on your support systems. “It’s my wish for everyone who suffers from Crohn’s disease to not feel embarrassed or guilty to tell people, ‘I’m not feeling so great today. I could use a little extra sleep because I have a lot to do tomorrow,’” Domilici says. “The disappointment of missing out on plans and being exhausted is enough to manage without feeling bad about canceling plans.”

You can also seek out a support group for chronic fatigue, Rao suggests. “Chronic medical conditions can be lonely and isolating,” Rao says. “I encourage anyone struggling with fatigue to seek out the companionship that comes with community.”

Fatigue is an invisible symptom, which means it isn’t always obvious to those around you. You’ll need to communicate with family, friends, and even healthcare providers so they understand how you’re feeling. This may involve setting boundaries around your limitations in social situations.

Domilici recommends that Crohn’s patients familiarize themselves with the Spoon Theory metaphor for chronic illness and share it with family and friends who may have trouble understanding the debilitating nature of this disease.

For Domilici, time management is essential to get enough rest, especially if she knows she has a demanding week ahead. She admits that at first it was difficult to turn down invitations from friends, but she knows it has to be done sometimes.

“Crohn’s patients can use this as a gauge to assess whether their fatigue should be addressed by a healthcare provider,” Dibba says.

Takeaway

• Crohn’s disease is an inflammatory bowel disease (IBD) that is commonly associated with fatigue.
• There are many possible causes of Crohn’s disease fatigue such as poor sleep, ongoing inflammation, anemia, and other nutritional deficiencies, and gastrointestinal symptoms such as frequent bowel movements.