Bales was more than just tired. She was experiencing fatigue — an overwhelming sense of exhaustion that is not relieved by rest or sleep, which is a common symptom of ulcerative colitis (UC). “When I was flaring, and for the last year before surgery [to remove my colon], the fatigue was absolutely unreal,” Bales recalls. Like Bales, about two-thirds of people with an inflammatory bowel disease (IBD) such as ulcerative colitis experience persistent fatigue, according to a study published in December 2020 in the journal Inflammatory Bowel Diseases. What’s more, very few people in this study saw an end to their fatigue within six months or even 12 months, suggesting this is a prevalent and long-lasting problem for those living with IBD. “Fatigue is not a universal symptom of ulcerative colitis, but it’s a common one,” says William Katkov, MD, a gastroenterologist at Cedars-Sinai Marina del Rey Hospital in Los Angeles. “The important point is that fatigue should be addressed by both the patient and the treating physician.” If you’re living with ulcerative colitis and you’re experiencing fatigue, it may feel as if you’ll never get your energy back. But by tightening control of your condition and making some healthy lifestyle changes, you can manage your fatigue. Tina Haupert, a nutrition coach living in the South Shore of Massachusetts who was diagnosed with ulcerative colitis in 2011, agrees. Before addressing her UC fatigue with dietary changes and exercise, she “pretty much always felt tired.” According to research by the British organization Crohn’s and Colitis UK, people with IBD often describe their tiredness with words such as: “brain fog,” “zombie mode,” feeling “woozy or fuzzy,” “completely wiped out,” and “overwhelming heaviness.” The group also found that IBD fatigue tends to be unpredictable — it can come on suddenly, without warning, and vary from day to day. It can also affect memory and concentration, interfere with work, make it harder to exercise and socialize, and take a hefty emotional toll, leading to reduced confidence and depression, they report. Experts agree that making sure fatigue doesn’t interfere with quality of life, the ability to work, and the capacity to have a normal social life is central to the goal of treating a chronic condition like ulcerative colitis. “We don’t want to settle for a lower quality of life than what can be achieved with aggressive treatment,” Katkov says. RELATED: Irritable Bowel Syndrome and Chronic Fatigue Syndrome: What’s the Connection?
Inflammation In some cases, fatigue is caused by the body’s response to inflammation in the colon, says Katkov. Chemical signals produced during inflammation can directly act on the brain to cause tiredness and lack of energy.Poor sleep The aforementioned 2020 study published in Inflammatory Bowel Diseases found that sleep disturbances were the strongest predictor of fatigue in IBD patients.Anemia A common complication of ulcerative colitis, anemia can result from blood loss, diarrhea, and malabsorption of certain nutrients. According to the Crohn’s & Colitis Foundation, IBD patients with anemia do not have enough healthy red blood cells to carry sufficient oxygen to the their body’s tissues, which can make them feel tired and weak.Medications Fatigue can be a side effect of some medications taken for ulcerative colitis. In addition, taking steroids for ulcerative colitis can lead to insomnia and contribute to fatigue. Antidepressants and narcotics can also cause lethargy.Nutritional deficiencies Low iron, low vitamin B12, and folate deficiency can also be linked to weakness and fatigue, notes the Crohn’s & Colitis Foundation.Emotional and psychological stress Anxiety, depression, and stress are consistently associated with fatigue in people with IBD, says Crohn’s and Colitis UK. It is not entirely clear, however, whether anxiety, depression or stress cause fatigue or are a result of fatigue. “With any patient — but especially someone with a chronic disease, you want to consider their emotional life, stress, and depression,” says Katkov.
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9 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. Additional reporting by Ashley Welch.
