IBD and Fatigue: What’s the Link?

Inflammatory bowel disease (IBD) can cause both physical and mental fatigue. But so can depression, and people with IBD often have depression. Here’s how to figure out why you feel so tired all the time.

Have you ever felt exhausted and weren’t sure why? Or felt tired even after sleeping well?

You may be experiencing fatigue. Fatigue is tiredness or exhaustion that is not relieved by rest. It affects you physically and mentally, and often limits your daily activities.

Fatigue is common in chronic conditions, including IBD. About half of people with IBD experience fatigue.

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Causes of fatigue in IBD

If you have IBD, numerous physical reasons could be contributing to your fatigue. These include:

• Inflammation: When your disease is active, your immune system releases certain proteins called cytokines, which cause inflammation and fatigue.
• Nutritional deficiencies: Inflammation in the gut can make it harder for your body to absorb the nutrients it needs. Anemia and low vitamin levels can cause fatigue.
• Medication side effects: Some IBD medications such as azathioprine, 6-mercaptopurine, or methotrexate can cause fatigue.
• Poor sleep: If you’re having nighttime symptoms such as pain, bathroom trips, or night sweats, your lack of quality sleep will cause fatigue.

You also may feel mental fatigue for a variety of reasons:

• Managing your care: Juggling communication with your doctor’s office, insurance company, and pharmacy can be time consuming and confusing. Navigating these systems takes effort and can be mentally draining.
• Stress or worry: Life with a chronic condition is full of unknowns. Thinking about the future can lead to stress or worry.
• Mental health conditions: People with IBD are more likely than the general population to have common mental health conditions such as depression and anxiety, perhaps due to neuroinflammation. Rates of depression in people with IBD are as much as three times higher than those without IBD.

How do I know what’s causing my fatigue?

Getting to the bottom of why you’re so tired can be difficult to discern, as your mental and physical health are closely intertwined. Before jumping to conclusions, it’s important to see your GI doctor to make sure you’re managing your IBD.

If you’ve just had a change in condition, like a flare, surgery, or change in medication, feeling tired is expected. Your body will need extra rest until your condition returns to baseline.

If you continue to feel fatigued, or if you have new fatigue, your IBD could be worsening. Your GI doctor can do blood or stool tests to check whether your levels of inflammation have changed or if you have any nutritional deficiencies.

Treating your IBD should help improve your fatigue.

How do I know if my fatigue is due to depression?

If your physical health is stable and you still feel persistently tired, consider your mental health.

Think about what kind of fatigue you’re experiencing. Physical fatigue involves a lack of energy. You may feel tired or weak even without exerting yourself.

Mental fatigue is sometimes called brain fog. You may have trouble focusing, remembering things, or making decisions. Physical and mental fatigue often go hand in hand, but you may notice one is worse than the other.

If you think your fatigue is more mental than physical, or if you also have other signs of depression such as sadness or hopelessness, loss of interest in activities you previously enjoyed, or changes in sleep patterns, your fatigue may be due to depression. About 25% of people with IBD also have depression.

A new study looked at the relationship between depression and different types of fatigue. Researchers surveyed 312 people with IBD about their levels of fatigue, disease activity, and mental health.

The results showed that among people with IBD, those who had depression were more likely to feel fatigue — especially mental fatigue — than those without depression.

This study is a good reminder that your mental health has the potential to cause even more fatigue than your physical health.

Your GI doctor may not ask about your mental health. If you notice changes in your mood and fatigue, it’s important to be your own advocate.

Your doctor can help treat both your physical and mental condition with medication. If that’s not enough, don’t hesitate to find a psychologist or counselor for psychological support.

The good news is that treating the cause of your fatigue — whether it’s active disease, depression, or both, will improve your overall health. Although more research is necessary, there is some evidence that treating active IBD leads to improvement in depression, and treating depression results in lower rates of IBD flares.

Researchers believe this is due to the connection between gut health and mental health. When one improves, the other tends to follow. You may have heard this referred to as the gut-brain connection or axis. So be assured that it is worth it to treat both your physical and mental health when dealing with fatigue.

The takeaway

Many factors can lead to physical and mental fatigue in people with IBD. If you’re experiencing new fatigue, be sure to rule out an IBD flare first.

If your physical health is stable and you’re still fatigued, consider getting treatment for your mental health. Depression is common in people with IBD and causes both mental and physical fatigue.

Treating the root of your fatigue is beneficial to your overall physical and mental health.