Before Abby Bales, a physical therapist in New York City, had surgery for ulcerative colitis, she couldn’t make it through the day without taking a nap.
Bales was more than tired. She was experiencing fatigue — an overwhelming sense of exhaustion that is not relieved by rest or sleep and a common symptom of ulcerative colitis.
“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 fatigue. What’s more, about half of people with IBD experience fatigue even when they’re in remission.
“Fatigue is not a universal symptom of ulcerative colitis, but it’s a common one,” says William Katkov, MD, a gastroenterologist at Cedars-Sinai Gastroenterology in Santa Monica, California. “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 experiencing fatigue, it may feel as if you’ll never get your energy back. But by making some healthy lifestyle changes, it’s possible to start feeling more energized.
Does Ulcerative Colitis Cause Fatigue?
Ira Breite, MD, a gastroenterologist at Mount Sinai Health System, explains why people with ulcerative colitis can experience fatigue.
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What Ulcerative Colitis Fatigue Feels Like
Fatigue is more than just feeling tired, according to Dr. Katkov. “People with ulcerative colitis can experience malaise, a profound kind of fatigue that makes it difficult to carry out normal activities.”
Tina Haupert, a nutrition coach living in the South Shore of Massachusetts who was diagnosed with ulcerative colitis in 2011, agrees. Before addressing her fatigue with dietary changes and exercise, she “pretty much always felt tired.”
People with IBD often describe the tiredness with phrases such as “brain fog,” “zombie mode,” or “completely wiped out.” Other people say IBD fatigue is unpredictable: It can come on suddenly, without warning, and vary day-to-day. It can also affect memory and concentration, interfere with work, make it harder to exercise and socialize, and take a hefty toll on emotional well-being, leading to reduced confidence and depression.
What Causes Ulcerative Colitis Fatigue?
People with ulcerative colitis may experience fatigue for a number of reasons, including:
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 act directly on the brain to cause tiredness and deplete energy.
Poor Sleep Sleep disturbances are a strong predictor of fatigue in people with IBD.
Anemia A common complication of ulcerative colitis, anemia can result from blood loss, diarrhea, or poor absorption of certain nutrients. People with IBD who develop anemia do not have enough healthy red blood cells to carry sufficient oxygen throughout the body, leading to fatigue and weakness.
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, particularly when they are first prescribed, can cause lethargy but can also help battle any anxiety or depression that comes from living with ulcerative colitis.
Nutrition Deficiencies Iron, vitamin B12, and folate deficiencies have also been linked to weakness and fatigue.
Emotional and Psychological Stress Anxiety, depression, and stress are consistently associated with fatigue in people with IBD. It’s not entirely clear, though, whether anxiety, depression, and stress cause fatigue or are a result of fatigue.
9 Tips for Managing Ulcerative Colitis Fatigue
The key to easing fatigue is not to ignore it. “Fatigue is a sign that something requires attention,” Katkov says.
1. Get Ulcerative Colitis Under Control With Treatment
Because fatigue is often related to the symptoms and inflammation of ulcerative colitis, it can be more prevalent when the disease is active. Work with your doctor to find the best treatment approach for you.
2. Rule Out Other Causes of Fatigue
“Go through the full list of diagnostic possibilities,” Katkov advises. For example, if the ulcerative colitis is in remission but you’re 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.
3. Move More
It may seem counterintuitive, but activity can ease symptoms and give you energy. Research shows that exercise can decrease fatigue and ease gastrointestinal symptoms in people with IBD.
Haupert, who blogs about food and fitness at Carrots ’N’ Cake, suggests trying to do something active every day, even if it’s a short walk around your neighborhood. “Even though I battle fatigue, I always feel better and more energized after some exercise,” she says.
4. Try to Sleep at Least 7 Hours a Night
“A growing body of evidence suggests that disordered or inadequate sleep can significantly impact health,” says Katkov. “And fatigue is central to that.” Usually, adults need at least seven hours of sleep each night.
If tossing and turning at night is leaving you feeling fatigued the next day, talk to your doctor about ways to improve your sleep. Also, consider cutting back on caffeine and removing distracting electronic gadgets from your bedroom.
5. Eat Healthy Diet
Eating well plays a big role in overall health, says Katkov. He suggests eating a healthy, balanced diet that’s high in nutrient-rich foods that don’t aggravate your digestive tract.
6. Plan Ahead
Have a big event on the calendar? “Make sure you have time to rest before and after,” Bales says. “Stress and lack of sleep don’t do anything good.”
7. Rethink the 9-to-5 Workday
“When fatigue is significant, adjustments in work are appropriate and recommended,” Katkov says. If fatigue is making it hard to get through the workday, consider asking your employer whether they would allow you to work more flexible hours.
8. Try to Reduce Stress
Relaxation techniques, such as deep breathing, meditation, yoga, reading, and tai chi, can help release tension and stress and, as a result, boost energy. You may also want to consider seeing a therapist to help with the anxieties around living with this disease.
9. Learn Your Fatigue Triggers
Everyone’s different, so try to figure out which habits wear you out and which tend to put a little pep in your step — and act on them accordingly. “Manage your life in a way that works for you,” says Bales, who also works as a running coach. “If that means you work out in the morning and go to bed early in the evening, that’s the way you need to do it.”
The Takeaway
Ulcerative colitis can cause severe fatigue for many reasons, including disturbed sleep, inflammation, stress, and the side effects of medication.
Anemia and low levels of certain vitamins can also contribute to fatigue in people with ulcerative colitis.
Treating the underlying condition may effectively manage ulcerative colitis–related fatigue. But adjusting your schedule to allow for fatigue, eating a nutrient-dense diet, improving sleep hygiene, and increasing exercise may also help you preserve energy levels during flare-ups.
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Resources
Uhlir V et al. Fatigue in Patients With Inflammatory Bowel Disease—Strongly Influenced by Depression and Not Identifiable Through Laboratory Testing: A Cross-Sectional Survey Study. BMC Gastroenterology. August 22, 2023.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Katie Kerns Geer is freelance health and lifestyle writer and editor living in Charleston, South Carolina. Before leaving New York City for Charleston, she spent two years as editorial director for a music- and lifestyle-focused YouTube channel of IconicTV. Before that, she was an editor at EverydayHealth.com for five years, two of which she was senior editor. Katie graduated from the University of Georgia’s Grady School of Journalism with a BA in magazine journalism.
