Is Your Ulcerative Colitis Causing Fatigue? | Everyday Health

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Ulcerative colitis fatigue can make it difficult to work and carry out everyday activities.
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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 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.
What Ulcerative Colitis Fatigue Feels Like
Fatigue is beyond just a passing feeling of being tired, explains Dr. Katkov. “ People with ulcerative colitis can experience malaise, a profound kind of fatigue that makes it difficult to carry out normal activities,” he says.
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.
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 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.
RELATED: 10 Common Mistakes That Can Make Ulcerative Colitis Worse
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.
Get your ulcerative colitis under control with treatment. Since fatigue is often related to the symptoms and inflammation of ulcerative colitis, it’s more prevalent when the disease is active. “When ulcerative colitis is well controlled, a patient is not expected to have fatigue,” Katkov says. Work with your doctor to find the best treatment approach for your condition.
Rule out other causes of fatigue. “Go through the full list of diagnostic possibilities,” Katkov advises. For example, if your ulcerative colitis is in remission and 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.
Move more. It may seem counterintuitive, but activity can ease symptoms and give you energy. According to a research review in the June 2020 issue of the American Journal of Gastroenterology , recreational exercise has been shown to decrease the risk of fatigue, as well as flares . Nutrition coach Haupert, who blogs about food and fitness at Carrots 'N' Cake , suggests that you try 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.
Try to sleep eight 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.” As a rule of thumb, the National Sleep Foundation recommends that adults get seven to nine 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.
Eat your vitamins. There’s no cure-all diet for ulcerative colitis or fatigue, but eating well certainly plays a role in overall health, says Katkov. He suggests that you educate yourself about a healthy, balanced diet, and reach for foods that are rich in essential nutrients but don’t aggravate your digestive tract.
Plan ahead. Got a big event on the calendar? “Make sure you have time to rest before and after,” recommends Bales. “Stress and lack of sleep don't do anything good for your immune system.”
Rethink the nine-to-five day. “When fatigue is significant, adjustments in work are appropriate and recommended,” Katkov says. If fatigue is hindering your ability to get through the workday, consider asking your employer whether they would allow you to work more flexible hours.
Try to reduce stress. Practicing relaxation techniques, such as deep breathing, yoga, meditation, reading, or tai chi, can help diffuse tension and stress, and, as a result, buoy your energy.
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,” advises 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.”
Additional reporting by Ashley Welch .
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