Key takeaways
- Managing underlying health issues such as inflammation, anemia, nutritional deficiencies, and arthritis can significantly reduce fatigue associated with ulcerative colitis (UC).
- Techniques such as modifying activities, using mobility aids, and allowing time for recovery between energy-intensive tasks are crucial for managing your energy throughout the day.
- Exercising as you can and addressing mental health conditions like depression and anxiety can also play a vital role in reducing fatigue related to UC.
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). It causes colon inflammation, which can lead to a range of related symptoms.
Fatigue is a state of extreme mental and physical tiredness that people often describe as persisting even when they are getting enough sleep and rest. It affects the whole body, causing some people to have difficulty even lifting their limbs.
UC-related inflammation, certain UC medications, and underlying medical conditions can all cause varying degrees of fatigue. But several strategies may help you manage fatigue so that you can continue your usual daily activities and maintain a good quality of life.
Several aspects of IBD can cause fatigue. The Crohn’s & Colitis Foundation suggests the following possible causes:
Inflammation
Inflammation is associated with fatigue and may cause fatigue when chemical signals related to inflammation affect your brain. As a result, you may feel tired and low on energy.
In people with IBD, fatigue is far more prevalent during periods of active disease and may not be present at all during remission. Managing inflammation during periods of active disease may help reduce fatigue.
Anemia
Anemia involves a shortage of red blood cells, which carry oxygen to organs and tissues throughout your body. When your organs and tissues don’t receive enough oxygen, you may experience fatigue.
According to the Crohn’s & Colitis Foundation, about 1 in 3 people with UC or Crohn’s disease also have anemia, which could be due to:
- low iron, vitamin B12, or folic acid levels (caused by intestinal inflammation that reduces vitamin and mineral absorption)
- intestinal bleeding
- medications
If you have low vitamin and mineral levels, a healthcare professional may suggest that you take supplements. Once your nutrient levels are restored, your fatigue may lessen.
Malnutrition and nutritional deficiencies
In addition to iron deficiencies that may contribute to anemia, people with IBD often have deficiencies in folate and vitamin B12, which can lead to fatigue and weakness.
Your healthcare team may recommend taking supplements if your levels of these nutrients are low.
Arthritis
Arthritis is the most common non-digestive complication of UC and may affect around 10% of people with UC. Pain, sleep disturbances, or inflammation related to arthritis may contribute to fatigue.
Most cases of arthritis that occur in people with IBD are peripheral arthritis, which affects large joints, such as the knees, elbows, or hips, and usually involves fewer than five joints
Peripheral arthritis flare-ups typically coincide with active intestinal inflammation.
The other type of arthritis that may occur along with IBD is symmetrical polyarthritis, which is less common than peripheral arthritis. People with symmetrical polyarthritis experience symptoms in the small hand joints that can last for a long time.
Symmetrical polyarthritis flare-ups do not seem to coincide with active intestinal inflammation.
Your healthcare team can help you manage the symptoms of arthritis, including any related fatigue you may experience.
Sleep disorders are common in people with IBD and may contribute to a lack of quality sleep.
A small 2017 study involving 15 people with IBD found that the participants slept for only 4.5 hours per night, on average. The reasons for their lack of sleep included IBD symptoms, stress, and habits such as watching TV in bed.
Sleep disturbances may be more prevalent when UC is active than during remission. Getting high quality sleep regularly can benefit your overall health in many ways, including by potentially reducing fatigue.
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- setting and sticking to a sleep schedule
- getting at least 30 minutes of exercise on most days, but not exercising right before bed
- avoiding alcohol, caffeine, and nicotine late in the day
- taking time to relax before bed, such as by taking a bath, reading, or meditating
- keeping your bedroom quiet and at a comfortable temperature whenever possible
- avoiding the use of devices such as a smartphone, tablet, or TV in your bedroom
- getting out of bed if you can’t fall asleep, and doing a relaxing activity like reading or listening to calming music until you feel tired
- talking with a doctor if you’re experiencing sleep problems that you can’t manage on your own
Energy conservation involves adapting certain activities or changing your environment to reduce the amount of energy you need to use in day-to-day tasks.
Managing your energy should help you decrease your overall fatigue levels without affecting your daily routines too much.
Here are some practical ways to do this:
| What to try | How it can help |
|---|---|
| Use a planner or smartphone app to organize your time and space. | You can avoid scheduling too many energy-intensive tasks close together. |
| Simplify activities or break tasks into smaller, more manageable steps (for example, use tools such as a dishwasher and food processor to reduce the energy required). | You’ll get the same outcomes over a slightly longer time frame. |
| Sit instead of standing while doing activities such as dressing, cooking, or cleaning. | You’ll save more energy for other tasks throughout the day. |
| Avoid doing physically taxing activities during the hottest or coldest part of the day. | You’ll avoid the unnecessary demand that extreme temperatures place on your body. |
| Maintain good posture when sitting and standing. | You may experieince less stiffness or risk of injury to your back and legs. |
| Use a mobility aid, such as a walker, a wheelchair, or orthotics. | You’ll use less energy for walking. |
| Park close to store entrances, use a shopping cart instead of a basket, and avoid shopping at busy times of day. | You’ll expend less energy on walking, holding heavy items, and standing in long lines. |
If you have a chronic condition, fatigue may make exercise more difficult, but that doesn’t mean you should avoid it. Regular exercise may actually help reduce fatigue.
A 2023 research review that included data from 2,091 people with chronic conditions found that resistance training, aerobic cycling, balance training, and a combination of all three significantly reduced fatigue. The most significant reductions in fatigue occurred in people who took part in the activities for 2 to 6 weeks or 16 to 24 weeks.
However, the studies included in the review were not specific to UC — they involved people with a variety of health conditions. More research is needed to explore the long-term effects of physical exercise for fatigue management in people with chronic conditions.
When living with UC, you may feel sadness, fear, or frustration. You might also experience symptoms of anxiety and depression, which are common in people with IBD. According to a
In turn, depression may contribute to fatigue. In a 2015 survey of 1,982 people with depression, 653 of them also had significant fatigue.
If you’re experiencing fatigue and other symptoms of depression, such as hopelessness, sleep problems, or appetite changes, consider contacting your healthcare team. Asking for help can be the first step in addressing any mental health concerns that may be contributing to your fatigue.
Fatigue can occur as a side effect of some IBD medications, such as the immunosuppressants azathioprine and 6-mercaptopurine, as well as methotrexate, antidepressants, narcotics, and steroids.
If fatigue is significantly affecting your quality of life, your healthcare team can evaluate your medications and may consider stopping any that could be linked to fatigue, as long as they have ruled out other possible causes.
If you experience fatigue even when your UC is in remission, your care team should review your medications as soon as possible.
When you have a chronic health condition like UC, some everyday activities can be tiring, so you might consider asking family or friends to help out.
It’s important to ask for help when you need it, and delegating tasks is one way you can make positive changes to your daily routine.
If you need more assistance than your loved ones can provide, a home health aide may be an option. You can talk with your healthcare team about the options available to you locally.
Fatigue can be difficult to manage alongside active UC, but experts agree that managing any underlying conditions you have can bring the best results. Strategies such as prioritizing sleep, conserving energy, and exercising may also be helpful.
You may want to consider asking loved ones for help with daily challenges and talking with your healthcare team about any support that they or other local organizations can offer. The Crohn’s & Colitis Foundation and the IBD Support Foundation can also provide information and resources.