DEAR MAYO CLINIC: I was diagnosed with Crohn’s disease nearly a year ago. The medication I am on seems to take care of most of my symptoms. But I am often extremely tired. Is there anything that can be done to help with fatigue from Crohn’s?
ANSWER: Fatigue is a common problem for people who have Crohn’s disease. There are a number of possible causes. The disease itself often leads to fatigue. Medication side effects and a lack of physical conditioning due to illness can contribute to fatigue, too. Crohn’s disease also may trigger anemia, a condition that often results in fatigue. When Crohn’s disease is well controlled and these other problems are addressed, fatigue often decreases.
Crohn’s disease is a form of inflammatory bowel disease, or IBD. The inflammation of Crohn’s typically occurs in patches throughout the digestive tract. It may spread deep into the layers of the affected bowel wall and at times may penetrate the bowel and involve other organs.Intestinal inflammation caused by Crohn’s disease can result in a variety of symptoms, including diarrhea, abdominal pain and cramping, blood in the stool, ulcers and fatigue.
Symptoms of Crohn’s disease usually come and go. A variety of medications have been shown to effectively keep symptom flare-ups to a minimum. When the disease is under control, people who have Crohn’s disease usually have more energy and less fatigue.
Although the medications used for Crohn’s can be quite helpful in managing the disease, some can lead to fatigue. Drugs known as immunomodulators — 6-mercaptopurine and azathioprine, in particular — can be associated with fatigue. Others medications such as corticosteroids like prednisone contribute to fatigue in part by causing sleep problems. Review your current medication list with your doctor. If you are taking medications that may trigger fatigue, ask if you can switch to an alternative.
As noted, another common cause of fatigue in people who have Crohn’s disease is anemia. Anemia is a condition in which you don’t have enough healthy red blood cells to carry sufficient oxygen to your body’s tissues. This can leave you feeling tired and worn out, even when you get plenty of sleep. It is important to identify and treat anemia because, if left untreated, not only will fatigue continue to increase, anemia could also lead to additional health problems.
Deconditioning related to illness can lead to fatigue, too. Staying active and exercising regularly may help reduce your fatigue. For many people, activities such as walking, swimming and biking work well to increase energy and ease feelings of fatigue.
If you haven’t been active in the past, or if you are starting a new exercise program, talk to your doctor about the activities that are best for your situation. If you feel worse with exercise, make sure to tell your doctor about it. He or she may be able to help you modify your activities to better suit your needs.
Finally, eating a healthy diet is very important. Pay attention to what you eat. Over time, you may be able to see patterns and identify foods that help you feel better, as well as foods you may need to avoid. It also can be useful to work with a dietitian to build a healthy diet that’s right for you.
To get started, discuss your concerns about fatigue with your doctor. Together you can review the possible causes and come up with a plan to reduce fatigue and help you feel better. — Jonathan Leighton, M.D., Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Ariz.