Fatigue and IBD
Debbie Pullen
Liaison Mental Health Nurse
Liaison Psychiatry
Background
• •IBD affects 3.6 million people worldwide &
240,000 in the UK
• •Fatigue is common in IBD
• •Leading concern for IBD patients- during
remission 40% of people affected
• •Multifaceted, unpleasant, distressing
• •Subjective and poorly understood
• •Fatigue is poorly managed
Definition of fatigue
• An overwhelming sense of unrelenting
tiredness, lack of energy or feeling of
exhaustion that is not relieved following
rest or sleep
Reasons for fatigue
• Pain
• Anaemia due to malabsorption of vitamins
and minerals
• Sleep disturbances – many causes!
• Side effects of medication eg steroids
which can make people feel “wired” or
other medications which cause drowsiness
Reasons for fatigue cont
• Changes in mood eg depression
• Stress levels
• Disease activity eg inflammatory
processes cause fatigue
Managing fatigue
• Compare energy to a battery
• Healthy person = charged battery
• Need to ration energy
• Need to learn how to increase
energy eg relaxation
• Relying on emergency supplies
• Consider how you are spending your
energy
• Physical, emotional, mental, social
• Tasks depend on many things –
where/when you do it, previous
experience, people present etc
Patterns of energy use
• Demonstration of boom and bust
Pacing and grading
• Pacing activities across the day to
minimise energy use
• Intersperse activity with frequent rest
• Know when to stop – stopping distances
• Need to break activities down into smaller
parts to make them easier
• Mix and match
• Process of grading is to increase activity
levels
• Progress is up a staircase not a hill
• Takes time so be patient
Managing energy
• Look at ways at either reducing demand or
improving supply
Improving supply
• Need to look at increasing activities that
are fun or give a sense of achievement
• Ignore the guilt!
Decreasing demand
• Demands from family, work, running a
house etc
• Also come from pressure of meeting own
standards or expectations
• May need to ask for help
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Work
Professional
Financial support and benefits
Self management programmes
Managing sleep
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Practise good sleep hygiene
set routine
get up if cant sleep
Manage environmental factors (noise,
light, have change of clothes or bedding at
hand etc)
• Exercise (not too late)
Sleep
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Write down troubling thoughts
Carry out relaxing activities
Avoid caffeine and alcohol
Don’t use computer or TV in bed
Avoid napping in day
Avoid looking at the clock
Improving energy
• Keep active and consider exercise
• Consider diet
• Don’t stop doing activities you enjoy
although may have to modify
• Prioritise tasks but be realistic ie don’t take
on too much
• Plan your week to allow rest periods
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Set simple realistic goals
Minimise stress
Practise relaxation
Consider learning breathing techniques,
mindfulness, yoga, relaxation CDs etc.
Reflective Group Activities
Where to access help?
• If you feel you are in need of help for any
aspect of your mental health you can
access counselling and therapy services
through your GP. Just visit them and ask
to be referred
• If you feel you are not coping with IBD at
all and would like help – liaison psychiatry
can be accessed through your local IBD
nurse