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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

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Fatigue and IBD

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Fatigue and ibd

Fatigue and IBD

Debbie Pullen

Liaison Mental Health Nurse

Liaison Psychiatry



  • •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

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

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

Reasons for fatigue cont

  • Changes in mood eg depression

  • Stress levels

  • Disease activity eg inflammatory processes cause fatigue

Managing 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

Fatigue and ibd

  • 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

Patterns of energy use

  • Demonstration of boom and bust

Pacing and grading

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

Fatigue and ibd

  • Process of grading is to increase activity levels

  • Progress is up a staircase not a hill

  • Takes time so be patient

Managing energy

Managing energy

  • Look at ways at either reducing demand or improving supply

Improving supply

Improving supply

  • Need to look at increasing activities that are fun or give a sense of achievement

  • Ignore the guilt!

Decreasing demand

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

    • Work

    • Professional

    • Financial support and benefits

    • Self management programmes

Managing sleep

Managing sleep

  • 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)



  • 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

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

Fatigue and ibd

  • Set simple realistic goals

  • Minimise stress

  • Practise relaxation

  • Consider learning breathing techniques, mindfulness, yoga, relaxation CDs etc.

Reflective group activities

Reflective Group Activities

Where to access help

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

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