Crohn’s Disease is a chronic disorder (inflammatory bowel disease) that causes inflammation in the digestive tract. Crohn’s Disease can affect any area of the GI tract, but commonly affects the lower part of the small intestine. The swelling extends deep into the lining of the affected organ. The swelling can cause pain and can make the intestines empty frequently, resulting in diarrhea.
Crohn’s Disease can be hard to diagnose because the symptoms are similar to other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis.
Crohn’s Disease is typically inherited and it seems to affect men and women equally. Crohns disease often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohns disease.
Symptoms
Diagnosis
Blood tests are run to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines.
Treatment
Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. Treatment for Crohns disease depends on the location and severity of disease, complications, and the persons response to previous medical treatments when treated for reoccurring symptoms.
Complications
Resources for Crohn’s Disease Patients
Crohn’s & Colitis Foundation of America
Digestive Diseases
Crohn’s Online
I believe that one of the reasons for not diagnosing Crohn’s properly is that medical professionals (and I use that term loosely after all that we have been through), focus on the pain being in the lower right abdomen. This was definitely not the case for my 15 year old daughter. Her pain was above her bellybutton area. She also was never having problems with an upset stomach but had constant constipation. She had over ten ulcers in her and lost down to 94lbs. It was a nightmare that went undiagnosed for five months and we went to four different doctors trying to get help. None of our doctors wouldn’t refer her out as he wanted to solve the problem and didn’t think she was that bad off. He wanted to do all the GI testing himself and took his sweet time assuring us it was her gallbladder. After finding that her gallbladder was barely functioning and before doing any other testing, he rushed her for emergency surgery. Thankfully the admitting ER doctor stopped the process and was able to get us in the next day to see a pediatric GI which I had been trying to do and had been put on a three month waiting list since I didn’t have my doctor’s referral… My daughter was immediately diagnosed with Crohn’s and then went through testing which more than confirmed it. She began medication immediately and we could see improvement right before our eyes within a day though it has taken months to get her healthy. She will be on 6mp indefinitely to suppress her immune system in order to keep her well…
Managing Crohn’s disease can be exhausting. Between flare-ups, doctor appointments, and watching your diet, you might feel spent before the sun goes down, only to have symptoms like abdominal pain and frequent bowel movements keep you from getting a good night’s sleep.
From the time Rhondell Domilici was diagnosed with Crohn’s disease at age 12, she committed herself to living a “normal” life — participating in activities, going out with friends, striving to achieve success in both school and work. But a social life paired with the demands of living with a chronic condition left her wiped out by week’s end. Even in high school, she’d go to bed after dinner on some Friday nights and sleep in all weekend, recouping her energy for the following week.
Domilici is not alone. Many people with Crohn’s disease report experiencing fatigue, which can be both a symptom of the condition and a side effect of treatment.
For Domilici, now the director of national advancement and volunteer engagement at the Crohn’s and Colitis Foundation of America, it’s essential that she manage her time to get enough rest, especially if she knows she has a demanding week ahead. She admits that at first it was difficult to turn down invitations from friends, but she knew she had to do it.
“For me, it’s my wish for everyone who suffers from Crohn’s disease that they do not feel embarrassed or guilty to tell people, ‘I’m not feeling so great today. I could use a little extra sleep because I have a lot to do tomorrow,'” Domilici says. “It’s such a relief and a weight off your shoulders to feel comfortable saying that.”
Quality sleep is important for keeping Crohn’s disease under control. A study published in February 2020 in Scientific Reports found people with active Crohn’s disease reported getting less sleep than people without the disease or those whose disease was in remission. Another study, published in December 2019 in the journal Inflammatory Bowel Diseases, observed that sleep disturbances can lead to worse outcomes for Crohn’s patients and that poor sleep quality is associated with disease activity.
The Need for Nocturnal Bowel Movements Crohn’s disease can cause sudden, frequent bowel movements, even in the middle of the night, which will prevent you from getting a restful night’s sleep. A study published in 2018 in Chronobiology International found poor sleep was associated with increased bowel symptoms.
The Persistence of GI Symptoms Such as Abdominal Pain Cramping and bloating can make it hard to fall asleep. “Sometimes it’s just a matter of trying to get comfortable enough to fall asleep and stay asleep throughout the night,” Domilici says. The International Foundation for Gastrointestinal Disorders reports sleep problems as a common issue among GI disorders and that waking up due to pain can prevent people from entering the restorative phase of deep sleep.
Blood Loss Slow continuous blood loss from lesions in the small or large intestine can lead to anemia, which causes fatigue, explain Cuckoo Choudhary, MD, an associate professor of gastroenterology at Jefferson University Hospitals in Philadelphia. Anemia and Crohn’s disease are closely linked to each other. A study published in September 2020 in PLoS One found that having anemia was associated with a higher risk of Crohn’s disease. Some signs that should set off alarm bells in your head include shortness of breath, lack of energy, and a sickly pale appearance — call your physician right away if this happens.
Nutrient Deficiency As with many digestive conditions, Crohn’s disease can keep patients from properly absorbing key nutrients, such as iron, particularly when the small bowel is affected. A study published in October 2019 in Nutrients found multiple vitamins and minerals necessary for quality sleep. Adults over age 19 with poor sleep had less calcium, magnesium, and vitamin D. Female study participants who were deficient in calcium, magnesium, and vitamins A, C, D, E, and K were more likely to get less than eight hours of sleep. Meanwhile, male participants were more likely to have trouble sleeping from being Vitamin D deficient.
Medication Side Effects In addition to her symptom-related fatigue, Domilici remembers one particular medication that worsened the problem. “I felt like I’d been run over by a truck,” she recalls. Unable to get up for work in the mornings, she called her doctor for a switch. “Some medications can make patients anemic,” Dr. Choudhary says. A study published in February 2019 in the Journal of Crohn’s and Colitis notes that patients with inflammatory bowel disease (IBD) taking steroids experienced more fatigue and overall lower quality of life. If this is the case, your doctor may stop or switch your medications to address this problem or recommend supplements.
Depression and Anxiety Like many others with chronic illnesses, people with Crohn’s disease symptoms are at increased risk for depression and anxiety. According to the Crohn’s and Colitis Foundation, insomnia is a sign of mental health issues. This may be particularly problematic when people are first diagnosed, says Domilici, adding that living with Crohn’s for over 30 years has helped her to gain some perspective and discover strategies to cope with the emotional and psychological challenges.
It’s true that your exhaustion could be due to sleepless nights, stress, and even situations unrelated to Crohn’s, but sometimes medical intervention may be needed. Work with your doctor to rule out or address what’s causing your fatigue and make lifestyle changes to cope. Here’s where to start:
Assess anemia. The Crohn’s and Colitis Foundation reports about 1 in 3 people with Crohn’s have anemia. A blood test can determine whether or not you’re anemic. At its most severe, anemia is life-threatening. Iron supplements given orally or through an IV can also help with iron deficiency. A review published in 2019 in the journal Acta Haematologica notes that oral iron can effectively treat anemia, but because it can change your gut bacteria, IV iron is preferred. And IV iron supplementation is the preferred treatment for people with active inflammation. According to the American Society of Hematology, blood transfusions can be a temporary solution if a person is actively bleeding or feeling chest pain and shortness of breath. While blood transfusions improve your blood, you will need to take other steps to address or prevent anemia.
Take a supplement. You might need more than iron supplements to make up for any nutritional deficiencies in your diet. Sophie Medlin, RD, a consultant dietitian at City Dietitians and chair for the British Dietetic Association for London, notes that people with Crohn’s are also at a higher risk for deficiencies in vitamin B12 and zinc. “B vitamins, iron, and zinc come largely from animal products such as meat, fish, dairy, and eggs. Cutting these things out comes alongside a risk of becoming deficient,” Medlin says.
A review published in 2020 in the journal Digestion also reported a higher risk of folic acid deficiency in patients with IBD. Choudhary says she often recommends that patients take a multivitamin and have frequent blood tests. Medlin advises talking with a dietitian who specializes in Crohn’s disease or your doctor before taking any additional medications.
Treat flare-ups. Inflammation can make it hard to fall asleep. Avoid irritants that can trigger flare-ups, such as coffee and smoking. Make sure you’re following all of the necessary steps to avoid and treat your Crohn’s flares. This means taking prescribed medication according to your doctor’s instructions in addition to maintaining a healthy diet and exercise plan.
Switch medications.Corticosteroids such as prednisone are commonly prescribed for patients with Crohn’s, but they can interfere with sleeping, according to the Mayo Clinic. If fatigue is a side effect of one of your medications, you might need to switch. Do so only with your doctor’s supervision.
Manage sleep. Americans, even those without a chronic medical condition, are notoriously short on sleep. Talk with your doctor about ways to improve life with Crohn’s so you can get some shut-eye, especially if Crohn’s disease symptoms are keeping you up at night. Also review your entire sleep routine to make sure you’re giving yourself a chance to get enough good-quality sleep. The Crohn’s and Colitis Foundation recommends going to sleep and waking up at the same time everyday and using fewer electronics closer to bedtime.
Manage stress. Yes, Crohn’s is stressful. Stress in itself is tiring and can interfere with sleep. The Crohn’s and Colitis Foundation advises patients to take up cognitive behavioral therapy, mindfulness, and meditation to relieve emotional stress. Taking a warm bath before bed or having a cup of chamomile tea can help set a relaxing mood.
Eat well. There are several food-based triggers for Crohn’s disease. Lisa Simon, RD, a registered dietitian in London, reports eating high amounts of animal protein worsens Crohn’s disease symptoms. While you should also avoid spicy food, it’s still possible to eat a healthy diet with a variety of fruits, veggies, whole grains, and lean meats from the list of foods you can eat.
Exercise. Aim for at least 150 minutes of moderate aerobic exercise — think brisk walking or mowing the lawn — a week, says the Mayo Clinic. But check with your doctor before starting a fitness plan, Choudhary advises. If you have severe anemia, working out may make you feel even more fatigued. “If you are over 65, low hemoglobin and exercise can put a strain on the heart,” she says. Also, if you’re experiencing flare-ups, it’s better to let the body rest before exercising, advises the Crohn’s and Colitis Foundation.
Manage your time. “It’s a matter of being good at prioritizing and delegating,” Domilici says. “Look at your week and have a sense of what you can manage and not manage.” If your day is overbooked, cut some of your commitments.
If you have Crohn’s, you’re used to problem solving to manage symptoms and flare-ups. Think of fatigue as another piece of the puzzle you and your doctor can figure out together.
If you have severe anemia, working out may make you feel even more fatigued. “If you are over 65, low hemoglobin and exercise can put a strain on the heart,” she says. Also, if you’re experiencing flare-ups, it’s better to let the body rest before exercising, advises the Crohn’s and Colitis Foundation.
The Crohn’s and Colitis Foundation advises patients to take up cognitive behavioral therapy, mindfulness, and meditation to relieve emotional stress. Taking a warm bath before bed or having a cup of chamomile tea can help set a relaxing mood.
Cutting these things out comes alongside a risk of becoming deficient,” Medlin says. A review published in 2020 in the journal Digestion also reported a higher risk of folic acid deficiency in patients with IBD. Choudhary says she often recommends that patients take a multivitamin and have frequent blood tests. Medlin advises talking with a dietitian who specializes in Crohn’s disease or your doctor before taking any additional medications.