Patient Strategies for Managing the Vicious Cycle of Fatigue, Pain and Urgency in Inflammatory Bowel Disease: Impact, Planning and Support

Dig Dis Sci. 2021 Oct;66(10):3330-3342. doi: 10.1007/s10620-020-06698-1. Epub 2020 Nov 8.

Lesley Dibley 1, Bernadette Khoshaba 2, Micol Artom 2 3, Victoria Van Loo 2 4, Louise Sweeney 2, Jonathan Syred 2, Sula Windgassen 2, Georgia Moffatt 2, Christine Norton 2, members of the IBD-BOOST PPI team


Author information

  • 1Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, School of Health Sciences, University of Greenwich (Avery Hill Campus: Southwood Site), Avery Hill Road, London, SE9 2UG, UK. 
  • 2Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
  • 3NHS Digital, Leeds, UK.
  • 4University of Nottingham Medical School, Nottingham, UK.


Background: Inflammatory bowel disease (IBD) causes inter-related symptoms of fatigue, pain and urgency which can persist in remission.

Aim: To understand how people with IBD experience and self-manage these symptoms and to inform the future development of an online self-management programme.

Methods: Using exploratory qualitative methods, we recruited participants from clinic and community settings. Focus groups, conducted across the UK, were audio-recorded and professionally transcribed. Transcripts were analysed over four rounds using framework analysis. Eight patients were consulted to agree the final structure of data and themes.

Results: Seven focus groups were held; five gave useable data. Twenty-six participants (15 female; ages 21-60 years; disease duration 2-40 years) with Crohn's disease (n = 10), ulcerative colitis (n = 14) and IBD-unclassified (n = 2) attended one of these five focus groups. Three core themes emerged: The Negative Impact of Symptoms, Positively Taking Control and Seeking and Receiving Support. The persistent, often stark impact of multiple co-existing symptoms on physical and emotional wellbeing can force unwanted adjustments and limitations in working, social and intimate arenas of life. Unpredictable symptoms are challenging and impact each other in negative vicious cycles. Managing diet, pacing, accepting background levels of fatigue, pain and urgency, seeking support, exercising and attending to mental wellbeing, are all perceived as helpful in self-managing symptoms.

Conclusion: Fatigue, pain and urgency are troublesome for patients, especially in combination, suggesting that these should be addressed simultaneously by clinicians. Participants reported several strategies for self-management, providing patient-focused evidence to inform future development of a self-management intervention programme.

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