Fatigue

1 Fatigue Summary

Fatigue is often expressed as being exhausted or lethargic, in common language. Many people find it difficult to describe fatigue in words. It is basically the absence of motivation and energy to do anything.

It is often confused with other symptoms like drowsiness, muscle weakness, and even breathlessness. And in some people all the conditions may be seen at the same time, making it more confusing.

Fatigue is a very common symptom and resolves easily without any specific treatment. It is not a disease in itself, and like fever, it is a symptom of an underlying condition. Thus fatigue is feeling of exhaustion due to lack of energy, while weakness is a lack of strength to perform an activity.

Fatigue starts gradually and ignoring the symptoms is very common among people. It is often considered as an indication of aging. This adds to the delay in getting medical attention.

People with fatigue have the following complaints:

  • Absence of motivation or energy to start an activity
  • Easily tiring during an activity
  • Inability to concentrate
  • Problems in memory that affect routine tasks

Fatigue can be mental or physical in nature.

Physical fatigue – it is also known as muscle weakness. People with physical fatigue find it difficult to do things which they used to do easily earlier. Activities, like climbing stairs and carrying weight, becomes very tiring, affecting daily routine to a certain extent. Strength test is the recommended way to diagnose physical fatigue.

Mental fatigue – the main feature of mental fatigue is the inability to concentrate. Many people complain of inability to perform daily activities with ease, as they used to do before.

It is usually found in association with physical fatigue. They are sleepy and have a low level of consciousness. Mental fatigue is a risk during certain activities like driving or working with heavy machinery.

There are many factors that lead to fatigue, including medical conditions and lifestyle factors. Excess physical activity, alcohol abuse, certain medications and unhealthy food habits may all result in fatigue.

It is also seen as a symptom of a number of medical conditions. Treatments like chemotherapy, radiation therapy, and antidepressants may also result in fatigue.

Medical attention is needed if fatigue is a symptom of a mental disorder, particularly if the symptom includes self-destructive thoughts or thoughts of harming someone else.

Some of the symptoms accompanying fatigue that are of concern are:

  • Chest pain
  • Breathlessness
  • Increased heart rate
  • Dizziness
  • Severe abdominal or back pain
  • Severe headache
  • Bleeding from rectum
  • Vomiting blood

Lifestyle modifications are very effective in controlling fatigue in the majority of cases. This includes a balanced diet, regular exercise, avoid stress, get adequate rest, and abstain from smoking and drinking.

Treatment of fatigue depends on the underlying cause. Fatigue may resolve within some time after the start of treatment for the condition. Earlier diagnosis of the underlying condition will help in starting the treatment soon enough. In some cases as fatigue sets in gradually, it is difficult to notice the problem.

2 Causes

Fatigue is very common and is mentioned as a potential symptom in almost all of the diseases and condition in medical literature. Thus there is a very long list of causes for fatigue. Causes are categorized as lifestyle factors and medical conditions.

Some of the lifestyle factors that cause fatigue include: 

  • Alcohol and drug abuse
  • Excessive, strenuous physical activity
  • Jet lag
  • Lack of adequate rest or sleep
  • Lack of physical activity
  • Certain medications like antihistamines
  • Unhealthy food habits

Some of the conditions that cause fatigue are: 

  • Metabolic conditions – metabolic or endocrine conditions like Cushing’s disease, renal disease, electrolyte abnormalities, diabetes, anemia, hypothyroidism, and liver disease
  • Cardiac and lung diseases – Chronic obstructive pulmonary disease (COPD), pneumonia, asthma, valvular heart disease, coronary heart disease and congestive heart failure
  • Infections and infectious diseases – Malaria, infectious mononucleosis, tuberculosis, hepatitis, flu, HIV infection, tropical diseases and cytomegalovirus infection
  • Treatments – chemotherapy and radiation therapy
  • Other diseases – cancer, rheumatoid arthritis, obesity, lupus, chronic fatigue syndrome and blood loss
  • Sleep problems – late night working, jet lag, work shift changes, insomnia, reflux esophagitis
  • Deficiencies – vitamin and mineral deficiencies
  • Certain medications – certain medications like antidepressants, antihypertensives, antihistamines, steroids, sedatives and anti-anxiety drugs
  • Pain – chronic pain disrupts sleep. Thus the person may have pain and will not be able to relax adding to the fatigue.
  • Problems in body weight – obese people have an increased risk of developing diseases which have fatigue as one of the symptoms. Underweight people have less strength in muscles and get tired very easily.
  • Mental health – psychiatric conditions like alcohol abuse, anxiety, eating disorders, boredom, and divorce may all lead to fatigue. Stress or mental pressure is one of the most common causes of fatigue. Severe stress drains the person and results in despair. Despair when present for a long duration result in fatigue. Clinical depression is also a known cause of tiredness and fatigue. Fatigue may be directly related to depression or may be a symptom of an associated condition like insomnia.

Some diseases like fibromyalgia are linked to other medical conditions like restless leg syndrome and sleep apnea, both of which causes fatigue. In many cases, fatigue is never ending. This is because a person who has fatigue exercises less or do not exercise at all.

Lack of exercise can cause fatigue. Moreover, lack of physical activity can make doing normal chores feel more tiring. Fatigue is also linked to certain forms of cancer, particularly breast cancer. Changes in the neuronal structure and their interactions may also lead to fatigue.

Certain jobs have an increased risk of fatigue when compared to others. The job of the police, doctors, shift-workers, and firefighters have different sleep patterns and are prone to sleep problems. This increases the risk of fatigue in these people.

The risk is elevated when the shift-routines are changed periodically. Having alcoholic beverages and caffeinated drinks, particularly during sleep time affects the sleep pattern. This leads to lack of adequate sleep and thus fatigue when the body does not get enough rest.

3 Diagnosis and Treatment

It is quite a challenge to diagnose the actual cause of fatigue as it is a common symptom of many conditions and diseases. Complete medical history of the person along with information on loss of energy and other associated symptoms provide important clues regarding the actual cause of fatigue.

Other symptoms point to the organ that is involved in the condition. The doctor may ask questions regarding the patient’s experience with fatigue.

The questions include progress of the condition through the day, fatigue while getting up in the morning, food habits like caffeine, the onset of fatigue, duration and quality of fatigue, conditions that make fatigue worse, the effect of fatigue, and the mental health of the patient.

Questions on alcohol and drug abuse are also included. Each response will point to the potential cause of the condition. A thorough physical examination is also included in the diagnosis of the underlying cause.

This will indicate general hygiene, vital signs and the signs of anxiety. Swelling in thyroid glands, lymph nodes, abnormality in heart sounds are particularly noted during the physical examination.

Other tests and imaging studies are recommended based on the initial findings from the medical history and physical examination.

Blood tests may include:

  • Complete blood count
  • Electrolyte levels
  • Blood glucose levels
  • Renal function tests
  • Level of thyroid stimulating hormone
  • Ferritin levels

Treatment of fatigue also depends on the underlying cause. For example, iron supplements are recommended for treating anemia that results in tiredness and fatigue.

Medications and medical devices are useful in controlling sleep apnea, which will then alleviate fatigue by providing adequate rest. Medications are suggested to regulate blood sugar levels in diabetes.

Diet is suggested to help in reaching and maintaining healthy body weight. Cognitive behavioral therapy and graded exercise therapy are effective methods for treating conditions like chronic fatigue syndrome. Meditation and training are suggested for multiple sclerosis to improve sleep and to control fatigue.

Yoga is also considered to be effective in alleviating fatigue caused by different conditions. Postures, meditation and breathing techniques used in yoga help to relax and to improve the quality of life.

Simple lifestyle modifications can also help in reducing fatigue, this includes: 

  • Getting adequate sleep
  • Developing a healthy food habit
  • Regular physical activity

Sleep can be improved by developing a good sleep pattern and routine. Having a warm bath and soothing music may help in falling asleep. Having food two hours before going to sleep also help to have a relaxing sleep.

Taking small quantities of healthy food at regular intervals provides a continuous supply of energy to the body. Avoid crash diets and try to follow healthy, well-balanced diet. Fatigue may prevent a person from being physically active.

Being motivated to continue with the activity is important in keeping fatigue at bay. Regular physical activity will also help in improving sleep.

Exercise should be chosen wisely with the help of a trainer so that the body feels active after the activity. Taking help from a dietician or a doctor may be of help in planning the diet and exercise regimen.

  • Vitamin B12, folic acid and iron levels
  • Erythrocyte sedimentation rate

Imaging studies like x-rays and CT scans are recommended based on the suspected condition.

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