An image of a person in bed. They are under the blankets, and have covered most of their face with a pillow. Their arm lays on top of the blanket, holding a pair of glasses.
Check out Aiswarya’s presentation slides on fatigue & IBD! She shares about the prevalence of fatigue, types of fatigue, risk factors, the impact fatigue can have on IBD patients, and some suggestions for managing fatigue.
A cream colored background with graphics of doctors and patients having discussions.
For many of us living with IBD, saying “I’m fine” has become a habit, something we were taught to say to avoid worrying others or causing trouble. But managing a chronic condition means we can’t afford silence. Doctors need us to describe what hurts, what’s changed, and what’s not working. At first, that shift feels unnatural. How do you speak up about pain when you’ve spent years trying to hide it? Learning to explain what’s wrong isn’t just about getting better care, it’s about breaking the silence, challenging stigma, and making sure our needs are heard. Speaking up is advocacy, and it starts with learning to complain. Many of us were taught to downplay pain, brushing off discomfort to seem strong.
This kind of silence runs deep, shaped by family, culture, and a society that equates quiet with resilience. But for people living with IBD, staying silent can be dangerous. It leads to delayed care, isolation, and missed warning signs. Although, learning to speak up about symptoms is just a part of it. Especially in developing countries like India, where systems often lack the integration, communication is not just helpful but essential. For most, the responsibility of managing appointments, tracking medical records, logging test results and prescriptions, consulting different specialists, and coordinating insurance doesn’t fall on an organised platform, it falls on the patient.
A cream colored background with graphics showing the many different effects of IBD. There are a series of graphics showing a cartoon person dealing with urgency, cramping, nausea, fatigue, hiding symptoms, taking medications, struggling to eat, and mental health. These graphics are circling an image the human body, to convey the multi-systemic nature of IBD.
Living with IBD means your body goes through changes that aren’t always easy to explain. Symptoms come and go, and sometimes they’re hard to put into words, especially if you’ve spent years being told not to make a fuss. When you share what you’re feeling clearly and honestly, you’re helping your doctor understand how to support you better. It’s not complaining, it’s communication. And with a little guidance and the right tools, you can learn to speak the language of your symptoms in a way that leads to real care and understanding.
Doctors rely on clear, consistent information to track how IBD is affecting your body, and that’s where accurate symptom-sharing becomes key. The table below outlines the kinds of details that help build a more accurate picture of your condition.
Living with IBD often means navigating a maze of symptoms, appointments and uncertainty. But the ability to speak clearly and communicate will go a long way in getting the care that we deserve. That’s why this table isn’t just a tool, it can help you bridge the gap between what you feel and what the doctor needs to know. Remember, this guide is meant to serve you, so feel free to adapt it, add to it, and make it your own. Bring it to your appointments, refer to it and use it to shape your care in ways that truly reflect your needs.
This log table is for you to document your symptoms and experiences in a structured manner. Save a copy and take notes or just use it as a reference for your next appointment!
A stoplight with red, yellow, and green lights is illuminated on a dark blue night sky.
When you're living with Inflammatory Bowel Disease (IBD), your body becomes its own navigation system. Your body is constantly sending you signals, just like traffic lights do. But unlike the red, yellow, and green lights on the road that we instantly respond to, many of us with IBD have learned to ignore or minimize the "rules" or "drills" that we should follow when our body sends us our own, personal warning signs.
So why is it that we respect a blinking car dashboard, a low battery warning on our electronic devices, and traffic signals/signs more than the signals coming from our own bodies? We wouldn’t ignore our car’s check engine light for weeks (and if we did, we’d expect it to eventually break down). So why do we ignore our body’s warnings? Why don't we listen? As with most things, the answer is complicated.
Here are a few reasons why as people living with IBD, we might forget to listen to these warnings, or try to “push past” them:
Living with IBD means that a few warning lights are always on. That is, we might always have some level of fatigue, bloating, or discomfort. This "always-on" background noise becomes our new normal, and we stop noticing when new signals show up. This is risky because it can lead to ignoring major warning signs or missing slow-building flare-ups.
Our symptoms can become our new normal or "background noise," so we're used to pushing through pain. This means that even when our bodies give us that "red" or "yellow" light signal to slow down or stop due to a symptom/pain that is out of the ordinary, we are still conditioned to push through it. For a lot of us, that is a survival mechanism of having chronic pain (pain that never fully becomes "background noise") in a medical system and society that often tells us to "push through." The world is constructed for those who are able-bodied, and having chronic pain/IBD can force us to sink or swim.
We are often taught to minimize our symptoms, for ourselves and others. Sometimes, doctors dismiss our warning signs, maybe because medical literature doesn't acknowledge all the intricate traffic signals for IBD. Maybe, they're just burned out. Or, maybe doctors—and people in general—can't fully understand the severity of IBD symptoms if they haven't gone through it themselves. Whatever the reason, though, we are conditioned to minimize our symptoms. We are taught that our illness "could be worse." In fact, when explaining IBD to others who don't quite listen closely enough, the false notion that IBD is simply "stomach problems" circulates. So much so that we, ourselves, sometimes say this to others or even believe it ourselves. We don't want to be sick. We wish it was just stomach problems. Being told that our personal traffic lights/signals are simply a result of "anxiety" or "are in our heads" make it easy to eventually believe it ourselves because, why would we want to be sick?
We don’t want to "miss out." Sometimes, we’d rather have a moment of fun—followed by a flare/low-spoons day—than not experience the fun at all. Ignoring the signals can sometimes feel "worth it" since it can give us a small glimpse of what "normal" might be like. We are forever torn between the notions of "respect your body's limits" and "you only live once."
Finding a way to make a choice, despite the consequences, can feel liberating in the short-term. This can look like eating a food that you know isn't "safe" just because you want to make a CHOICE and have autonomy over your own body. As IBD patients, choice is often not in our vocabulary – so pushing through the pain of IBD is often the only way we can feel slightly in control of our own bodies. This is a sense of freedom that we greatly lack as IBD patients.
We don't want to be a “burden.” IBD, in itself, is a burden that we already have to carry. Living with it every day is extremely difficult, and that is an understatement. Even so, we still notice how it affects those around us— our caregivers, partners, family members, friends, co-workers, employers, and even doctors. Carrying the burden alone is never the solution, but it sometimes seems like the right one since it feels wrong to allow someone else to feel even remotely similar to us. It doesn't feel right to allow anyone to be down in the trenches with us—at infusion appointments, at ER visits, at ICU admissions, or at "bathroom sleepovers." It doesn't feel right to allow anyone to feel so wrong, even if they want to. Therefore, we ignore the signs, because if we took action that would mean that we'd need help, whether we like it or not. We'd have to reach out to someone, even if that's just a doctor. Simply alerting your doctor that you've failed another biologic can make you feel like a burden since you might feel as though you're giving them more work. Reaching out to loved ones can be even harder as they will often want to be there for you, and you simply don't want to burden anyone anymore.
We’re afraid of what we’ll find if we stop and really listen. As previously mentioned, we don't want to be sick again. We don't want to discover a new co-morbidity again. We don't want to switch medications again. We don't want to be flaring again. We don't want to go to the hospital again. We don't want to experience medical trauma again. We don't want to put life on pause again. We don't want to miss out again. We don't want to be a burden again. We don't want to lose control again. Listening to your body, and truly paying attention to what it's telling you poses the risk of you having to accept the fact that you might have to go through all of these things again. And at the end of the day, we just want to live—freely. It feels like a constant tug-of-war between surviving and actually living.
The truth is: Your body will always tell you what it needs. It’s just your job to check in—gently and consistently.
Since there is no cure for IBD yet, much of this disease has to do with symptom monitoring and, thus, taking as many preventative measures as possible. I, for one, know that I would like to stay in remission and avoid a flare-up for as long as possible. Even so, I know that's only possible if I listen to my body—genuinely listen. Whether that's taking note of unusual fatigue or nausea, a new sensitivity to food, etc., these are acts of listening to your body and its signals. While we are taught from a young age what traffic lights mean and why it's important to follow them, we aren't taught how to notice and follow the signals that our bodies give us.
A few simple things that you can do to start the practice of ‘checking in’ with yourself and your body:
Create your own ‘traffic light:’ write down some of the signs you notice, when you’re feeling ‘green, yellow, or red!’
Set aside a few minutes each day to ask yourself: What "color" am I today? What makes me that color? What am I feeling, and where am I feeling it? If I’m yellow or red, what needs to change? If I’m green, what can I do to stay there?
Not sure where to start? Here’s an example of my “traffic lights,” and some of the signals I use to check in with myself and my body!
A light blue background with a boarder of green triangles. The text reads “Green means you’re good to go! It doesn’t mean you’re “cured.” With IBD, there’s no one-size-fits-all version of wellness/remission, but it means your body is operating at a manageable and comfortable baseline. When you’re in green, lean into it! Move your body (if you can), make plans, enjoy safe foods, and take note of what helps you stay in this zone. Celebrate ‘green days’ without guilt. They are precious!” There are bullet points with “green light signs” below, the text reads “No Signs of Infection or Illness, Up-to-date on Medications, Overall Mental Clarity, Overall Emotional Stability, Doctor Cleared for Basic Activities, Feeling Energized/Rested, Eating Well-Tolerated Foods, Regular Bowel Movements, Healthy Consistency of Stool, Medications Working Effectively, No Incontinence, No Urgent Bowel Movements, Stable Lab Work, Hydrated, No Constipation, and Minimal Pain/Bloating.” Scattered throughout the page are graphics of a stoplight, a full gas symbol, a fully charged battery, and a green thumbs up."
A light blue background with yellow and black caution tape boarder. The text reads “Yellow is your caution zone. You’re not necessarily flaring, but your body is whispering (or maybe even raising its voice a little). Yellow can be subtle and easy to dismiss, but it’s the most important time to pay attention. In the yellow zone, it’s time to pause and reassess. This may mean: Canceling plans, taking a rest day, eating safe/bland foods, booking a doctor’s appointment, requesting follow-up lab work, reintroducing self-care routines, and more. Yellow isn’t failure. Yellow is wisdom. You’re responding to your body before things worsen. Think of it as preventative maintenance.” There are bullet points with “yellow light signs” below, the text reads “Borderline Lab Results, Mild Changes in Appetite, Changes in Digestion, Low Mood/Increased Anxiety, Sleep Disturbances, Mouth Ulcers, Chronic Nausea, Slight Fatigue/Brain Fog (Not Explained by Medications), Slightly More Frequent/Urgent Bowel Movements, Mild but Persistent Abdominal Discomfort, Decent Consistency of Stool, Mild Joint Pain/Inflammation, Migraines/Headaches, Changes in Skin (Inflammation, Acne, etc.), Worsening Menstrual or Premenstrual Symptoms, or Chronic Bloating.” There are graphics of a yellow stoplight, a half-full gas symbol, a ‘low battery,’ and warning/slow signs.
A light blue background with red EKG patterned boarder. The text reads “Red means something is wrong. It's time to STOP everything else and prioritize your health immediately. This is where IBD forces you to pay attention, whether you’re ready or not. Red means it’s time to: contact your gastroenterologist, take time off school/work, let someone else step in to care for you, follow strict diet/symptom-management protocols, reevaluate or switch medications, get imaging or scopes done, advocate HARD for yourself if you’re not being heard, and go to the ER or urgent care if needed. Red is scary, but it doesn’t mean failure. It means your body is fighting hard and needs you to listen.” There are bullet points with “red light signs” below, the text reads “Ongoing/Sudden Incontinence or Urgent Bowel Movements, Labwork w/ Significant Abnormalities (i.e. Inflammation or Anemia), Complete Loss of Appetite/Ability to Eat, Sudden/Dramatic Weight Loss, Emotional Overwhelm, Not Responding to Medications, Severe Abdominal Pain, Blood in Stool, Mucus in Stool, Dehydration, Fever, Vomiting, or Extreme Fatigue.” There are graphics of a red stoplight, empty fuel tank, ‘stop’ and ‘warning’ signs, and a red low battery symbol.
A few things to remember/keep in mind:
Checking in doesn’t mean obsessing. It simply means being mindful enough to care. Just like we do for our phones, our cars, and our jobs—we deserve to offer ourselves the same level of awareness, support, and maintenance.
Living with IBD doesn’t mean you’ll always be stuck in red or yellow. Some days are green—some weeks or months, even. You deserve to honor those days as much as you manage the hard ones.
This stoplight system isn’t about fear. It’s about empowerment. You are not weak for needing rest, medical support, caregiving, or time. You are wise for knowing when to go, when to slow down, and when to stop.
Your body isn’t the enemy—it’s the messenger. Listen to it. Trust it. Respond with love. Your body is doing the best it can to keep you alive. Let’s return the favor.
Image from @tsvetoslav on Unsplash.
A person in a dark blue shirt holds a rectangular mirror over their face. The bright blue sky with clouds is reflected in the mirror.
Living with inflammatory bowel disease, my body has changed in ways I didn't choose. People see my outward appearance and make assumptions. Often, they don't wait to hear your story, and they judge you based on your size or looks: no words, no chance. It hurts because words can't always express what we feel inside.
They don't see the battles I fight every single day. I’ve heard it all:
"You are too skinny."
"You don't look strong."
"You must not eat enough."
But I know myself - I am strong. My journey is filled with courage, healing and hope. I don't have to be judged by my size, I am more than that. My size doesn't define my strength, my resilience does.
I have faced many tough times, but people don't see me as a serious person because of my appearance. I have survived painful flare ups, countless hospital visits, difficult medication side effects, surgery, and emotional lows and that could have broken me.
And yet, I am still here: still standing, still fighting.
I may not have a body society views as "tough," but I carry strength in my spirit.
I carry it in my story.
Being judged by my body and appearance has been painful, but it has also taught me what really matters: my ability to rise again and again.
I am not a slab of meat to be consumed or judged. Your power lies in what you overcome, not in the size of your frame or your appearance. We are more than our bodies, we are warriors.
No one knows what tomorrow holds, and what we have today is not guaranteed. Life changes, and bodies change, but our worth remains. Let’s learn to see beyond appearance, and appreciate our strength. We never know the silent battles someone is fighting – behind every look, there is an untold story.
Photo by Unsplash.
I was planning on writing this article about the meaning of IBD community support in my life. But as all IBDers and folks with chronic illnesses know, sometimes the best laid plans have to change based on how you're feeling.
I recently had a wakeup call from my complacency during the longest remission of my life. My biologic medication has done such wonders for not only my daily quality of life, but the impact of my ulcerative colitis on my body. I will never forget my doctor's amazement at my last colonoscopy a couple years ago when they were unable to identify any active disease.
When they said they could no longer see any ulcers, I was on cloud nine. Apparently, hundreds of ulcers that had taken root in my digestive system had vanished. A true miracle drug. Since I started my biologic medication a few years ago, I have had occasional hiccups, but my symptoms were 95% reduced from what they had been.
Due to a switch in my modality of medication, from an infusion to an injection pen, I have had some delays in receiving the medicine, largely due to a lengthy prior authorization process (nothing new for many IBDers and folks with other chronic illnesses). Because of this delay in getting my treatment, I started experiencing my old pattern of symptoms, seemingly back with a vengeance.
Nausea, near vomiting, extreme cramping, frequently going to the bathroom - the works. Maybe it was just because I haven't had these symptoms in a while, but I truly felt the worst I have felt in a couple years - at my lowest of lows health-wise.
This was undoubtedly compounded by my recognition of the precarity of my health, the delicate balance that my health rests on daily in managing my IBD that I had neither realized nor accepted. Just by going a week without my medication, slightly spicy foods that I have come to enjoy on occasion since my remission knocked me for a loop. Having these symptoms after being only seven days overdue for my medication put me in disbelief - how could my ulcers and inflammation be all gone, as my doctors had told me? My ulcerative colitis seems to have been barely there, perhaps hiding underneath the surface, waiting for one slip up or mistake in receiving my medication to rear its ugly head.
Now I can fully acknowledge that experiencing some of these symptoms for a little while is not much in comparison with what I've experienced in the past, or what others often go through. I am extremely grateful to have access to the medication I need to maintain my health and quality of life. But I cannot again take for granted how close I can be at any given moment to another flare. Even when I have been doing extremely well for several years on a medication that clearly is highly effective for me.
These moments are important reminders of the truly unpredictable and chronic nature of the disease, and how, even when you are doing everything you can to maintain your health, it's ultimately not always up to you. It is, however, a lot easier to deal with emotionally if you take the journey one step at a time and prepare yourself to experience the one thing that IBD can predictably be: unpredictable.
Featured photo by Digital Buggu from Pexels.
The last thing out of the million concerns swirling around my mind while administering my newly prescribed biologic drug was the worry that I might have extremely uncomfortable and visible symptoms from my medication. Especially not when it was about a month and a half to two months after first injecting the medication when I noticed my first symptom: my hair falling out more than usual.
I dismissed my hair falling out as a potential side effect of the flare that I had had earlier that year which led to the medication change. I had gone from mesalamine to prednisone to budesonide treatments over a period of months, all to no avail. It was the second semester of my first year of college, and all I wanted was a little bit of stability while I settled into college life. Instead, I was occupying the one private bathroom in my dorm constantly or running as quietly as possible to the public bathroom on my floor in the middle of the night.
I had doubts at the beginning of the school year about whether college could be viable for me. I was pleasantly surprised during my first semester when my symptoms quelled, and I made good grades and new friends. I rode that high into my second semester feeling like I had things relatively under control. That all came crashing down very quickly.
When my gastroenterologist prescribed me a biologic drug, it was nerve-wracking to hear the potential side effects and impact the drug could have on my body, particularly my immune system. At that point, however, I was ready to try anything to get back to a relatively “normal” baseline. After my first few injections, I felt relieved to notice that my symptoms were calming down.
While I was feeling better, I started to notice clumps of hair appearing on the floor or in the shower. It was easy enough to dismiss that. I had summer classes to focus on and my hair was the least of my worries. Then I noticed some sores and psoriatic plaques on my scalp that were irritating and uncomfortable, but nothing I still couldn’t ignore. When I thought about it more, however, it was a headscratcher. I hadn’t changed detergents or personal care products, so if I was having an allergic reaction the cause was not obvious.
Then came the symptom that was a bit harder to ignore: small abscesses appearing on different areas of my body. I went to the university health clinic several times to have them drained. My providers acknowledged that these did not just appear to be in-grown hairs or a reaction to the intense summer heat. There was something more going on.
After getting a couple of these abscesses, I began to think more critically about my new medication. That was the one new factor in my life. My food, personal care products, and surroundings had largely remained the same.
As I returned to college for my sophomore year, I hoped the fall weather would help cool this strange reaction that was taking place in my body. Almost immediately when the semester started, my whole body broke out in a strange, blotchy rash. My eyes were swollen but I had no other symptoms that indicated anaphylaxis such as my throat closing or shortness of breath.
After this last episode, when no provider could come up with an explanation for my odd progression of symptoms, my gastroenterologist took me off the biologic drug I had been taking. Fairly soon after that, things went back to normal. While my gastroenterologist would never say that the biologic drug caused the reaction, and it’s true that there’s no way to definitively establish a correlation between it and my symptoms, I can say that things only got better when I stopped that medication. Now I was back to square one, but at least with the knowledge that the biologic drug I had been on was not going to be the answer.
Most often, side effects or adverse events related to biologic drugs happen much sooner after medication administration than in my case. They typically also feature clearer signs of a reaction such as shortness of breath, chills, redness, itchiness, itchy eyes, or itchy lips. While these symptoms are fairly uncommon, rarer reactions can involve central nervous system disorders, cardiac issues, and Lupus-like syndrome.
There can be a lot of fear built up around biologic drugs, however for many IBD patients they can work wonders. I’m on a different biologic drug now and have experienced the longest period of remission that I’ve ever had in my life. It’s an amazing feeling.
Nonetheless, it is important to be on the lookout for side effects when starting any new medication. It might be easy to dismiss the list of side effects in tiny print on the medication safety sheet or as they are read out to you by a clinician, but it’s critical to be aware of when a medication may be harming rather than helping you. Stay vigilant for the first few weeks and even months of a new medication and keep track of how your body is feeling and reacting. Not every medicine may be right for you, and it’s important to let your provider know if you feel like your medication is negatively impacting your health. Even if you feel like there may not be a better treatment option out there for you, there are likely more options than you think. It is your provider’s job to work with you to find the treatment that best fits your body and your needs.
Source: Side Effects of Biologic Medications - Johns Hopkins (hopkinsarthritis.org)
Written by Natasha Kacharia from the United States
Featured photo by Erin Profaci from Pexels.
I never thought about myself as a superficial person. But if someone asked me about the worst part of living with ulcerative colitis, it would not be the hemorrhaging of blood, the vomit, the diarrhea, the stomach cramps, the sleepless nights, loss of muscle, or the joint pain.
It would be moonface. It would be the fat deposited on my cheeks and neck making my face appear round like the moon.
Whenever I enter a flare, my doctor prescribes me oral steroids called prednisone. Desperate for relief, I always agree and consume the prednisone without protest. A couple of the many unfortunate side effects of prednisone is weight gain and moonface. Thus, whenever I start on prednisone, I also make an effort to watch what I eat to help minimize the side effects. But it never works. And, everytime, in addition to having my clothes not fitting, my face abnormally expands, making my cheeks puffy and my pointy chin a double chin. I get moonface.
I learned to handle weight gain. I wear my classic XL Stanford Christmas sweatshirt in the winter and my oversized CS t-shirts in the summer. No, I never liked how my body looked on prednisone, but I could hide it. But how do I handle moonface? I cannot exactly cover up my face, even with a mask.
And, what my friends and family fail to understand is that it is one thing to hate your body - everyone hates their body to some extent - but to hate your face is an entirely different beast.
There is no escaping your face. Your face is what you stare at when you brush your teeth or you enter a zoom meeting. It is the first part of you that a person looks at when they meet you. Your face makes your first impression.
And moonface is not the first impression I want to make. I tell people that I used to be a nationally ranked roller skater, and they don't seem to believe me. I tell people about my past romances, and they don’t seem to believe me. To them, I look like a slightly overweight girl who fell victim to freshman fifteen, even the people who know about my ulcerative colitis do not entirely believe that my face is simply a side effect of a medication. It is not their fault. I have a hard time believing myself too. Flare me and remission me always feel like an entirely different person. A different entity.
Because the girl with moonface spends an hour long zoom meeting distracted by how puffy her cheeks are, she wears a mask everywhere - partially because she is high risk but mostly to cover up her face. She misses random guys flirting with her. She misses believing someone when they call her pretty. She misses how the world treats her because let’s face it; the world is easier to the pretty and skinny.
So, no, I never really thought about myself as superficial, but it is easier to dig deeper than the skin when you like the surface.
