What is fatigue?
Everyone feels tired sometimes, if they have been working very hard, or had a bad night’s sleep. Fatigue is much more than this.
Fatigue is extreme tiredness and weakness. It will not go away after a couple of good night’s sleep. It can make it very hard to do normal everyday things. People with fatigue can struggle to concentrate or to find the motivation to do things they would usually enjoy.
But it can be difficult for people to understand if they have not experienced it.
What causes fatigue in people with a liver condition?
Many medical conditions can cause fatigue. But there are some extra reasons why it might be a problem for people with a liver condition.
Food
Not getting enough food is a big problem for some people. If your tummy is swollen, you can feel full all the time and not want to eat.
Not getting enough food can cause you to lose muscle which will make you feel weaker.
This can happen even if you have not lost any weight. Fluid in your tummy weighs a lot and this might hide the weight you have lost from muscle.
Sleep
It can be really hard to get a good night’s sleep if you have a liver problem. You might be itchy or need to get up to go to the toilet a lot. If you have a lot of fluid in your tummy this can be very uncomfortable and can make it harder to breathe when you are lying down.
If you are very tired in the day you might take naps but find that that makes it harder to sleep at night.
Medicines
Fatigue is a very common side effect of lots of medicines you might be taking because of your liver disease.
Some medicines can also make it harder to sleep.
If you are worried that your medicines could be making your fatigue worse, talk to your doctor.
Find out what works for you
The first step to managing your fatigue is finding out what makes it better or worse.
It can help to keep a diary of how you feel at different times of day and after different activities. Your fatigue can go up and down so keep track of things for a few weeks and see if there is a pattern.
Think about what matters most to you. Aim to get back to doing those things. Even if that means stopping or changing other things for a while.
Try one or two things out, if they make you feel better keep doing them. If they leave you exhausted for the rest of the day, then try to stop or change them.
There are a lot of suggestions on this page. But be patient with yourself.
Do not be discouraged if the first things you try do not help. Figuring out what works for you can take some time and can seem very restrictive at first.
If you find something that helps, then stick with it. Once you get to know how to cope with fatigue you will be able to be more flexible and get back to doing more of the things that matter to you.
Food
If you have a serious liver condition you might find it hard to eat. Not eating enough will make you feel more fatigued and can make your condition worse.
Try to have a snack every 2 hours. Especially if you cannot manage to eat full meals.
High protein snacks are best, but if you are struggling then just eat whatever you can manage.
Some examples of high protein snacks are:
- Hard boiled eggs
- A few nuts
- Hummus
- A piece of cheese
- Yogurt
Have a snack just before you go to bed. Ideally this snack should have lots of carbohydrates in.
Some examples of high carbohydrate snacks for bedtime:
- Cereal
- Toast
- Crumpets
- Fruit loaf
Exercise
Exercise is not just going to the gym or running a 5k. Being active is the most important thing and can make you feel better. You can even get active while sitting down.
But doing too much will increase your fatigue and some days will be harder than others. So start slowly and find the right balance for you. Be kind to yourself if you cannot do everything you want to some days.
Being active around the house is a good place to start.
Things to try around the house:
- When you get up to make a cup of tea or coffee, sit down and stand up again 3 times before you go to the kitchen.
- While you are waiting for the kettle to boil, do a few gentle squats.
Walking is another great way to be active. Start out with a very short walk from your home and slowly increase how far you walk.
Online exercise workouts let you pick the best time for you.
We are undefeatable has lots of information on getting and staying active for people with long term health conditions.
The NHS website has exercises you can do. Including workouts you can do while sitting in a chair.
Strength and balance exercises are important and you do not need weights or any special equipment for them.
Sleep
Improving your sleep at night can help you to feel better in the day. A regular sleep routine can help. If your sleep has been a problem for a while your body might have stopped being ready for sleep at the right time. But you can help it to get back into a pattern.
Try to get up and go to sleep at the same time each day. You can find out more about sleep routines in the box below.
Naps can help some people. But other people find a daytime nap makes it harder to sleep at night.
Setting up a sleep routine
Morning
Get up at about the same time each day
Try to get some daylight in the morning.
Getting daylight in the morning helps your body to learn when it is time to wake up. This will help it to know when it is time to sleep later.
If you have an outside space at home, you could have your first cup of coffee of the day outside. Keep a chair outside and some warm clothes by the door to make this easy on colder days. Or try going for a short walk.
Afternoon
Naps can help some people but make things worse for others. If you already take naps, try to just have a short one in the early afternoon or try not napping one day. Make a note of how you feel for the rest of the day and how you sleep later.
Evening
Dim the lights before bed
Having just dim lights for an hour or two before you go to bed will help your body to know to prepare for sleep. You could try a dim lamp and use plug in nightlights in areas you will need to walk through.
Turn off screens
Computers, tablets, TVs, and smart phones all shine a lot of light right into your eyes. This can confuse your body into thinking it is time to be awake. Set a time when you will turn off your screens each night. Then do something that you find relaxing. For example, reading a book or listening to a podcast.
Have a nice sleep space
If you are able, keep the place you sleep free of reminders of things you need to do. Try to make it as dark as possible and not too warm. Darkness and a cooling temperature are the natural ways your body knows it is time to sleep.
Go to bed at about the same time every night.
It is ok to change this sometimes but try to stick to the same time most nights, especially when you are just starting your new routine.
Ask your medical team for help
If your symptoms are stopping you sleeping, you should speak to your medical team. There might be some medicines that can help.
Making tasks easier
Making tasks a bit easier means you have more energy for what is important to you.
Here are some examples:
- If nice home cooked meals are important to you, then try a stool to perch on while you cook. This will let you have more enjoyable and nutritious food, which in turn will give you more energy for other things.
- If you enjoy walking, then walking poles could help you to go further.
- Putting a stool in the shower could make that task easier and free up some energy to use for something else.
Fatigue can come and go so you might need your tools some days but not others. And they might just be temporary. Using them when you need them means you can reduce your fatigue and might not need the tools in the future.
Get more help
Fatigue is a very serious problem and can have a huge impact on your life. But there are things that can help.
You might not be offered help for, or even asked about, fatigue. So if you are getting very tired, talk to your medical team. Even if you are coping with it at the moment, being prepared means you won’t have to find answers while struggling with fatigue. Ask them what help is available in your area and how to get it. This might take a bit of time but keep asking. Fatigue is a common and serious issue for people with liver conditions so your medical team should know about it.
Depending on your condition different healthcare specialists might be able to help:
Dieticians –are experts in food for people with medical conditions. They can help you to find foods that work for you and give you the energy and nutrients you need.
Physiotherapists –can help you to be active. They can recommend activities and exercises that are right for you and help to make sure you can do them.
Occupational therapists – Can help you find ways to do what is important to you. They can give advice on tools that can help you and on simple changes that make tasks easier.
GPs – Some GPs offer an exercise referral scheme. This gives you free access to a gym or exercise classes. This might be too much if you are dealing with severe fatigue. But as you improve it can be a good way to continue building up your exercise.
Friends and family
Fatigue is a hidden problem, and it can be hard for those close to you to understand. It can help to give them information that they can look at in their own time. You could send them a link to this page.
Explain that you only have a small pool of energy right now. So you have to choose what things you can do and what you cannot. But doing this means that you can build up that energy pool and do more things in the future.
It is ok to ask for help and to accept it if it is offered. You might not be sure of what will help most to start with. So explain to your friend or family member that you are figuring out what works best and might ask them to do different things at different times while you work it out.
Things they could try:
- helping with essential tasks at home, like shopping and cleaning
- helping with cooking, like batch cooking a few meals you can save in the freezer
- coming to you for a chat and a coffee, rather than you having to go out to see them
- coming with you to appointments so that they can help you to remember what is said and ask questions
Special thanks
We would like to thank all the healthcare professionals who helped us to create this information, including Jessica Moss, Clinical Lead occupational therapist. Eleanor Faulkner, Clinical Lead Physiotherapist, and Kirsty Burrows, gastro/colorectal dietician, Royal Devon University Healthcare, and Fiona Finlay, Consultant in palliative medicine, Queen Elizabeth University Hospital, Glasgow.
Also all the patients who reviewed this page, including Sally Benatar and Stephen Burgess.
Published: January 2024
Review due: January 2027