8 Tips for Runners and GI Distress

Q Have you heard of runner’s colitis? I had to have a colonoscopy about two years ago. My GI doctor told me he saw internal haemorrhoids and everything else looked okay but he did say that I could have runner’s colitis. Usually it is only seen in world-class athletes who run long distances. Now I am nowhere near world-class but over the past few months it has been getting worse. Today I went running only 16 kilometres but I had severe diarrhoea and was cramping up. I don’t want medical advice but if you have any info on this could you send it to me? – ROBIN


A Glad you wrote in because I agree with you that many runners suffer from GI issues, but since it’s not a topic most people feel comfortable discussing it stays in the shadows. Some reports show that as many as 60 per cent of all runners report experiencing bathroom issues when running. Here is some information on this condition, but please note that this is definitely not medical advice and in no way a substitute for visiting your physician.

Colitis is an inflammation of the colon. Runners’ Colitis is a term used to describe an exercise-induced form of colitis that is usually a temporary condition, brought on by long mileage or the intensity of a run, in other words, physical stress. Symptoms may persist for a few days up to a few weeks, depending upon the level of irritation. The fact that this is occurring to you on relatively shorter runs is of concern, so please contact your physician immediately.

Runners are particularly susceptible to GI conditions for a number of reasons. When we run, the large muscles of the body need to be well supplied with oxygen-enriched blood to fuel working muscles. In order to deliver an adequate blood flow to these muscles, the body has a shunting mechanism that diverts blood flow away from our internal organs, like the gastrointestinal tract, and directs it to the exercising muscles instead. Our skin also receives a portion of this diverted blood flow where it functions as a cooling mechanism. The percentage of blood flow that is diverted directly correlates to the intensity of the exercise. In other words, the more intense the run, the more blood flow is diverted away from the GI tract. In addition, the longer the run, the longer the GI tract is deprived of its’ usual blood flow.

Another factor thought to play a role in this condition is dehydration. Some level of dehydration is typically associated with a long run, especially in hot, humid conditions. A loss of more than one per cent of body weight can impair athletic performance; therefore, running in the heat requires special attention be paid to fluid intake, hydration and electrolyte balance. As dehydration sets in, the stress on the GI tract is compounded. The combination of reduced blood flow and dehydration puts the colon under great duress.

In addition, some studies show that the physical jarring and jostling of running can irritate the GI tract as well. And, simply put, gravity does not work in our favour either. Reduced blood flow, dehydration, the physical jarring and jostling of running along with gravity becomes a recipe for disaster for many runners.

The symptoms of Runners’ Colitis range from mild to severe cramping, diarrhoea, nausea, and bleeding. The bloody diarrhoea is the intestine sloughing off its’ inflamed lining. Fortunately, the colon replaces its’ lining rapidly. The lining of the colon is shed on a daily basis, so cell turn-over occurs at a rapid rate. The risk of permanent damage to a healthy colon remains unknown. It is very important to give your body healing time after a bout, so consult with your doctor before resuming running. Do not continue to train while you are still experiencing symptoms.

A lesser condition of GI distress is sometimes referred to as Runners’ Trots. While the symptoms are not as severe as Runners Colitis, it is still a serious issue and runners should see their physician to rule out any underlying causes. Common factors that may contribute to runners’ trots can be the physical stress of running, diet, certain medications, and/or weak pelvic floor muscles.

Most of the time, the physical stress from training is a good thing; the body adapts to physical stress by becoming stronger and fitter. In some cases, more adaptation time may be in order. Some runners may need more time adapting to this new level of physical exertion. Stop training until symptoms disappear. Then, when returning to running, back off the run pace, keep it easy, and reduce mileage volume to see if these same symptoms appear. If you remain free of symptoms, gradually increase mileage in small increments. Follow the 10 per cent rule when adding to weekly volume. Again, if no symptoms occur after several weeks of easy paced running, then gradually add in some increases in pace. Keep track of your workouts so you have a record of the intensity and/or duration of any onset of symptoms. As the body adapts to the rigours of running, hopefully these episodes will decrease or even cease as well.

In summary:

  1. First and foremost… Consult your physician! Discuss your use of all anti-inflammatory medications and review any other medications you may be taking. Discuss all of your options. Ask about using an over-the-counter anti-diarrhoea medication before running; use these only with your physician’s approval!
  2. Keep a training diary. Record mileage, pace, weather conditions, and the onset of any symptoms. This will give you and your physician more information.
  3.  Hydrate, hydrate, hydrate – Drink plenty of water and include electrolytes. It is very important to keep your electrolytes in balance, especially when having GI issues.
  4. Consider your diet – Some foods that may irritate the GI tract are: wheat products, dairy products, fibre, caffeine or artificial sweeteners. Try eliminating these from your diet and then keep a food diary to correlate diet with any episodes, include everything you eat or drink and the time of day it’s ingested. Note any links between food, drink and incidents.
  5. Timing your meals with your runs can also be important; especially if are trying to re-train your body clock to eliminate before you run. Try eating 4 or 5 smaller meals throughout the day rather than 2 or 3 larger ones. For example, eating earlier in the evening may help when you are running in the morning.
  6. As you plan your run routes, include bathrooms for a safety net. Knowing you have a place to go is comforting and will reduce some stress.
  7. Weak pelvic floor muscles, especially among women who have had children, may play a role. This condition can make it difficult to control the bowels, especially during intense activity. Discuss this with your physician; he or she may be able to prescribe exercises for strengthening this area.
  8. Be prepared for emergencies! Carry a small amount of toilet paper or wet wipes with you in a ziplock baggie just in case. When you feel the urge to eliminate it is important to do so as soon as possible. Waiting will further irritate the bowels.

In closing, I hope this information is helpful, but I urge you to seek medical attention as soon as possible.

Susan Paul has coached more than 2000 runners and is an exercise physiologist and program director for the Orlando Track Shack Foundation, U.S. For more information, visit www.trackshack.com.
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