Diarrhea in the Endurance Athlete

It's race day. You've worked hard and you're pumped up to give this race (half marathon, marathon, triathlon, enter your race here) everything you've got. Things are going well, and then IT hits. Cramping, urgency. You spend the rest of your race port-a-potty hopping and praying you'll make it to the next one in time. Worse yet, you're home recovering from your race and the severe pain sets in and lingers. Maybe bloody or tarry stools fill your toilet bowl. This is scary stuff. But you love running, triathlon, racing. You don't want to quit! 

Runners diarrhea, the trots, GI distress. Call it what you want.  It can be a real bummer on race day.  These symptoms are actually very common in athletes, particularly runners.  They can lead to severe problems requiring hospitalization.  Let's break down what could be contributing and things you can do to reduce your risk. 

 

When you exercise, your sympathetic nerve system is in overdrive.  Remember "fight or flight" and "rest and digest" from grade school?  There are both hormonal and blood flow affects from sympathetic nerve stimuli.  In my opinion one of the biggest factors which causes runners diarrhea is that blood is shunted away from your GI tract to allow for more blood flow to the heart, lungs and skin (to cool you down).  Because of this, parts of your GI tract have what's called ischemia which is a lack of blood flow to supply nutrients and oxygen to a tissue.  One part of the left side of the colon is particularly susceptible to ischemia because of the anatomy of our blood flow.  In runners this can also happen in the small intestine and even stomach.  The ischemia can be mild in some cases but also can be severe and actually very dangerous in others.  Once there is ischemia it can bleed and also cause trouble with absorption of nutrients, water causing cramping, pain and diarrhea.

  Studies show the harder you are working (ie. faster and longer) the high risk for symptoms from ischemia.  It's common for symptoms to occur after the blood flow goes back to normal (when you are done exercising).

 Mechanically vibration to the intestine while running has also been reported to cause diarrhea.  There is a theory called the "cecal slap" that was described decades ago.  The cecum is the part of the colon where your small intestine joins the colon and appendix hangs off of it.  It can move about a bit, and the idea is running makes it bounce and hit the wall of your abdomen so much it can actually get bruised.  This also would cause irregular hormones to release and absorption problems temporarily. I'm not sure how valid this theory is, but it certainly could contribute. 

Hormones in the body are altered when we are exercising at high intensity.  Alteration of hormones can cause diarrhea and cramping as well. The good news is our bodies seem to be somewhat adaptable to these hormones, meaning if we train properly then our symptoms can improve.
 

 First things first, other causes of diarrhea and cramping should be ruled out by your doctor. 
If you are seeing blood, this is not normal and can potentially be serious, so please seek medical attention immediately. This blog does not substitute for a doctor-patient relationship and you should meet with a gastroenterologist in your area.

Ask your doctor to make sure you have normal blood flow to the colon when you are NOT exercising.  Assuming everything checks out fine with your GI doc, here are some tips to get you back to running.

*You may have anemia from heavy menstruation, iron deficiency or increased red cell distruction from the impact of running.  Anemia means there is less oxygen in the blood volume you have, so you want to maximize your oxygen carrying to the tissues.

**Constipation, Constipation, Constipation.  Just because you are having daily bowel movements, doesn't mean you are not constipated.  Not all bowel movements are created equal.  You would be amazed how many people are constipated to the point of severe pain and still don't believe they are constipated until they do a bowel cleanse and see how good they could actually feel.  If you are constipated and then during a long work out you have hormonal release and mild ischemia, all the more stool to be expelled once your bowels get moving.  Look out! 

 ***Eating and drinking during your exercise takes training.  Doing so keeps a little more blood flowing to the GI tract. I would recommend avoiding high fructose containing supplements and also lactose which may make things worse.

 I hope you find this helpful.  If this happens again, you may need to reduce your intensity for at least a few months and slowly resume in order to give your body some time to hopefully adapt.

Good luck to all the #INGNYCM Runners this weekend!

Troubleshooting Runners "Bloat"

Bloating is a common complaint among endurance athletes.  It can significantly impact your race after months of training.  Many different factors may contribute to bloating, some serious medical conditions and some not.  In this post I will discuss some of the most common and less serious causes of bloating in endurance athletes.

The GI tract is not as adaptable to exercise as the heart and lungs, each person's issues must be addressed individually. Small changes in your nutrition and racing/training practice could make all the difference.

Of course, if it doesn't, it's time to visit your local Gastroenterologist.

(yes, this is an incredibly embarrassing selfie of me running)

Delayed Gastric Emptying- nausea, feeling of fullness, pain and sometimes vomiting.

 A higher gastric emptying rate during racing is important because the small intestine absorbs the water/nutrients and helps prevent heat stroke and fatigue.  The rate a stomach empties varies from individual to individual, but studies show that in athletes the following affect this rate:

• The higher the carbohydrate percentage, the slower gastric emptying (at least up until a high intensity VO2max, where water and high carbs level out and both empty slowly).  Most recommend no higher than 8% carbohydrates in supplements

• Intensity of exercise

• Volume in the stomach.  A higher volume in your stomach also helps gastric emptying rate. The higher volume that can be tolerated by athletes without GI discomfort is recommended. Adding salt or cold fluids helps athletes get the fluid down.  Salt use to aid in fluid absorption is controversial but the Academy of Sports Medicine does still recommend supplementation to help with pallor of fluids and also to possibly help prevent hyponatremia.

Air Swallowing- common causes are chewing gum, anxiety and positioning.  Laying down or bending forward such as in aeroposition for triathletes could contribute to air swallowing.

Carbohydrate Malabsorption- if your body doesn't absorb the carbs you take in, they stay in the gut allowing for rapid fermentation = MORE GAS. Most people know lactose is a common problem, but fructose malabsorption is a big one too.

Constipation -  This goes along with delayed gastric emptying.  If you're constipated at a baseline, you may find what you take in has no where to go.  Regular BMs even when not exercising are essential for so many reasons.  This is also one of the most common causes for runners diarrhea "runners trots" which I'll blog about another time.

Gluten Sensitivity In this day and age, you can't talk about bloating without talking about gluten sensitivity. This will be addressed in a future blog post, but briefly you may consider switching to gluten free supplements to see if your bloating improves.

If you're still experiencing bloating, see a gastroenterologist to assess other significant health problems which can cause bloating such as chrons disease and celiac disease among others.

Coming Soon

 I was hesitant at first to blog about anything other than photos that my mom and my 3 closest friends would enjoy.  But, since joining FitFluential, I've been so excited at the opportunities I've had.  Mud runs, nutrition supplements, and running gear to review.  I've met so many interesting women.  Both in Fitfluential and in my triathlon training, it's inevitable that when people hear about my profession the conversation ends up making it's way to GI symptoms and distress.  

I decided to work on a new section on my blog focusing on common GI complaints in athletes.  I'm hoping to post some general information in this section that could be helpful for basic complaints like bloating, nausea, diarrhea.   I'm thinking I'll post some general information about different medical conditions in Gastroenterology and Hepatology.  Since I have all these fantastic magazines delivered to my house every week, I will summarize some of the articles I think people might find interesting.

 I may occasionally look into interviewing people with these conditions to discuss lifestyle changes which have made their illness more manageable, allowing them to achieve their athletic goals.

I'm sure these posts will be few and far between, but feel free to send me a message with any topic you might be interested in.

And you'll now find this on the bottom of my blog.  
THE MEDICAL INFORMATION ON THIS WEBSITE IS FOR INFORMATIONAL PURPOSES ONLY AND CANNOT BE SUBSTITUTED FOR CARE PROVIDED BY A QUALIFIED HEALTH PROFESSIONAL. THE CONTAINED INFORMATION DOES NOT ESTABLISH A DOCTOR-PATIENT RELATIONSHIP, AND I CANNOT TAKE RESPONSIBILITY FOR ITS USE OR MISUSE. EVERY EFFORT HAS BEEN UNDERTAKEN TO MAINTAIN THE ACCURACY OF THIS WEB SITE AND THE INFORMATION CONTAINED WITHIN. THE INFORMATION IS NOT INTENDED TO REPLACE MEDICAL ADVICE OFFERED BY A PHYSICIAN. I RECOMMEND THAT YOU INDEPENDENTLY VERIFY WHETHER THE MEDICAL INFORMATION IS APPROPRIATE TO YOU BY CHECKING WITH YOUR DOCTOR. USE OF THIS WEBSITE CONSTITUTES AGREEMENT WITH THE ABOVE