It’s a bit ironic, but every runner you meet is probably all too familiar with “the runs.” Having to find a bathroom in the middle of a distance workout is a common complaint. With all the bouncing and moving about that runners do, it’s no wonder their digestive systems can get a bit irritated at times. Not to mention, there’s a delicate art to figuring out what to fuel and refuel with that won’t upset the stomach before and after a run. Here’s a look at some of the common gastrointestinal (GI) problems runners may face and how to keep them in check, so you can keep hitting those mileage goals without having to run to the nearest portable toilet.
Why do runners tend to face GI issues?
It’s common for runners to face some digestive challenges, explains Karen Woods, M.D., a gastroenterologist at the Lynda K. and David M. Underwood Center for Digestive Disorders at Houston Methodist Hospital. “The most frequent exercise-induced gastrointestinal symptoms are short-lived abdominal pain, heartburn and acid reflux, vomiting, diarrhea, and bloody diarrhea,” she says.
Dr. Woods says the cause of these symptoms isn’t entirely understood. However, she can pinpoint a few factors that may up the risk of discomfort. “Many athletes who have eaten a meal within two to three hours of exercise, who are dehydrated, or who consume sugary fruit juices prior to or during exercise report problems,” she says.
In particular, studies have shown that women and younger runners are more prone to digestive discomfort, including nausea. It’s not entirely clear why this is the case, but it’s something to be aware of if you’re a distance runner, and you may want to discuss with your doctor.
If you tend to feel especially nauseated before or during a race, you’re not alone. “Anxiety and pre-competition stress may also contribute to GI symptoms, particularly upper-GI symptoms like acid reflux, heartburn, and GERD,” says Jessalynn Adam, M.D., an attending physiatrist of sports medicine at Mercy Orthopedic Specialty Hospital in Baltimore.
How can runners avoid getting “the runs” during a training session or race?
If you’re prone to uncomfortable stomach symptoms before, during, or after a run, Dr. Adam says to stay hydrated. She offers the following tips:
- Watch what you eat. Try to avoid eating right before a run. Ideally, you should wait two to four hours after eating. Avoid lying down after eating.
- Put down the orange juice and coffee. Citrus, alcohol, chocolate, fatty foods, and caffeine can lower the tone of the esophageal sphincter, leading to increased acid reflux.
- Wear comfortable, loose clothing to run. Avoid restrictive clothing, as it may exacerbate symptoms.
- Take care with energizers. Gels, energy bars, and artificial sweeteners may contribute to diarrhea for some runners.
- Take care with painkillers. Avoid nonsteroidal, anti-inflammatory drugs (NSAIDs) because they can cause stomach upset and irritation of the stomach lining.
- Watch antidiarrheal meds. Take caution with using antidiarrheal medications such as Lomotil. For runners, they can affect sweating and could increase your risk for heat illnesses.
Dr. Adam also recommends keeping a training diary with a record of what you’re eating before and after your run plus your symptoms. You may be able to pinpoint some triggers and avoid them in the future.
She says that if your stomach is upset, you can try decreasing your training volume and intensity for one to two weeks and gradually return to running. “You can also cross-train with low-impact activities to decrease symptoms,” she advises.
If pre-race anxiety is a problem for you, try deep breathing and meditation. Or, visualize yourself finishing strong to stay calm and keep heartburn at bay.
When to See a Doctor
While Dr. Adam says runners are bound to face stomach discomfort at some point, always see your doctor if your symptoms don’t go away or you think something more serious is happening.
Let your doctor know if you’re experiencing any of the following symptoms. They may be signs of a more serious condition.
- blood/mucus in the stool or dark/black stool
- persistent pain or symptoms that do not resolve after running ceases
- intractable nausea or vomiting
- severe diarrhea
- weight loss
- early satiety (full faster than normal)
Dr. Woods says that it’s rare, but runners can occasionally face a more serious intestinal condition called intestinal ischemia, which occurs when blood is forced from the intestines to the muscles and heart during intense or prolonged exercise. Seek medical help right away if you have sudden and severe abdominal pain or notice weight loss, blood in your stool, or pain that gets progressively worse over weeks or months.