Runner’s GI distress

It’s almost time for THE marathon in NYC. If you lived here in the city, you can’t miss the hordes of runners in Central Park and West Side highway getting their training miles in these last few months, or the over 40,000 marathon runners who take over the boroughs the first weekend of November.

I want to discuss three uncomfortable and slightly embarrassing GI issues a long-distance runner may have or will face.

Runner’s trots

‘Runner’s trots’ is a friendlier name for runner’s diarrhea that affects distance runners by an urgent need for a bowel movement mid-run. The cause is controversial, one theory is the enzyme that is known to increase peristalsis (the food-pulsing of the large intestine). Another potential etiology is bowel ischemia, the process where the body shunts blood to running legs and away from the digestive organs, causing them to reject what they can’t digest. Diet is also a common cause. Runner’s diarrhea will clear up from several hours to a few days after running. As the case with diarrhea of any cause, electrolytes and fluids will need to be replaced. These tips might be useful for you: Cut down on eating the night before the race from 5pm on, except for something light (toast) or pretzels. Avoid fat,  high fiber foods (fruit, vegetables, legumes) and caffeine. I try to eat basic and bland (no Indian food, no seafood). I like quinoa and a few slices of turkey breast or homemade pasta with very little tomato sauce and French bread. Drink plenty of water (close to 64 ounces). Choose foods that are naturally constipating such as bananas, plain bagels, rice, oatmeal, and pasta. For the day of the race, get your breakfast in as soon as you wake up to allow at least 2 hours of digestion. I like small portions of either a slice of bread and peanut butter or 1/4 of a plain bagel with Gatorade to drink. Make sure you aren’t eating anything that’s “new” to your body, I had a friend who tried a new carbohydrate gel during our half marathon that didn’t agree with her. Make sure to sample out your gels, blocks, or sports drinks ahead of time to determine the best fit for you.

Hemorrhoids

Hemorrhoids or ‘roids are painful or swollen internal or external varicose veins in the rectum. The internal ones can bleed a lot, and the external are seen and extremely painful. It is common for runners to get hemorrhoids, just like the common patients who get them (obesity, pregnancy, older age). Dehydration and long exercise can lead to constipation, so it is important to drink plenty of water leading up to your running, and after to refuel. You may want to run with a Camelback or a water bottle during your run, especially on hot or humid days to assure hydration. Eat enough fiber (beans, fruits, broccoli, oat and wheat bran) or a fiber supplement (Metamucil). Also try to avoid straining or spending too much time on the toilet with bowel movements, as this increases your risk of hemorrhoids. If you are a toilet reader, stop now before it is too late! Hemorrhoids can be treated by surgery or by an outpatient banding procedure in a GI office. Trying over the counter meds such as Preparation H and soaking in a warm bathtub once or twice a day can also alleviate them.

Runner’s colitis

Runners colitis is associated with Ischemic colitis. This is a medical condition where inflammation and injury of the large intestine results from inadequate blood supply, usually due to dehydration and limited blood flow to the intestines during intense exercise. The symptoms may include mild to severe cramping, diarrhea, nausea, and bleeding. The bloody diarrhea is the intestine sloughing off its’ inflamed lining. Patients are usually treated with IV fluids, pain medicine and bowel rest, so no food or water by mouth until the symptoms resolve. Those with severe ischemia can develop complications such as sepsis, intestinal gangrene, or bowel perforation and may require more aggressive interventions such as surgery.

I personally have experienced runner’s colitis and it is very painful. I finished a half marathon in 1:37, and I’ve never been so sick. The amount of blood that came out of me was extreme and nothing made me feel better for 24 hours. I made a poor decision to compensate my late night party the prior evening by taking an Adderall before my race to wake me up. I found out later from my GI doc that I basically shut my lower organs down during the 90 minutes. I was surprised there are not more cases of this reported, but it could also be summed up as dehydration (which is effect of Adderall).

While running is a great exercise for our body and our minds, we should be mindful that long endurance running requires us to pay extra attention to nutritional preparation and hydration.

Happy running and good luck marathon runners.  





(That's me puffing through the finish of a half-marathon)




Further readings:
  http://www.mayoclinic.com/health/ischemic-colitis/DS00794
http://www.hindawi.com/crim/gastrointestinal.medicine/2012/356895/