Talk to any runner about suffering from tummy troubles and they’ll almost always have a story to share. From a mad dash to find a toilet 20 miles into a marathon, to a pre-race jittery belly, we’ve all been there. However, for runners suffering from IBS, these symptoms go well beyond the well-known “runner’s trots”, with sufferers experiencing a whole host of unpleasant symptoms, which can be improved and exacerbated by running. We’ve teamed up with Dr Nick Read, medical advisor at the IBS Network, GP and WR Contributor Juliet McGrattan and Sports Nutritionist Emma Barraclough to get the low-down on running with IBS. Here we explain the condition, the symptoms and how best to control them.
What is IBS and what are the symptoms?
According to the The IBS Network, Irritable Bowel Syndrome (IBS) affects 12 million people in the UK (15% of our population.) This poorly explained illness includes abdominal discomfort and altered bowel function, affecting individuals in different ways. Although there are no specific tests for IBS, many patients have an increase in bowel sensitivity, often triggered by certain food groups, anxiety or a stressful event or situation. Symptoms include diarrhoea, stomach cramps, constipation and bloating.
How can running both improve and exacerbate symptoms for IBS sufferers?
Running can both exacerbate and improve symptoms for IBS sufferers. For those who suffer from constipation, “running can relax the bowel… and induce a more regular bowel movement,” explains Dr Nick Read, medical advisor at the IBS Network. Running can likewise help to ease symptoms for those who find their symptoms are primarily stress-induced. “Moderate regular exercise prevents the build up of stress and tends to relieve symptoms in most runners,” says Read.
However, for some runners, particularly those who suffer from increased bowel sensitivity, running can worsen the condition, causing much stress and irritation as they are frequently forced to stop mid run to find a toilet.
For celebrity sports presenter, keen endurance athlete and IBS sufferer Charlie Webster, this is a common problem. “It’s a nightmare,” she said. “I know where every toilet is. When I was training for my forty football club run (a 250-mile challenge), some of the people that were running with me laughed and said I should make a book with all the best toilets in Britain when running. I had to because sometimes I’d be so desperate and you just can’t control it.”
It is thought that the physical action of running, causing the bowel to “jangle” up and down, can induce this urge to go the toilet, however this remains unexplained.
Time of day also plays a key role in the culmination of symptoms. “IBS symptoms are often worse in the morning and after eating,” explains Dr. Juliet McGrattan, causing much irritation for those attempting to squeeze in their training early morning before work. A sudden dash to find a toilet before a race can also become a key point of concern for IBS sufferers, given their early start time.
However, that’s not to say that the endless queues for the portaloos at early-morning races are necessarily inhabited by IBS sufferers. While sufferers with stress-induced symptoms may find their symptoms worsened at races due to pre-race nerves, this apprehension, and sudden urge to go to the toilet as a result, is not restricted to those suffering from IBS. “A nervous jittery belly can make any runner need the toilet,” says McGrattan. Read adds: “An increase in emotional tension can make the rectum (and bladder) more sensitive, encouraging an urge to go. There may also be effects on colonic peristalsis and secretion, especially if the race starts in the morning.”
“The twenty-mile trots”
The “twenty-mile trots” is also a common complaint of both IBS sufferers and marathon runners in general. At around twenty miles, runners often find their energy levels decline as carbohydrate stores deplete and the body switches to fat-burning mode. This 20-mile point is also the point at which the queues fill up for the portaloos, as runners dash to find a toilet. “Why that occurs almost certainly has something to do with a shift in activity in the autonomic nervous system,” explains Dr Read, “perhaps the body switches to a more conservative mode of operating (less fight or flight), which would encourage bowel peristalsis.”
Controlling the symptoms
Adopting a tried-and-tested nutrition strategy and routine is crucial to controlling IBS symptoms and also those suffering from “runner’s trots”. “Trial and error is your biggest friend,” says Juliet. Juliet recommends keeping a food diary to spot any triggers, eliminating the foods from your diet which appear to be causing problems.
As an IBS sufferer, Charlie Webster found that knowing and eliminating the foods that seemed to worsen her IBS has helped her to control the condition. She said: “I know I can’t eat porridge or pasta, but I’m not gluten intolerant so I can eat bread no problem. I know that coffee also makes it worse. It’s knowing the little triggers.”
Sufferers may also find sports drinks and energy gels worsen the condition – something Charlie has experienced when competing in long-distance endurance events. “On my Ironman I had really bad diarrhoea, because my bowls couldn’t cope with the sports drinks,” she explains. “On the marathon of the Ironman I must have gone to the toilet about eight times. It’s so frustrating.”
Senior Sports Nutritionist Emma Barraclough recommends runners select their sports gels and drinks carefully. “Gels that are very heavily concentrated can also worsen the problem as more water has to be transported into the gut to help the gel absorb, which can bloat you. You need to always make sure that you take enough water with them, or play safe with a SiS GO Isotonic Energy gel, which is already balanced with the right amount of water to help it absorb.”
Emma also advises sufferers limit their intake of high-fibre and high-fat foods. “Keep your fibre intake moderate, but don’t over do it,” she says. “Some vegetables such as onions, raw peppers, leeks etc. naturally produce more gas in your gut, so many IBS sufferers benefit from avoiding those. Higher fat foods should generally be avoided, such as fried food, high-fat dairy, such as cream and hard cheese, fatty processed meat and too many cakes and biscuits.”
Where symptoms are exacerbated by stress and anxiety, Dr Juliet McGrattan advises runners make their pre-race ritual as smooth and stress free as possible. “Make sure you’re well prepared so you can avoid any last-minute stress like lost race numbers. Try listening to relaxing music before a race to keep you calm.”
For those struggling to manage their IBS symptoms on a daily basis, despite trying dietary tips and routines, then there are some medications that might help. It is worth chatting with your pharmacist to see what’s best for you.
If you’ve had a change in your bowel habit lasting more than six weeks or have passed any blood in your stool then you shouldn’t assume you have IBS and should see your GP.
For more information visit The IBS Network – the UK’s national charity for IBS. Its website includes a comprehensive information portal on all aspects of IBS alongside an IBS Self-Care Plan.