Many endurance athletes are forced to deal with irritable bowel syndrome and must find ways to minimize its effects during racing and training. In this article, Molly Hurford explains why it seems to affect so many and how to deal with it.
It was an almost perfect start to my first triathlon when those three little words made my heart sink into my already churning stomach: no toilet paper. For a nervous triathlete, hearing that is akin to the end of the world. For a nervous triathlete with irritable bowel syndrome (IBS), it’s a death sentence. Since then, I’ve learned my lesson: Always bring a spare roll.
Endurance athletes can hardly afford to have undiagnosed gastrointestinal problems. Athletes and IBS patients are scarily similar in their profiles: According to a study published in Gut, IBS patients were less likely to rest in the face of their illness and exhibited all-or-nothing behavior by continuing their activities despite their symptoms. Sound familiar?
While up to 60 percent of runners may suffer stomach problems, only a small handful actually suffer from IBS. It’s a chronic disorder characterized by abdominal pain, changes in bowel habits and bloating, stemming from an overactive colon. According to the National Health Institute, it’s one of the most commonly diagnosed disorders, though no definitive cause for it has been found.
Athletes find this condition especially challenging, since the pain can interfere with training; changes in bowel habits leave us perfecting our 100-meter dash for a bathroom on runs, and bloating can make even the toughest athlete shrink away from being seen in a trisuit. Perhaps the worst news for athletes is that IBS is commonly brought on by stress, like right before a race starts.
Diagnosing IBS can be difficult, since it is characterized by lack of evidence of other stomach problems. It’s diagnosed only when all procedures used to find other problems show up negative.
Athletes, especially those with pre-existing stomach pains, are at risk for developing IBS. In a study published in the American Journal of Gastroenterology, a survey showed 71 percent of runners and 65 percent of cyclists suffered from either lower or upper GI problems.
While there is no cure for IBS, it is possible to treat the symptoms holistically and medically, though the most effective treatments vary by individual. Studies have shown that exercise can help with IBS by improving mood and relieving stress, and it can help to speed up what could otherwise be painful bowel movements.
Some can point to trigger foods and avoid them to prevent pain, but for most people, there’s no specific food that triggers pain. Of course, people with IBS should pay careful attention to nutrition, as a recent study has shown that subjects in IBS remission ran a higher risk for malnutrition. Clinical nutritionist Michelle Moder says that eating too much high-protein and high-fat food (such as bacon and eggs) shortly before exercise can cause GI problems. Instead, she suggests eating low-fat, carbohydrate-rich favorites as part of a daily training diet. Examples of GI friendly pre-workout foods are: low-fiber cereal and milk, a bagel with low-fat cream cheese, oatmeal and a banana, and yogurt. Moder’s most important nutrition tip is to ignore strict nutrition advice: Try different foods and see what works for you. Hydration is also key, especially during workouts.
Your doctor can also prescribe medications including laxatives, antispasmodics and anti-depressants for those in extreme pain. Perhaps the best advice for an athlete with IBS is to develop a routine, including a sense of when major bowel movements occur, a basic diet plan and a training schedule.
Triathletes with IBS have a lot to be nervous about on race day. While the swim and bike legs of the course have relatively low impact on the digestive tract and bowels, the sport drinks and energy gels consumed on the bike may come back to haunt racers during the run, when movement of the bowels may cause an emergency that sends a racer sprinting to the nearest Porta-Potty. So how can a triathlete properly fuel during a race without succumbing to stomach upset?
First, don’t focus on the hours before the race. Rather, look at the days preceding before the race as well. Since large meals have been known to worsen symptoms, avoid carb loading the day before the race. Instead, increase your carb intake throughout race week in the form of frequent, smaller meals. Moder suggests trying different combinations before race morning to see what works, listing bagels, toast, cereal, milk and bananas as good race-day breakfasts.
Terri Schneider, a triathlete and triathlon coach, says that psychology can play a huge part in improving an IBS athlete’s race. “It comes down to getting in the zone,” she says. “You want to be excited but not over the edge.” Schneider also emphasizes a nutrition plan for any race longer than Olympic distance; since calories must be consumed, it’s important for IBS athletes to have a strict plan.
Of course, the situation is not without humor: Tim Phelan, author of Romance, Riches, and Restrooms, a memoir about his IBS struggles, is quick to open up about his experience as a struggling triathlete learning to cope with IBS.
Triathlon was exactly what he needed. “In Masters swim, I was always 25 meters from a bathroom,” he says, and when running and biking, “the Rockies are the biggest open-air bathrooms in the world.” Phelan learned the best ways to cope, saying, “It’s a regimented, pre-planned existence.”
Athletes experiencing frequent gastrointestinal distress should ask their doctors about IBS. There’s no single medication, diet tip or holistic remedy that’s a surefire cure for IBS, but you can learn how to control it. After all, when you train this hard, shouldn’t you be able to fully enjoy the rush of competing instead of waiting on the sidelines for a Porta-Potty to open up?
On the bright side, triathlons are possibly the best competitions for people with IBS. After all, as Tim Phelan reminded me, just look to Julie Moss, the original Ironman legend. He asks, “What other job can you have where you finish second, crap your pants and people love you?”
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