Over a decade ago, I remember reading about a woman who won the Boston Marathon. By the end of her run, she had blood and stool draining down her leg. I was a runner at the time, but I had never run a marathon, nor had the thought entered my mind. I had no idea what would happen to a person that they would be OK with having their own body fluids stuck to them while running.
Last year, I went to a continuing medical education conference sponsored by the Brigham where they presented a patient case of a marathon runner who stopped getting her periods. The focus of the case was more on her hormone abnormality, but the doctor presenting the case mentioned, in passing, she would get the runs, you know, when she would run marathons. Then, the doctor moved onto the next topic as health care professionals around me nodded, Yes, the runs. They happen when you’re running a marathon, of course.
Thinking back on my own clinical experience, I have heard patients tell me about similar symptoms of gastrointestinal distress with intense running or exercise, and this often improved on its own.
After reviewing the literature on a basic PubMed search, I found that lower gastrointestinal tract symptoms do occur frequently in runners, specifically bowel urgency, diarrhea, and even rectal bleeding. These symptoms can be accompanied by nausea, vomiting, and abdominal cramping. There are several thoughts on why this occurs. The more obvious explanation seems to be the extreme amount of stress placed on the human body would cause it to combust internally. Or, that would be my first thought. But to be more scientific about it, some have proposed the following as explanations for runners’ trots: electrolyte imbalance, autonomic nervous system stimulation, ischemia, and just plain trauma. There have been cases of rectal bleeding with intense workouts, related to hemorrhagic gastritis. These can be treated with over the counter medications like Ranitidine, also known as Zantac. However, like with any case of rectal bleeding that comes into my office, I take it seriously and do a full evaluation. Most cases of diarrhea with running are benign, but you’re not wrong to call your doctor’s office and ask questions if it doesn’t get better with taking a break from your workout regimen.
With temperatures creeping into the 80’s today and the less elite runners starting later this morning, we may see more blood and poop on the marathon route than we have in the past. We may see more serious medical conditions, too. I hope more runners will opt to defer to next year, or if they go ahead and start, to stop or slow down and rest when their bodies tell them to. I’m not sure how likely this will happen in marathoners, though. My marathoner patients tend to be high achieving, no matter the cost. The mind is much stronger than the body. I will often tell them to slow down if they are injured, but I know better than to expect they will listen. They will need to reach their decision on their own, and when they do, I’ll be there to support them.
I am no marathon runner. I did go running outside this weekend with my now 8-month-old infant daughter, but for 30 minutes. We ran in the morning when it was a breezy 60 degrees, and by the end, I was burning up. By the way, only one of us had any kind of incontinence that day, and it wasn’t me. She slept through it.
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