Beyond the Finish Line: Strategies for Beating Runner's Colitis

Understanding Runner's Colitis: Symptoms, Causes, and Diagnosis

Running can offer many positive aspects to overall health and wellness, from increased longevity to improved cardiovascular health, endurance, strength, and bone health. These are just a few physical manifestations, but there are also mental and emotional gains to adding this sport to your regimen. Running can be an excellent way to manage stress and prevent cognitive decline with increased production of endorphins and other chemicals responsible for learning and memory. 

With all good things, there can be less-than-ideal things as well. If you are like me, a long-time, avid runner who suffers from runner’s colitis, then you know the woes that can come along with a temperamental GI tract. This diagnosis does not have to sideline your stride. Continue with me while I help you navigate different treatment options based on your severity. 

Diagnosing the Dilemma

Before we dive right into Narnia, let us define the problem. Understanding what you are up against can be a huge benefit when seeking solutions. With runner’s colitis, also known as exercise-induced Ischemic colitis, there are two major changes in the body while it is undergoing the stress of running. First, blood flow reroutes from the GI tract to the muscles that are working to allow you to run. Second, there is a depletion of adequate body fluid caused by inadequate hydration throughout your activity. 

Diagnostic criteria are subjective at first, often based on symptom description and the consistency in which these symptoms occur. One example would be having loose bowel movements during or directly after completing an endurance run. If symptoms persist, further objective testing can be done, such as abdominal X-rays, abdominal CT scans, colonoscopies, labs, and stool analysis. These tests will also help rule out any underlying issues contributing to the problem.

Dietary Tweaks and Lifestyle Adjustments

As someone who suffers from runner’s colitis, I always choose the least invasive methods to resolve symptoms first. One of the best things you can do for yourself is recognize trends. Do you have adequate hydration for your run? Have you planned for the weather and taken into account humidity? Are there foods you eat before a run that always cause GI upset? Are you overly sensitive to caffeine? These are all contributors to gut unrest. 

Fuel yourself before your run with low-fiber foods or foods you have recognized as “safe’ non-trigger foods. Make sure you have a hydration plan, whether you carry it, stage it, or have some friends’ houses along your route that you can use as a water stop. I have literally done all of the above. I have a handheld water bottle on all my long runs. I had mapped out my route the day before and staged water or sports drinks along the route (I hid them under bushes or in an inconspicuous location so no one would mess with them). I have also planned my route to run past friends’ houses where they have put water out for me. 

Figure out what your preferred fuel is during your run. I like gels or Gu as I can keep them in my pockets and pull them out when needed. I have it timed out when I take them based on trial and error during my training runs (usually every 30 minutes). Another discovery I made was that combining isotonic beverages, gels, and distance runs did not work well for my runner colitis. Consuming any fluid that contains more ingredients than plain water would always wreak havoc on my GI tract. My own experience has allowed me to dial in on what works best for me; there may be a better solution for you. I only consume isotonic drinks if it is very hot and my sweat loss is high or after I have completed the activity. I will also carry dissolving electrolyte tabs with me instead of drinking a sports drink; I will take these if I run in the heat for over one hour.  

Medication or Alternative Therapies

Medical treatment for runner’s colitis varies depending on the severity of your symptoms or if you have developed further complications. If your symptoms are severe enough to lead you to the emergency department, expect them to start IV fluids to replace fluid and electrolyte losses. Broad-spectrum antibiotics are often started to prevent a potential infection that can develop in your abdominal cavity. Unlike ulcerative colitis and Crohn’s disease, which develop in the tissue lining the intestines, runner’s colitis starts in your circulatory system. Because of this, you would not use the same medical treatment since runner’s colitis manifests through a different pathway. 

Generally, conservative treatment is the best option to promote a positive treatment response. When conservative methods are not effective, the alternative is surgical treatment. Alternative therapies, when paired with complementary approaches, are very effective ways to treat runner’s colitis. Stress management, physical therapy, and yoga can complement dietary changes and lifestyle adjustments, optimizing gut health for continued running success. 

In the comments section, please share your experiences with runner’s colitis and some tips that have worked for you. Fostering an environment of sharing and encouragement is essential for a community of individuals living with GI troubles. Get after your goals without your gut holding you back!

1. _{Cleveland Clinic. (n.d.). Ischemic colitis: Symptoms & treatment.}
2. _{Grames, C., & Berry-Cabán, C. S. (2012). Ischemic colitis in an endurance runner. Case reports in gastrointestinal medicine, 2012, 356895.}
3. _{Mayo Foundation for Medical Education and Research. (2022, October 22). Ischemic colitis. Mayo Clinic.}
4. _{Robinson, R. S., 3rd, Modi, R. M., & Krishna, S. G. (2018). Acute Abdominal Pain and Hematochezia in a Long-Distance Runner. Gastroenterology, 154(6), 1582–1583.}
5. _{What is an isotonic sports drink? - The Complete Guide. (n.d.).}