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Training With Colitis Flair Up
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I have an athlete who has colitis, and he's currently having a flair up. He's done a colonoscopy and seen his doctor this week, and the doc has recommended 6 weeks off. He's eager to get back to training in 1-2 weeks, but I wanted some thoughts from anyone who might have experience with this? I don't want to encourage a quick return if it risks long term damage, just not super familiar with colitis
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Re: Training With Colitis Flair Up [boltz1] [ In reply to ]
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boltz1 wrote:
I have an athlete who has colitis, and he's currently having a flair up. He's done a colonoscopy and seen his doctor this week, and the doc has recommended 6 weeks off. He's eager to get back to training in 1-2 weeks, but I wanted some thoughts from anyone who might have experience with this? I don't want to encourage a quick return if it risks long term damage, just not super familiar with colitis


I have UC, but have never had a flare to the point where 6 weeks off was recommended. And I would think that if it was that bad, the athlete would have absolutely no desire or ability to train anyway. I have been told to take an extra day or two very easy after a colonoscopy due to biopsies being taken. But never more than that.

I am neither a doctor nor your athlete. The only comments I can offer is that easy volume is easier on the UC than hard workouts; staying hydrated is key; and low impact exercise like aqua jogging, swimming, and biking is easier on the UC than running.

I would want to know why exactly the 6 weeks was recommended - what are the concerns. Were there a lot of biopsies/removals during the colonoscopy? Are things really inflamed?

I'll also note that it's crucial IMHO to have a GI doctor with some familiarity with endurance sports. If not, you can get some awful advice (one doctor suggested to me that I fast for 48 hours before marathons...)
Last edited by: darkwave: Jun 12, 21 11:43
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Re: Training With Colitis Flair Up [boltz1] [ In reply to ]
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I have Crohn's, but I would say this is really hard to answer. Crohn's can be bad enough to put you in the hospital with IV nutrition only, or mild enough to do ironman, and everything in between. I would say with todays biologic drugs (Humira, Cimzia, Stelara, Entyvio, etc...) if your athlete isn't on one they should be. (if they need 6 weeks off). These drugs were a life changer for me, but doctors still try and start with all the drugs from the 1950s that really just don't work (for anyone I've ever met). There is a big cost difference so they always start there, and that does a huge disservice to patients. (soapbox:) There is a huge disparity between gastros that focus on IBD and those in the mainstream btw. That's where I would start with your athlete.

Bill
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Re: Training With Colitis Flair Up [darkwave] [ In reply to ]
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Thanks for the thoughts both! Good experiences to help give a bit clearer advice
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Re: Training With Colitis Flair Up [boltz1] [ In reply to ]
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You also might want to reach out to JONNYO. I believe that he has experience in this.

clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com
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Re: Training With Colitis Flair Up [boltz1] [ In reply to ]
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I agree with everything posted by the others, and thought I'd add my own (limited) experience for more data. It's kind of all over the place, but that's been my experience with ulcerative colitis!

I had what I think was a very mild, albeit months'-long flare up last year before any diagnosis. It came during training for a 100-mile ultra, and I trained through it figuring the (mild) symptoms were from the big running volume. I completed the 100, it went really well and I felt relatively fine, and the flare up seemed to go away not long after.

The symptoms came back early this March when I wasn't running as much but cycling a lot, so I talked to a GI doctor. I was diagnosed with ulcerative colitis in mid-April. I told my doctor that I was an endurance athlete, and he said training, itself, wouldn't worsen the condition -- it could make symptoms worse, but wouldn't affect the state of my colon one way or another. Take that for what you will. My case of UC is minor (only 1/4 of my colon), but the flare up of that 1/4 was "pretty severe" (doctor's words) in April. For whatever reason I felt fine from about 7am-3pm everyday, and I kept training during that period like nothing was wrong. Cycling was more comfortable than running. The flare up didn't usually impact the training sessions themselves, but it did impact my sleep, mental stress, ability take in enough calories and eat "healthier" foods, etc. The condition worsened throughout this time, and I have no way of knowing whether exercise made it worse/sped up that process or if the condition was headed that way regardless.

Anyway, things got bad last month -- could barely eat, weeks of being basically bedridden, uncontrollable weight loss, aches/fatigue, and all the symptoms you'd expect from UC. Despite all this, my doctor said that I could ease back into exercising as soon as I felt able. I took 4 weeks off and, for most of that period, had absolutely no ability/desire to train. I just got back to it (still underweight and a bit fatigued, but much better) and have logged ~600 TSS of running/cycling in the last 10 days, which is maybe half of what I was doing back in April. I feel fine.

The upshot of this is that, as someone else said, it'd be very important to know *why* the doctor recommends 6 weeks off, and how severe the flare up is. Does the doctor think exercise worsens the condition, or only symptoms? Is it concern over the athlete being able to eat/retain enough food to fuel exercise? I don't know of any, but maybe the doctor sees a long-term risk? Etc. With a very mild flare up, a 100-miler was in the cards for me. With a more severe flare up, I went from uncontrollable weight loss, horrible UC symptoms, and being literally unable to stand up comfortably for more than 2-3 minutes to moderate 25-50 mile rides and 7-8 mile runs in fewer than 6 weeks. But that's me, and big picture my case is mild and my medication is working. Your athlete's doctor might have great reasons particular to your athlete.
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Re: Training With Colitis Flair Up [boltz1] [ In reply to ]
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Long-time UC patient here -- initially diagnosed in 1997. I've been through the wringer on meds: ASA-5, Colazal, Immuran... currently on an infusion of Entyvio every 8 weeks. Just had a treatment yesterday, but I'm on my second flare-up in the last year, so things might be changing a bit. I'll be starting (another) round of prednisone today after I take a stool sample...

I've been able to figure out some of my triggers over the years, but they can be different for everyone. For me, sleep deprivation and excess alcohol (especially the hard stuff) will put me over the edge pretty quickly. I avoid high-fiber foods as well, which seems counter-intuitive.

Aside from a bad bout in 2006, I've been able to train through flare-ups, even with what was medically called "pan-colitis" (basically involving the entire colon). I guess I learned to get intervention early so I wouldn't have to lay off. I can't make any comment on why your particular athlete is being advised to take 6 weeks off.

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