Ulcerative Colitis and Run Training

Triathlon Forum
1

I have a few questions geared to those of you who are unlucky enough to have Ulcerative Colitis, like me. I have a call into my GI, but as I’m not sure when I’ll see him… I figured I’d ask Slowtwitch.

To start, a little background. I’m 22, and was diagnosed about 4 years ago now. I’ve got all of my symptoms under control (more on that later) from a day-to-day basis, taking 3-4 Mezavant (Lialda in the USA) daily. I’m a lifelong athlete, having playing competitive soccer and hockey (up to tier 2 junior) my whole life. Since I’ve gotten my symptoms in check, UC has never affected my training, outside of flareups. Flareups for me tended to occur during university exams, but I didn’t have any throughout my senior year of school, and graduated in April, so stress in my life is non-existent at this point.

I swim 2-3 times a week, ride 3-4 times a week, and run 3-4 times a week also. Cycling and swimming cause no problems, regardless of duration and intensity. Since about May, I’ve had my eye on running a marathon, and was planning to do one in October. As such, I’ve started completing longer (and more) runs. However, every time I run for more than ~45 minutes, I have stomach pain, as well as the need for several bowel movements. Pain intensity seems to be correlated with duration, not intensity. For example, the other day I did 4x1km@4:15, and took me about 40 mins. No pain. This morning I did about 10km, with 8km at 4:30, and had a small amount of pain post run (overall duration was around 48 mins). Last week, I did ran for ~1:45 (about 21km) and I was doubled over in pain for hours, and had many many BMs. This seems to be consistent with other longish runs, though the pain was far more severe than I’d dealt with before.
I’ve been running for the entire time I’ve had UC, and it’s never been an issue before. In past years I have completed runs from 12-20km, with no pain. No diet changes recently either. I have to eat exceptionally healthy, as fatty/fried foods cause serious pain also.

I guess my question is, do any other sufferers of UC have this problem? If so, has it gone away as your body has gotten used to running longer distances? I’m not fully set on doing this marathon. I will just switch to the half if problems continue.

2

Have you ever had broadband antibiotics prescribed? Like clindamycin? That’s what did me in. It took 4-5 years to get the GI tract back under control.

Try eating GF. Also try the FODMAP diet. Give them a few weeks or a month, see what they do. I’m not saying they will help. I’m saying they might.

Also try probiotics. I’ve had good luck with Culturelle and with Align. Eventually I got one of those probiotics with a couple of dozen different live cultures in it - which kinda messed me up more while I was taking it, but when I stopped it had a long term curative effect. My GI tract was much better, permanently, since then. Coincidence? Yes of course it could be. Or I repopulated the missing gut bacteria.

Try those things. That’s long term. Short term what helped me a lot is coffee first thing in the morning with breakfast. That will help move things and make the rest of the day much better. Another thing you can do is run on a treadmill for 30 minutes, hit the head, then finish the ride outside. I no longer need to do any of these countermeasures though. The years of taking probiotics and a diet have helped me a lot. First year or two were wretched, until I learned more about this, so I know exactly what you are dealing with.

If all else fails, there’s fecal matter transplant. Apparently wildly successful in clinical trials, but still not approved for treatment.

3

15+ year sufferer of UC here. Been on every medication and no surgery yet. Currently on Humira.

Anyways to the point… relax and enjoy your long runs. I either run long on a bike path in the woods or, a short loop with a bathroom. You know yourself you cant fight it. The more it stresses you out the more it takes over. Just stop and go to the bathroom as soon as possible when the urge presents then continue. Let your long run become a peaceful relaxing enjoyable activity. With luck, symptoms and running will cease to co-exist.

When it comes to racing long, there are always portapotties. Stay reasonable with your goals if the bathroom is calling. Stress exasperates symptoms in a lot of cases (no more so then in mine!) The less you think about it the better!

4

Hi All,

Thanks for the replies. I’ve tried GF, which didn’t do a whole lot for me but I’ll look into FODMAP and probiotics. I don’t think I’ve been on any antibiotics since I’ve been diagnosed; I don’t really get sick. Having a coffee before I train is a staple for me.

I was a bit unclear of my description in my symptoms. My stomach pain/need for BMs doesn’t start until about 20-25 mins after I finish, and then persists for several hours. Usually after I’ve taken a shower and started stretching is when the pain starts coming. I’ve never had pain during a run nor the need to use the bathroom either.

Have either of you (or anyone else) experienced this?

5

If he doesn’t have concomittant celiac disease, the likelihood he will have any sustained benefit from GF is low. FODMAP diets are effective in irritable bowel syndrome, but of unexplored utility in IBD, and likely don’t impact the inflammatory process at all. The data supporting probiotics in fairly limited, and really only seems applicable to more mild disease (though, if maintained on only a 5-ASA, he is likely within that target range).

There are NO data to support the use of FMT in the treatment of inflammatory bowel disease at this time, unless there is superimposed C. diff infection. “Apparently” all clinical trials in Crohn’s are negative and those in UC have demonstrated conflicting results. We REALLY (and I can’t emphasize that word “really” enough) don’t know what we are transplanting when we perform an FMT at this juncture, and until we have more data on better defined “infusates” with standardized delivery methods and quantified, speciated strain information, I suspect this field will continue to struggle to produce consistent results.

just my 2 cents…

6

I have UC. It is mostly controlled with occasional flares every few years. I had similar symptoms as yours at the last part of IM Chattanooga run last year (which I raced for Team Challenge fittingly). That was first for me - usually the thing I have to manage is a access to a portapotty STAT during the run but would be fine after. That was the first time i had cramping that went on for an hour or so post race . I haven’t found a food culprit that i can cut out that resolves all my issues and I’ve tried eliminating them all at some point. it seems to be a constellation of factors that add up to an ‘okay gut’ or a ‘not okay gut’ - some possibly food, others stress, etc.

Sugar (as in pretty much everything they offer on course in a race) will have undesirable effects and some electrolyte concoctions may also be suspect too.

I don’t have a miracle suggestion other than:

  1. check with your docs to make sure you aren’t at the start of a flare that is progressing and needs medication. Some forms of UC are indeterminate and can involve areas other than the colon. IBD, as you know, is a spectrum disorder so where you land on that spectrum may determine your symptoms.
  2. try anti gas pills like Beano. Maybe experiment with one prior to the run, especially if you are eating dairy and sugar (gels, gatorade, clif blocks, etc).
  3. If you are putting dairy in the coffee and are lactose intolerant that can catch up with you later?
  4. It may not be UC? Running is a great treatment for constipation even if you don’t have UC. It could be your gut just gets amped up and busy after being stimulated by the run?

We all love simple answers but, like all autoimmune disorders, this isn’t a simple disease (or it would be cured by now).
Good luck.

7

You noted that you are currently maintained on a 5-ASA alone. Have you had a recent assessment to determine if there is any active residual inflammation? I think this would be of import at this juncture to ensure you really do have mucosal healing with your current regimen. It’s definitely worth a conversation with your gastroenterologist, to assess if some simple inflammatory markers or perhaps endoscopic evaluation are warranted; I would not attempt to discern what may or may not work for you until I knew some up to date information on what is going on in your colon.

PM me if you would like to discuss further. I’d be happy to provide some references if you are in need of a new GI as well and are in the U.S.

8

Thanks for the replies again everyone. I am in Toronto, so while I appreciate the offer for a referral in the United States I’ll likely just wait things out to see my current GI. I was assessed after a minor flare in May of last year. I had a minor scope, and the doc said the bottom 6" of my colon was what was inflamed. He gave me some mescaline suppositories along with my 5-ASA. I used 2/day, until the symptoms were gone for a while, then backed down to 1/day, then 1/every two days, etc. over the course of a few months. Haven’t taken them in probably 6 months however. May try them before another 45 minute run to see if that knocks anything down.

Thanks a lot for you help everyone.

9

When you run long like that, do you use supplements containing caffeine? If so, try once without caffeine in your system. You are lucky you are controlled with 5ASA (Simponi here) but control can have grey areas.

Given that frankis was my GI doc when I was living in Philly (and a fine one at that) all I can really add is personal experience