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Copyright: Nancy Clark MS RD CSSD August 2010

Undesired Sideliners: Side Stitches and Runner’s Trots

“I'm afraid to eat before I exercise … I might get a side stitch.”
“I always carry toilet paper with me when I go on a long run.”
“How can I change my sports diet to so I don't need pit stops..???”

Little is more frustrating to a competitive runner than to be well
trained for an event and then get sidelined with a side stitch or
diarrhea. Yes, the sports diet that’s intended to enhance your
performance can also bring you to a screeching halt! Sound familiar?
Transit troubles and gastrointestinal (GI) concerns are common among
athletes, particularly those who run and jostle their intestines. An
estimated 30 to 50% of distance runners experience exercise-related
intestinal problems, with women experiencing more problems than do men.
If you are among the many runners who fear side stitches, loose stools,
and GI distress, keep reading. The goal of this article is to offer some
information and advice that can help you manage, if not reduce, your
transit troubles.

Side stitches
A side stitch—that stabbing pain in your gut that can bring you to a
stand-still—is familiar to about 60% of athletes. Because getting
attacked by a side stitch is unpredictable (that is, one day you might
get one but the next day you don't), they are hard to research. The
available data suggests they commonly occur in the same spot: on the
upper right side of the abdomen where the liver is attached to the
diaphragm by two ligaments.

While we aren't 100% certain what causes a side stitch, the prevailing
theory is exercise creates stress on the ligaments that connect the
liver to the diaphragm. Stitches can be provoked by a heavy dose of
pre-exercise food/fluids, minimal training and inadequate pre-exercise
warm-up. Wearing a tight belt can help reduce organ jostling and reduce
the symptoms. You could also record your food and fluid intake to try to
detect triggers (too much pre-exercise water? too large a meal?). With
repeated dietary tweaks, you can hopefully discover a tolerable portion
of pre-exercise fuel.

To treat a side stitch, many runners bend forward, stretch the affected
side, breathe deeply from the belly, push up on the affected area,
tighten the abdominal muscles, and/or change from “shallow” to “deep”
breathing. (Pretend you are blowing out candles while exhaling with
pursed lips.)

Dreaded Diarrhea
Marathoner Bill Rodgers may have been right when he commented more
marathons are won or lost at the porta-toilets than they are at the
dinner table! Diarrhea is a major concern for many runners.
Understandably so. Running jostles the intestines, reduces blood flow to
the intestines as the body sends more blood to the exercising muscles,
stimulates changes in intestinal hormones that hasten transit time,
alters absorption rate, and contributes to dehydration-based diarrhea.
Add some stress, pre-event jitters, high intensity effort—and it’s no
wonder athletes (particularly novices whose bodies are yet unaccustomed
to the stress of hard exercise) fret about "runners’ trots."

Exercise—specifically more exercise than your body is accustomed to
doing—speeds up GI transit time. (Strength- training also accelerated
transit time from an average of 44 hours to 20 hours in healthy,
untrained 60-year old men.) As your body adjusts to the exercise, your
intestines may resume standard bowel patterns. But not always, as
witnessed by the number of experienced runners who carry toilet paper
with them while running. (They also know the whereabouts of every public
toilet on the route!) Runners with pre-existing GI conditions, such as
irritable bowel or lactose intolerance, commonly deal with runners’ trots.

Solutions for Intestinal Rebellion
To help alleviate undesired pit stops, try exercising lightly before a
harder workout to help empty your bowels. Also experiment with training
at different times of the day. If you are a morning runner, drink a warm
beverage (tea, coffee, water) to stimulate a bowel movement; then allow
time to sit on the toilet to do your business prior to exercising. When
running, visualize yourself having no intestinal problems. A positive
mindset (as opposed to useless fretting) may control the problem.
The following nutrition tips might help you fuel wisely and reduce the

1) Eat less high fiber cereal. Fiber increases fecal bulk and movement,
thereby reducing transit time. High fiber = High risk of distress.
Triathletes with a high fiber intake reported more GI complaints than
those with a lower fiber intake.

2) Limit “sugar-free” gum, candies and foods that contain sorbitol, a
type of sugar that can cause diarrhea.

3) Keep a food & diarrhea chart to pinpoint food triggers. For a week,
eliminate any suspicious foods--excessive intakes of juice, coffee,
fresh or dried fruits, beans, lentils, milk, high fiber breads and
cereals, gels, commercial sports foods. Next, eat a big dose of the
suspected food and observe changes in bowel movements. If you stop
having diarrhea when you cut out bran cereal, but have a worrisome
situation when you eat an extra-large portion, the answer becomes
obvious: eat less bran cereal.

4) Learn your personal transit time by eating sesame seeds, corn or
beets--foods that can be seen in feces. Because food moves through most
people's intestines in 1 to 3 days, the trigger may be a food you ate a
few days ago.

5) Stay well hydrated. GI complaints are common in runners who have lost
more than 4% of their body weight in sweat. (That's 6 lb. for a 150 lb.
athlete.) Runners may think they got diarrhea because of the sports
drink they consumed, but the diarrhea might have been related to

6) When all else fails, you might want to consult with your doctor about
timely use of anti-diarrhea medicine, such as Imodium. Perhaps that will
be your saving grace.

The Bottom Line
You are not alone with your concerns. Yet, your body is unique and you
need to experiment with different food and exercise patterns to find a
solution that brings peacefulness to your exercise program.


Nancy Clark MS RD CSSD (Board Certified Specialist in Sports Dietetics)
counsels both casual and competitive athletes in her practice at
Healthworks, the premier fitness center in Chestnut Hill MA
(617-383-6100). Her Sports Nutrition Guidebook and food guides for new
runners, marathoners, cyclists and soccer players are available at
www.nancyclarkrd.com. See also sportsnutritionworkshop.com.

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