The day he ran the Walt Disney World Marathon, Todd Snider’s alarm went off at 1:30 a.m. Groggy, he dragged himself to the hotel bathroom, where he more or less remained on the toilet for the next two hours. Only then was he ready to do what other racers were just rising to do: things like eat bananas, drink electrolyte-rich fluids, lace up shoes and head to the start line. Needless to say, “it made for a long day,” says Snider, a 48-year-old elementary school teacher in Eatonton, Georgia.
Snider has ulcerative colitis, a chronic autoimmune disease that causes inflammation and subsequent sores or ulcers in the lining of the colon (also known as the large intestine). The condition is an inflammatory bowel disease and can cause stomach pain, bleeding and frequent, urgent bowel movements. While UC is limited to the colon, the other main inflammatory bowel disease, Crohn’s disease, can involve inflammation in any part of the gastrointestinal tract and result in similar symptoms — stomach cramps and pain, urgent and frequent diarrhea, rectal bleeding and fatigue.
While the conditions can be managed with medications, lifestyle modifications and in some cases surgery, there is no cure and the symptoms often set in and dissipate in unanticipated waves. As a result, people with IBD tend to adjust their daily lives and even careers to account for bathroom proximity. One study even showed that about a quarter of employed people with IBD were on sick leave and almost as many received a disability pension. Nearly 80 percent said their condition contributed to a “low working pace.” In other words, the disease affects patients’ social, mental and physical well-being, says Katie Taylor, an assistant professor of exercise science at Eastern Washington University in Cheney, Washington, who studies physical activity in people with inflammatory bowel diseases.
It can also affect their willingness to exercise: Research suggests about one-third of people exercise less after an IBD diagnosis. People with IBD may be particularly reluctant to take up running, a sport known to trigger digestive issues, aka “runner’s trots,” even in runners with the healthiest of GI tracts, thanks to its repetitive, pounding motion. “Certain types of physical activity can really have more of a negative impact on the gut itself,” Taylor says.
But exercise in general, and especially light-to-moderate activity, seems to be helpful for weight management, mood, osteoporosis risk and symptom management in people with IBD. Now, Taylor’s research is looking at how higher-intensity exercise including running stacks up against less intense exercise like walking, which is less likely to jostle the bowels. In one study last year, she and colleagues found that, as with walking, moderate-to-vigorous exercise is related to better quality of life, especially if it’s done more than 150 minutes a week, in people with IBD. “Physical activity can act as a great coping strategy,” she says. “It’s something they feel they can do that they’re in control of.”
For Snider, running with colitis isn’t a burden, it’s “freedom,” he says. “UC can take a day or two away from me from time to time,” he says, “but on the days I’m not in a flare, I want to do whatever anyone else is doing — and I can.” He and others share their tips on lacing up if you have IBD:
Dewey Thom was diagnosed with ulcerative colitis at age 14 and didn’t run until about age 40. The turning point came when the investor and retired stock broker in San Francisco saw a Crohn’s & Colitis Foundation brochure advertising its “Team Challenge” program, which promised to provide patients like him the coaching and support to complete a half-marathon in exchange for fundraising. “In my mind, it was like, ‘All right, I’m going to get to the start line, cross the finish line, raise the money and follow through on what I said I was going to do … and be done (with running),” he remembers.
That didn’t happen. Since then, Thom estimates he’s completed about 30 half-marathons and has finished two marathons — almost all with and because of Team Challenge. “In that environment, you’re automatically supported by definition,” he says. “You don’t have to do it on your own.”
Outside of Team Challenge, there are Facebook and other online communities for runners with IBD, Snider says. “They are friendly, helpful and care about you.” Plus, even non-IBD specific running groups tend to be sympathetic to bowel issues. “If you have to go to the bathroom in the woods, go to the bathroom in the woods and catch up in the next mile,” says Earl Walton, global director for training and coaching at Ironman, about triathletes’ and runners’ mentality. “A lot of those barriers come down.”
Work with pros, if possible.
Working with a coach or trainer can be especially helpful for people with chronic diseases — if you feel comfortable telling him or her all about your disease, medications (if any), diet and IBD-induced challenges. It’s important to connect that person with your doctor, too. “That’s what coaches are there for: They don’t want to just tell you to run faster, they want to help you solve a problem,” Walton says. “Whether your challenge is IBD or a prosthetic leg, we’re going to work with you to get results as much as we can.”
For example, he may help runners with IBD develop a less-jarring running stride, adjust a running route to be closer to bathrooms or experiment with their nutrition. What you don’t want to do, Walton says, is avoid eating or drinking prior to a long workout in an attempt to avoid a flare mid-workout. “That’s not sustainable,” he says.
When possible, Snider runs in the afternoons when he’s typically emptied his bowels enough to exercise most comfortably. On race days, he rises earlier than most and packs wipes. “I’ve jumped in the bushes a handful of times and am so thankful I run prepared,” says Snider, who’s on a prescription non-steroidal anti-inflammatory drug that pretty effectively prevents flares and makes his bathroom schedule relatively predictable. “I don’t see it as coping, I guess, but just my normal life.”
For Thom — who has a “J-pouch,” or an internal reservoir for stool surgically created from the small bowel, since his colon was removed — needing to go on the run isn’t typically a problem. “What running does sometimes for me is it allows me not to focus on the bathroom,” he says. His challenges, however, are overcoming IBD-related fatigue in order to train, and staying hydrated enough. Because he doesn’t have a colon, which absorbs water, dehydration is a particularly real threat that’s led to race-halting cramps in the past.
No matter what your IBD-related barriers to running are, identifying them and preparing accordingly is critical. For instance, if you’re someone who does need to use the bathroom hourly (or even more frequently), run in a loop by a bathroom or on a treadmill at gym with a bathroom you feel comfortable in, Walton says. “A lot of the challenge of an endurance sport is the discipline that you’re instilling in your schedule and life to achieve a goal, and it carries over into this type of situation as well,” Walton says.
Keep at it.
Like IBD itself, your relationship with running and exercise in general will have its ups and downs. “There will be a little bit of trial and error, but don’t get disheartened,” Taylor says. If you decide running isn’t for you, try something less intense before building up to a higher intensity again, she suggests. “Cycling is phenomenal exercise because you remove that mechanical stress,” she says. Walking is a great option too, especially if you can do it with friends who will hold you accountable. But really, any type of movement you enjoy will pay off not just in IBD management, but also mental health, disease prevention and longevity.
The point is to keep moving in spite of your condition. As Thom tells other people with IBD interested in joining Team Challenge, but who are worried that they can’t complete a long race, “I know you can, the question is, do you think you can? If you think you can, you can. … It’s a function of being willing to try.”
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