Running with Crohn’s: Diarrhea!

Running with Crohn’s: Diarrhea!

As the title implies, this entry deals with biological functions that some will find extremely distasteful. Proceed with caution!

The symptoms of Crohn’s Disease that affect my running are small bowel obstructions, diarrhea, severe intestinal cramping, and anemia.  I also suffer from things like kidney stones & fistulas that interrupt my training.  In this entry, I will discuss how I deal with diarrhea (and to a lesser extent intestinal cramping).

Perhaps the trickiest but definitely the most embarrassing issue that Inflammatory Bowel Disease (Crohn’s and Colitis) and Irritable Bowel Syndrome (IBS) suffers must face is diarrhea.  When you are also a distance runner, this moves from the realm of embarrassment into the realm of severe logistical problem.  Over the two years I have been doing distance running, I developed multiple strategies for dealing with this problem that is so common among IBD & IBS patients.

My first strategy involves eating or more accurately NOT eating before a run.  I do not know when my diarrhea will strike but, after 25 years of dealing with Crohn’s Disease, I do know roughly ½ of my bouts of diarrhea (and cramping) happen within an hour or so of eating.  So now I never eat more than a food bar prior to running.  If this means waiting to eat dinner until 8 or 9 pm in the evening so that I can run first, that is what I do.  For some runs, I have had to go 8 – 10 hours without food to ensure that I do not trigger a bout of diarrhea and/or cramping before an important run.  When I am able to run on an empty stomach in the morning, I have found that this works really well.  When I eat energy bars or gels during a run, I only nibble the food to ensure that it does not trigger my digestive system’s massive overreaction.

CAUTION: I am not a medical professional.  Please ask your doctor about using these medications and if (s)he disagrees with my methods, then follow your doctor’s advice!

My next strategy includes using the over the counter medication Imodium.  Please discuss this option with your doctor(s) prior to using it.  My doctor limited me to eight pills per day but allowed me to take them as I deem best for dealing with my diarrhea.  On a side note, it seems to me that my system develops tolerance to this drug, meaning the more that I use it, the less effective it is.  To help with this tolerance, I will often stop taking Imodium when I can spend time at home close to a bathroom.  If I do not take these medication holidays, then I end up taking eight Imodium per day with only marginal effect.  When I do take medication holidays, I often find that only taking two Imodium per day provides a lot more control.  Prior to runs lasting more than 30 minutes, I take 1-2 Imodium.  This helps with both diarrhea and cramping. It does NOT prevent me from experiencing cramping and diarrhea during a run but it significantly reduces the chances of having these problems during my run.  I also bring Imodium with me in a Ziploc baggy (to keep it from dissolving in my sweat).  If I begin to suffer from diarrhea during the run, I immediately take another pill. If I suffer diarrhea urges again after waiting for 20 minutes, then I take another Imodium.  I have never had to take more than three pills during a run.

Check with your doctor on these drugs:

Some other drugs that may be useful include the any cramping drugs Levsin (Hyoscyamine) and Bentyl (Dicyclomine).  These prescription medications usually eliminate intestinal cramping for me but they also help to reduce the frequency of diarrhea.  Although Imodium works better, these help me.

Another prescription drug that has helped me in the past is Questran powder (cholestyrarmine).  This is normally prescribe for high cholesterol, however, one side-effect is that it helps firm up your stool.  It is especially helpful if you suffer from short-bowel syndrome and/or had your terminal ileum removed.  The powder binds bile and bile in the colon irritates the colon and causes diarrhea.  After my small bowel resection I needed to use Questran powder for a number of years before my colon began to tolerate bile.  Eventually, I weaned myself off of it.

My third strategy is to ensure that my route includes restrooms.  The trails I use to train near my home have port-a-johns and my fitness center has rest rooms.  In addition, for races longer than 5k, I look for races that include facilities at frequent intervals.  To help with ensuring I am “close” to restroom facilities, I use a “figure 8” running route.  This involves:

Leg 1:    Run ¼ of the distance away from the start point (which has the restroom facility)

Leg 2:    Run ¼ of the distance back to the start point

Leg 3:    Run ¼ distance away from the start point in the other direction

Leg4:     Run the final leg ¼ of the distance back to the start point.

The training course I use ensures I am never more than about 15 minutes from restroom facilities during any of my runs, up to and including a full marathon.  Using this strategy, I occasionally struggle with diarrhea urges during a run but I so far I have been able to overcome the urge to go until I had the opportunity to get to the available facilities.

This last bit is advice and not a strategy for dealing with diarrhea.  The company that makes PreparationH (Pfizer), a rectal cream/ointment for dealing with hemorrhoids and other rectal issues, also makes a product called “PreparationH Wipes.”  In concept, these wipes are similar to the infant wipes that parents use to clean the bums of their kids.  However, PreparationH Wipes are flushable (unlike infant wipes).  They also include both aloe and witch hazel which are both very soothing on your nether regions, especially when they are inflamed from constant diarrhea.  I highly recommend that everyone who suffers diarrhea for any reason use this product.  I personally buy & use Walmart’s generic version of these wipes (they are much less expensive but every bit as effective.  In fact, I now use them every time that I use the restroom.  When I go on runs, I always bring a small Ziploc baggy filled with these wipes.  I use them for my personal hygiene so I never have to use the coarse, sand paper like toilet paper available in port-a-johns (I also bring them when I'm going to be away from home so that I can use them when I use public restrooms).  It also means that I never have to worry about the port-a-john running out of the toilet paper!  One final blessing is that these wipes possess a high concentration of alcohol, so in a pinch you can use them as a hand sanitizer if that runs out too.