Published on 26/11/2011

Many athletes complain of a sharp, colicky pain in the left or the right upper quadrant of the abdomen during strenuous exercise. This is commonly referred to as a stitch.

This may be due to muscle spasm of the diaphragm or trapping of the gas in the liver or spleen flexure of the colon. This condition has often been thought to be associated with exercise undertaken soon after eating a solid meal.

There is no proof of this but avoidance of solid meal prior to exercise may be an appropriate treatment. Occasionally, athletes get cramping type of abdominal pain. This occurs in association with intense, endurance exercise and is thought to occur as a consequence of relative ischemia due to shunting of blood away from the gastrointestinal tract to the exercising muscles.

The effect is aggravated by dehydration. The possibility of abdominal pain being referred from the thoracic spine should always be considered. A thorough examination of the thoracic spine should be performed in any athlete complaining of abdominal pain.

Reduced mobility detected in one or more intervertebral segments should be corrected by manual therapy techniques and the effect on the athletes symptoms noted.

Diarrhoea appear to be the more frequent, with exercise especially with long distance running, as a result, the terms runners trot and runners diarrhoea have been coined to describe the condition.

Athletes may complain of an urge to defecate while running, approximately half of those who experience this urge to defecate actually complain of episodes of diarrhoea during running.

The incidence of runner’s diarrhoea seems to be related to the intensity of the exercise and occurs more commonly in competition than in training. The anxiety associated with competition may be a contributory factor. The exact cause of runner’s diarrhoea is uncertain.

Relative intestinal ischemia described above may be a contributory factor. an increase in intestinal motility may also contribute to the development of diarrhoea.

Studies of the relationship between intestinal transit time and exercise have shown conflicting results but would appear that intestinal motility is increased with intense exercise.

This increase in gut motility and changes in intestinal secretion and absorption may be related to increased level of hormones associated with exercise. When faced with an athlete with diarrhoea, the clinician should also seek a history of vitamin and mineral supplementation or ingestion of caffeine or artificial sweeteners prior to exercise.

Each of these may contribute to runner’s diarrhoea. Acute diarrhoea is usually due to an infective cause and may be viral or bacterial. This is a particular problem when the athletes are travelling away from home.

Treatment of athletes with exercise related diarrhoea involves dietary changes to include reduction of fibre content of the diet 24 hours prior to intense competitive exercise.

Dr Gondi, a medical practitioner, is a member of National Olympic Committee’s Medical Commission and board member of Regional Anti-Doping Organisation.

Tweet