By now, you’ve maybe read from my introduction that I live with Crohn’s disease. My goal today is to shed some light on what exactly this disease entails, how it affects me and other runners who live with it, and what it means for our running routines.
What is Crohn’s Disease?
Crohn’s disease is among a group of diseases called Inflammatory Bowel Disease (IBD). Crohn’s disease can affect any part of the gastrointestinal (GI) tract. The GI tract includes the mouth, esophagus, stomach, small intestine, and large intestine (or colon), rectum, and anus. The exact cause of the disease is unknown, but it is believed to be a combination of a malfunctioning immune system, genetics, and environmental factors. It can be aggravated by stress and diet, but these have not been found to cause inflammatory bowel disease. 
The GI tract contains harmless bacteria that can aid in digestion. Foreign invaders, like bacteria, viruses, fungi, and other microorganisms, are attacked and killed by the immune system. The harmless bacteria in the intestines are typically protected from attack by the immune system. In people with IBD, these bacteria are mistaken for harmful invaders. The immune system responds with cells traveling out of the blood to the intestines to produce an inflammatory response.  Inflammation is a normal response of the immune system, but in the case of a person with IBD, the inflammation does not subside. This leads to chronic inflammation that creates ulcers and thickening in the intestinal walls. This leads to the symptoms that define inflammatory bowel disease. 
Crohn’s disease, like other inflammatory bowel diseases, has periods of active inflammation and periods where there is little to no disease activity. This time period is also referred to as remission. When the disease is active, typical symptoms include: persistent diarrhea, blood in stool, urgency to move bowels, abdominal bloating, cramping, and pain, constipation, nausea, reduced appetite and weight loss.  Other general symptoms can include fever, fatigue, night sweats, and loss of menstrual cycle. People with severe disease can also have inflammation of the eye, skin, liver, bile ducts, or joints. 
Running with Crohn’s
All of these things make it sound like running could be pretty difficult, right? During active flares of the disease, it really can be. I once told a friend of mine that in every race I run, I like to play a mental game called “Is today going to be the day I poop my pants in public?”
Many healthy runners have also experienced the dreaded “runner’s trots.” In healthy athletes, higher intensity exercise has been found to produce GI symptoms and disturbances. The urge to defecate is a common GI disturbance during exercise. There is a decrease in colonic phasic activity, offering less resistance to colonic flow and decreased transit time, leading to this urge to defecate. This is a highly undesirable side effect for someone with IBD who is diarrhea-prone. 
For those with moderate to severe Crohn’s symptoms, exercise may even be discouraged due to physical restrictions, inconvenience, and discomfort. For those in a remission state, studies have shown that low to moderate intensity exercise is well tolerated. Although there are limited studies on the effects of exercise on inflammatory bowel disease, there have been promising results from a study on athletes participating in high intensity activities in which there was no change in certain inflammation markers after these activities.
Barberry’s Rules for running with Crohn’s Disease
So how do we make it work? Well, here are some general rules I have found out for myself and have learned from some of my fellow Crohnies. They are by no means hard and fast rules to live by; each person with IBD has a unique experience and perspective on what works for them!
- Take your medications! Or take whatever it is that keeps your system calmed down! There is no cure for Crohn’s disease, but medications have been shown to help induce remission and to help those who are in remission stay that way.
- Always be aware of the bathroom situation. I usually make sure I have gone to the bathroom at least twice before I start my runs (especially long runs), but this does not mean I
can always avoid a mid-run pit stop. Because of this, I have plotted my course around where bathrooms are along my running path, be they in public parks, public buildings, etc.Living in the suburbs, there typically are not any restaurants or businesses that will stop you from using their facilities if you ask. I have a few places I know that I can use if the park bathrooms happen to be closed for the winter. This is not always the case if I am doing a run in downtown Indianapolis and this is something I have to keep in mind. I try not to have more than a mile between bathroom stops, and if all else fails, I know a few secluded spots where I can have some privacy. Take some durable wipes or paper towels with you if you have concerns about distance between bathrooms. It may also help to have a route designed that keeps you close to home. There are also always those special friends or family members who let you have access to their bathrooms even if they aren’t home. They are angels on earth.
- Watch what you eat in the days leading up to a race. Although every person’s clinical presentation and tolerances are different, it is usually best not to eat anything high in fiber leading up to a race. This is typically a good recommendation for anyone leading up to a goal race, but especially important if you have IBD! High sugar foods, raw foods, high fat foods, and spicy foods can also cause issues for those with IBD. (Appropriate) Carb loading for the win!
- Practice on-the-run nutrition and hydration. A race is never a good time to try anything new nutrition-wise, especially if you have digestive issues. It is important to figure out what brands of food/energy supplements can work while on the run.For example, prior to my diagnosis, I always used energy gels that were made of simple sugars and had no issues with them. I made the mistake of using the same gels during my first half marathon after remission of symptoms without trying them out before the race, assuming I would be just fine. I spent the next hour after the race trying really hard not to throw up on a friend of mine and his mom. I’ve had to get picky about my fueling options during my runs and races and tend to use gels and waffles that are organic with more natural sugars.
- Figure out your routine/running timing. I know that I typically feel best running in the morning. There is very little in my digestive tract at that time and I have the most energy. My energy drains and fatigue worsens as my day goes by. I try to do as much as I can in the mornings before crashing! Again, this is different for everybody with autoimmune issues.
- Be flexible! There are good days and bad days with this disease. Having a rigid plan can often be a stressor. Be willing to move runs around, slow down paces, and know when to bag it up and head home. Be kind to yourself and readjust the day’s running goal if needed. Do what you can and listen to your body! Having a great support team can also be beneficial to help you see the big picture rather than focusing on a few bad runs.
So to sum it up, we aren’t much different from runners with superior digestive tracts! We are just super aware of where the bathrooms are located and are generally a lot more comfortable talking about bowel movements. Living with IBD has its own set of challenges, with every person presenting with their own unique characteristics. Running gives us an opportunity to take control of our days and not let this disease define us.
Any other runners on here with digestive issues? What are your go-to running tips and tricks?
- Crohn’s and Colitis Foundation. “Crohn’s & Colitis.” Crohn’s | Colitis | IBD | Crohn’s & Colitis Foundation, Crohn’s and Colitis Foundation, 2015, www.crohnscolitisfoundation.org/?referrer=http%3A%2F%2Fwww.crohnscolitisfoundation.org%2Fwhat-are-crohns-and-colitis%2Fwhat-is-crohns-disease%2F%3F.
- Mayo Clinic Staff. “Crohn’s disease.” Mayo Clinic. 2018. https://www.mayoclinic.org/diseases-conditions/crohns-disease/symptoms-causes/syc-20353304
- Ng, V., Millard, W., Lebrun, C., & Howard, J. (2006). Exercise and Crohn’s disease: Speculations on potential benefits. Canadian Journal of Gastroenterology, 20(10), 657–660.