Do you or a runner you know suffer from inflammatory bowel disease? It’s likely, considering about 3.1 million adults in the United States suffer from inflammatory bowel disease, or IBD, according to the Centers for Disease Control and Prevention.

We talked to Sophie M. Balzora, M.D., gastroenterologist at NYU Langhorne Health, to learn more about IBD, including how it affects runners and what sufferers can do to ease symptoms.

What is IBD?

IBD is an immune mediated digestive disease, meaning it’s caused by abnormal immune system activity, Dr. Balzora explains. Unlike another common digestive issue, IBS (or irritable bowel syndrome), IBD is characterized by inflammation throughout the intestines.

There are two main subtypes of IBD: Crohn’s disease and ulcerative colitis.

Ulcerative colitis is inflammation throughout the colon that typically starts in the rectum and moves upward toward the small intestine. Crohn’s disease differs, as it can affect anywhere in the digestive tract, from the mouth to the a***, including the esophagus or even the stomach.

On top of inflammation, Crohn’s can also cause fistula, which are abnormal abscesses connecting two organs normally not connected. For instance, a hole could form between the bladder and the uterus, creating additional complications for runners if untreated, such as loss of bladder control.

These cases are rare in the United States and only 50,000 to 100,000 occur worldwide every year, according to the World Health Organization. Once a fistula is discovered, it can usually be sealed or plugged with collagen or medical adhesive.

Another side effect of Crohn’s is fibrostenotic strictures, where areas of the digestive tract become scarred and blocked. Studies have found that this can occur in 30 percent of Crohn’s patients, causing pain, cramping, nausea, and vomiting—which make it very hard to exercise comfortably. There is no complete treatment known besides providing anti-inflammatory medication.

As for what causes IBD, Dr. Balzora says the medical world isn’t sure: “That’s the million-dollar question, right? These things are multifactorial—part of it is genetics, and maybe some of it is environmental.”

How is IBD diagnosed?

Anyone from the young to the elderly can receive an IBD diagnosis, but severity of symptoms depends more on each individual case rather than age.

Generally, people who are diagnosed with IBD experience bloating, diarrhea, abdominal pain, unintentional weight loss, and fatigue. However, it can sometimes affect other parts of the body—patients can experience eye pain, athritis symptoms in joints, or painful bumps on the skin.

To get a diagnosis, patients will see a gastroenterologist like Dr. Balzora. She first listens to the patient’s story to get a sense of their symptoms. Then, she’ll call for a colonoscopy.

If Dr. Balzora finds there might be a fistula or fibrostenotic strictures, she’ll recommend a CAT scan, an MRI, and bloodwork. If she confirms that the patient has one of these side affects, she refers them to a rheumatologist (doctors who specializes in arthritis and other bone, muscle, and joint disease) or a dermatologist (doctors specializing in skin conditions).

How is IBD treated?

While there is no definitive cure to IBD, there are steps patients can take to manage the disease. Depending on the severity of the case, Dr. Balzora will prescribe medication or call for surgery.

Dr. Balzora may prescribe oral medications, such as anti-inflammatories, steroids, immunosuppressants, or antibiotics. Anti-inflammatories and steroids mitigate the pain and irritation caused by IBD; immunosuppressants calm the immune system’s response that creates inflammation and swelling; antibiotics prevent infections. Patients might need one or a combination of these three medications in order to control symptoms.

If those drugs aren’t effective enough, a patient might be prescribed biologics, given via injection or IV drip, which puts living organisms into the body to block either proteins or white blood cells that cause gut inflammation.

Finally, if all else fails, Dr. Balzora calls for surgery.

To treat severe ulcerative colitis, patients may have their colon and rectum removed. An artificial pouch is placed internally for bowel movements. However, when in some cases a pouch cannot be inserted inside the body, patients use an external ostomy bag.

An ostomy is a small, waterproof pouch that's attached to an opening in the body (called a stoma) to collect the bodily waste that would normally pass through the urinary tract or a***. Instead of using the toilet to relieve themselves, their waste goes into the bag, and they empty it.

Crohn’s disease is often more difficult to manage. Nearly two-thirds of Crohn’s patients require at least one surgery, and most of the time the benefits are temporary. In severe cases, doctors remove the affected part of the patient's digestive tract and reconnect the healthy parts. Unfortunately, sometimes the disease can return and the procedure repeated.

The good news: Most IBD patients react well to medications and go into remission from their symptoms, allowing them the freedom to run and exercise as they wish—just remaining mindful of their symptoms and listening to their bodies.

How does IBD affect running?

Thanks to treatment, many people with IBD don’t have to worry too much about their affliction affecting their day-to-day life. It depends on if they’re in remission, which is defined as having normal bowel movements—that means no blood in their stool, no abdominal pain, and maintaining a consistent weight.

Once patients are in remission, Dr. Balzora wouldn’t put any restrictions on running. “There are a lot of people that have inflammatory bowel disease, are on medications, and we don’t even know it,” she says. “They can run, they can go to work, they can go to school—all those things.”

Even if a patient isn't in remission, they can still enjoy moderate exercise like running or yoga. Dr. Balzora recommends staying away from more intense exercise like speedwork, which can exacerbate symptoms such as abdominal pain and diarrhea. But otherwise, patients can feel free to run.

Those who have had surgery might have to run with an ostomy bag. “Everybody’s normals are different,” says Dr. Balzora, referring to the stigma that might come with an ostomy bag. She says that it’s totally fine to run with a bag, as long as patients stay hydrated and are mindful of their symptoms in order to avoid flareups.

“We tell patients to watch out for‘runner’s trots,’” says Dr. Balzora, referring to the strong urge to poop during or right after running, “which everyone can suffer from, whether they have IBD or not.”

For more guidelines on exercising with IBD, the Crohn's & Colitis Foundation, a non-profit that raises funds for IBD research, offers the following advice:

• Talk to your doctor about what exercises might best benefit you and your fitness level—a physician can help you tailor a program to your individual needs. That’s especially important if you had a recent surgery.

• For those running or exercising outdoors, plan ahead by finding places to stop for a bathroom break if you need it.

• Stay hydrated, drinking plenty of water as you go.

• An exercise routine and a healthy diet can benefit those with IBD, as they can help you avoid complications. Your medical team should discuss how exercise can benefit you and your disease and body.

• Talk with a dietician to make sure you’re eating enough, especially to fuel your exercise routine.

The bottom line when it comes to exercising with IBD: Do what feels right to you, listening to your body, making sure to take breaks or rest days when you need them, and working with your medical team to come up with the best plan for you.

Do runners with IBD have to be mindful of their diets?

Everyone’s situation is different, and therefore there is no one-size-fits-all solution to diet.

“Right now, there isn’t compelling data to tell us that there are any food regiments that will actually decrease the inflammation that is present in patients with inflammatory bowel disease,” Dr. Balzora says. However, she does recommend a few general guidelines for runners with IBD to ease their symptoms.

For starters, avoiding caffeine can help with symptoms, as this stimulant can make some people run to the bathroom. Dairy products are also often disagreeable with patients, so it’s good to keep consumption to a minimum. Same goes with alcohol. But above all, Dr. Balzora stresses that her patients drink plenty of water and keep a food diary to learn what triggers their specific case of IBD, as every IBD patient can have certain foods that make their symptoms act up.

In general, runners with IBD shouldn’t worry too much about their disease affecting their running, as long as they’re getting the right treatment and keeping symptoms in check.

“Don’t let IBD take away the joy of running,” Dr. Balzora says. “It’s just a matter of approaching it a little differently and a little bit more intentionally in terms of what you’re putting in your body and in terms of what medications can do for you.”

The post Here's What Runners Need to Know About IBD appeared first on Runner's World