Exercise and Reflux

[lsgs]

I am being driven MAD by reflux (in general but especially when exercising)

Has anyone experienced this, or has anyone found a solution?

I'm strongly considering going to my GP to see if they have any suggestions. I'm trying to lose my pred weight and everytime I go for a cycle I end up panicking thinking I'm going to be sick. I already take omeprazole but I have read people with my autoimmune disease have a weak pyloric sphincter...

Unfortunately my consultants seem spectacularly uninterested in this but it is driving me nuts!!

Cheers.

 

[nogutsnoglory]

Exercise can absolutely trigger it aggravate reflux. WebMD has some good tips to help those with the issue who still want to incorporate fitness into their routine.

http://www.m.webmd.com/heartburn-gerd/features/6-tips-ease-exercise-heartburn

 

[Cat-a-Tonic]

lsgs, YES! Me me me, I work out all the time and I have severe GERD, and my reflux is at its worst when I'm in the gym. Here is what I've found works for me:

1. Eat nothing & drink NOTHING but water for at least 1-2 hours before & during exercising. Personally I cannot even drink Gatorade before/during a workout or I will get so nauseous that I cannot continue. Seriously, only water in your stomach, nothing else.

2. Medicate as needed. I take a 40 mg Nexium first thing every morning, whether I'm going to exercise or not. About 20-30 mins before a workout, I'll take a 300 mg Zantac (ranitidine) followed by 8 to 10 Tums. Your medication needs may vary - when I first started working out, I only needed 5 or 6 Tums and no Zantac before hitting the gym. My medication needs have risen over time.

3. The more you use your abdominal muscles, the more you'll reflux. I've been in a flare for the past couple months, and my GI advised me to go easy on my abdominal muscles. So I've been purposely not working those muscles much, and as a result I find I'm refluxing a bit less.

4. Keep yourself upright. A typical workout for me involves 10ish minutes of cardio to warm up, then weight lifting, then stretching and cool-down. When I stretch, I sometimes have to lie on my back or bend over forward to do certain stretches, and I find my reflux is MUCH worse if I'm not upright. I think the not being upright thing is worse if you have a hiatal hernia, which I do.

5. I see you're on Omeprazole - what dose? I was on 20 mg Omeprazole for awhile, and at first it worked great. Then, over time, not so much. So then I went up to 40 mg Omeprazole, and at first that also worked great, and also over time lost efficacy. Now I'm on Nexium 40 mg, and so far so good I think. Sometimes these things lose power over time and an increase in dose or a med switch is in order. Something to ask your doctor about for sure.

6. If you're working out and feel really refluxy (for lack of a better word!), stop for a few minutes, stand upright, and drink some water. It should settle and you'll be able to continue once it settles back down.

I hope that helps. I've been working out regularly for 2+ years now with terrible reflux so those are the things that I've learned - but like I said, that's just my experience, yours may vary. Good luck!

 

[Axelfl3333]

I tae lanzoprazole on prescription from my gp it works a treat

 

[ezekiel67]

I also suffer from reflux, at times the symptoms are worse than my UC. I've had a number of tests done (endoscope, xray, ultrasound) to try find the cause but so far everything looks normal. The doctors are still scratching their heads but they don't seem terribly concerned, their only solution is to keep dishing out the Omeprazole.

In terms of exercise, anything that puts a lot of strain or pressure on my core/chest triggles my reflux. Unfortunately that means no core work and only light leg press, squats and chest work. I find cycling is better than running when it comes to cardio.

Eating also helps me, if I'm hungry or haven't eaten enough I find my reflux reminds me to.

Odd I know.

 

[UnXmas]

I get horrible reflux. The heartburn I get can be so painful sometimes - whenever I look up web pages from medical sites on heartburn, the way they portray the pain doesn't come close to capturing how unbearable the pain I feel is. I have such classic symptoms that I'm sure that's what I have, and when I had an endoscopy they could tell I had really bad reflux because of how inflamed my stomach and oesophagus were, but despite being sure of the diagnosis I've never heard of it making you feel as if your stomach is literally burning like mine does. I get the reflux also, my food comes back up and I can taste it and it's gross.

I don't do any strenuous exercise so I'm not sure if that would trigger it for me, but what I do find (and sorry for the Too Much Information) is that when I go to the loo straining to go brings on reflux and sometimes it makes it impossible because I can't go without straining but every time I start to strain the pain from the reflux gets unbearable or I feel like I'm going to be sick just like you described. I guess this is what Cat's GI was talking about with the abdominal muscles. (That's really interesting btw Cat - I've never even mentioned the problems I have going to the loo with reflux to a doctor, it just seemed so weird that I couldn't imagine anyone else having this problem, but reading what you wrote about the abdominal muscles made me think perhaps I'm not so strange as I thought and that there is a real physical explanation!)

No medications seem to help me at all, although prednisone made it worse after I'd been on it a while, so you might like to check your meds and see if you can change any that have reflux as a side effect. What time of day do you exercise? My reflux gets worse and worse as the day goes on, and I believe this is quite common. So if you're not already, you might try exercising first thing in the morning, maybe before you eat breakfast? Also drinking milk helps me, and again I've heard this does help with many people's reflux.

That's all I've got I'm afraid!

 

[Cat-a-Tonic]

UnXmas, the weird thing is, my GI actually had told me to stop using my abdominal muscles for a different reason - because I had started passing blood after doing intense abdominal workouts, particularly bicycling. I had been riding the stationary bike all winter to build up my leg muscles and my stamina, and that went fine, no bleeding nor reflux issues. But when springtime came along and I started riding my regular bike, it apparently required too much from my abdomen - it had to be flexed and tense all the time for me to be balanced and steer and all that stuff, and as a result I started feeling awful and passing blood (although I'm not sure exactly why that caused me to pass blood!). So my GI said, no more bike rides and don't do anything with your ab muscles in general if you can help it. As long as I follow his advice, I don't pass blood and my reflux is also much more tolerable. So it was basically just an interesting benefit that my reflux eased, I was mostly just trying not to bleed out my butt anymore.

UnX, my reflux sounds a lot different from yours though - I very rarely get actual heartburn. I reflux all the time, I can feel water/stomach contents come up my throat and sometimes into my mouth, but it almost never feels burning or acidy or painful. It makes me nauseous like crazy sometimes, on occassion I wake up refluxing so much that I have to run and grab a puke bucket. And like I said, it can get bad when I work out - sometimes I just have to stop what I'm doing, breathe, drink water, and try to talk myself out of puking. So far so good, I haven't actually vomited in the gym yet (knock on wood) but I've come really close numerous times.

UnX and lsgs, have either of you had reflux-specific testing done? I had a test done about a year ago, called pH impedance. Basically, they stick an NG tube in you for 24 hours, and it's attached to a little computer thing that records how much you're refluxing, how acidic the reflux is, how high in your esophagus the refluxate comes up, etc. It was very illuminating for me, I found out my reflux was far worse than I thought it was. I'm going by memory, but I believe it recorded 48 separate reflux incidents for me in 24 hours, with roughly half of those episodes reaching the top of my throat, and the longest single episode of reflux was over 5 hours! And the results also said I reflux the majority of the time when I'm lying down too which would explain the episodes of waking up suddenly with awful reflux/nausea. With this test, they give you a score on how bad your reflux is, saying what percent you are over normal. So 0% would be totally normal, no reflux, and 100% above normal would be like the worst reflux ever. I scored a 95% above normal! That got my GI to take my reflux complaints a lot more seriously, he knew I had complained about refluxing but he didn't realize it was so bad until I had that test (I really didn't realize it was quite that bad myself either). Just a thought for you guys, it might be worthwhile to ask about that test if you haven't already had it.

 

[UnXmas]

No, I've never had any testing done other than the endoscopy. It is odd that your symptoms are so different, Cat. I don't get nausea, I feel like I'm going to be sick because the acid and food is literally coming up into my mouth, but it's not the same as vomit or the nauseous feeling that you get before vomiting. The reflux and heartburn pain don't always come at the same time for me either - I can reflux without pain and can get awful burning pain when I'm not refluxing.

That's odd the symptoms you got from exercising - bleeding as a result of exercise doesn't sound right at all! Was your doctor concerned about it?

lsgs, I hope your doctor does find some way to help you. I have a hard time getting any doctor to take much interest in it. I don't think doctors consider reflux or heartburn particularly serious symptoms, though I once had a GP tell me I should take the medication even if it doesn't help with symptoms because it can reduce a slight cancer risk that comes from having parts of your GI tract constantly inflamed.

The only time my reflux has been seen as a serious problem by doctors is when I have surgery. Apparently if stomach contents comes up when you're under anaesthetic it can be dangerous if you choke on it or it gets in your lungs. The anaesthetist always has me take a ton of reflux meds on the night before and morning of surgery to avoid problems with the anaesthetic and I guess it works as I've never had a complication. But I've tried taking the same meds at the same dose outside of hospital just to try to reduce symptoms and I haven't noticed a difference. Waking up at night with reflux/heartburn is common because when you're laid down it's easier for stuff to come back up from your stomach, and I've definitely found this, so I can see why it would be a problem when you're anaesthetised.

Does anyone find the reflux/heartburn interferes with eating? The reflux puts me off eating because it's so gross, but the pain stops me eating altogether when it's bad. It feels like everything I swallow gets stuck in my chest and burns so much I can't eat and have to wait for it to pass (which can take hours). But my doctor says no one loses weight from heartburn.

 

[Cat-a-Tonic]

UnXmas, no, I find that eating usually makes my reflux better (as long as I'm not in the gym at the time, of course). It's when my stomach is empty that the acid starts to boil up too much without anything to digest or dilute it - drinking water or eating something usually calms that down.

With what you said about feeling like stuff gets stuck in your chest, that makes me wonder if your esophageal motility might not be working right. There's another test (I haven't had this one yet myself), I believe it's called esophageal manometry, and that can test the motility of your esophagus. My GI mentioned that test to me once, because if I do decide to get my hiatal hernia surgically repaired, I would need the manometry test first to make sure I'm a good surgical candidate (apparently if your esophageal motility is not normal, the hiatal hernia surgery will actually just make things worse!). I'm not going to have the surgery anytime soon so I haven't had that test yet, but I know a little bit about it, and it sounds like something that might shed some light for you.

Yeah, I have no idea why using my abdominal muscles too much has caused me to start bleeding. My guess is, since I seem to be mildly flaring as of the past couple of months, perhaps using my abs is pushing on the inflammation and somehow causing bleeding that way, but I really don't know. I'm not a bleeder normally so it's been worrying. It's bright red blood, and they've ruled out things like hemorrhoids, fissure, bacterial infection, etc. I see my GI in a week so we're going to discuss it more then, and I'll probably be asking him for a colonoscopy since it's been over 3 years since my last one anyway.

 

[Offramp]

There are better drugs for Reflux out there.. Zantac is over the counter and I used zantac 150 after being recommended by an emergency room doctor but found it lacking.. My GI specialist did a scope of my throat and found evidence of scarring of my esophagus and prescribed Tecta for me and it works well. I don't seem to have it as bad as some of you who cant exercise normally as I don't have any such difficulty. Tecta has basically removed the sensation in my throat of swelling and pain and I can drink wine again!!!. You might want to ask about it...

 

[Cat-a-Tonic]

Offramp, I haven't heard of Tecta, is that a newer medication? I find that Zantac works well for me in conjunction with other meds (Nexium and Tums). Those 3 medications together are a good balance for my reflux, and I went through a lot of reflux med combos before I settled on that one. I can't take too many reflux meds or I find that I don't have the right digestive pH needed to digest my Delzicol (I was passing them in my stool, undigested), so I have to walk a fine line between keeping my reflux in check and being able to break down my other meds.

 

[UnXmas]

I've not hear of Tecta either, but just did a quick google and it looks like it's a PPI, which I've tried other versions of. For surgery I'm given ranitidine (same as Zantac).

With what you said about feeling like stuff gets stuck in your chest, that makes me wonder if your esophageal motility might not be working right. There's another test (I haven't had this one yet myself), I believe it's called esophageal manometry, and that can test the motility of your esophagus. My GI mentioned that test to me once, because if I do decide to get my hiatal hernia surgically repaired, I would need the manometry test first to make sure I'm a good surgical candidate (apparently if your esophageal motility is not normal, the hiatal hernia surgery will actually just make things worse!). I'm not going to have the surgery anytime soon so I haven't had that test yet, but I know a little bit about it, and it sounds like something that might shed some light for you.

Thanks, that's interesting as I do have motility issues through the rest of my digestive tract - I have gastroparesis and my colon was removed because it kept getting impacted. Have you had motility tests done on other parts of your digestive system? I haven't, they worked out the diagnosis by exploratory surgery, and apparently it was so obvious I had dismotility that they've never bothered ordering the proper tests though I know the tests are quite widely available. I never actually choke though, so I'm not sure if there's something more wrong in my oesophagus than reflux.

Yeah, I have no idea why using my abdominal muscles too much has caused me to start bleeding. My guess is, since I seem to be mildly flaring as of the past couple of months, perhaps using my abs is pushing on the inflammation and somehow causing bleeding that way, but I really don't know. I'm not a bleeder normally so it's been worrying. It's bright red blood, and they've ruled out things like hemorrhoids, fissure, bacterial infection, etc. I see my GI in a week so we're going to discuss it more then, and I'll probably be asking him for a colonoscopy since it's been over 3 years since my last one anyway.

That is weird. I've had bright red blood but it's always been from haemorrhoids or slight tears in the skin. I thought you have to have some kind of problem right in the last part of the intestine to cause red blood? There's a test my colorectal surgeon does every appointment - a camera on a very short tube that he uses to look just inside the rectum, like the very first part of a colonoscopy. It's painless and needs no anaesthetic or any kind of prep - he just does it there and then in his office. If you have a long wait for the colonoscopy it might be something you could have in the mean time.

 

[Cat-a-Tonic]

UnXmas, no, I have not had other motility tests done - I did have the pill cam done though, and it exited my stomach and moved through me at a pretty normal pace, so my GI doesn't suspect I have motility issues. But it will be better safe than sorry if I decide to have the hiatal hernia surgery, so I will have my esophageal motility tested if/when I go that route.

As for the blood, yes, bright red usually means it's coming from the rectum or the end part of the colon, but apparently not always. Another person on the forum said she experienced bright red blood in her stool, and it turned out to be coming from her terminal ileum! And since it's been awhile since my last colonoscopy, I figure it's time for another one anyway. I think what you're describing is a flexi sigmoidoscopy? My GI said he could do one of those, but if I'm having a scope shoved up my backside, they may as well do it right and send it all the way to the TI. The flexi-sig might not find the source of the bleeding, and since I seem to be flaring anyway, may as well do a full c-scope and take lots of biopsies and see if I can't get a proper diagnosis already.

 

[UnXmas]

I thought it was a sigmoidoscopy, but when I went to check the Wikipedia page said you need to fast and take laxatives to prepare before having one, and I definitely don't have to do that. I've also had all my colon besides the rectum removed, so I've no idea what the test I have is called! My surgeon just calls it "the-camera-up-the-bum-test"!

It would be good for you to get a diagnosis. I'd noticed your posts on the undiagnosed club thread and thought you were perhaps the only person who's been undiagnosed as long as I was!

 

[Cat-a-Tonic]

UnX, my GI did offer to do a flexi-sig when the bleeding first started, but we agreed that I'd keep an eye on it for awhile, and I think I'm going to ask for a full c-scope just to be thorough. But he did say, when he offered me the flexi-sig, that I wouldn't need to fast nor do prep - I was told they could just do an enema in the office to clean out the latter part of my colon and that would be fine for a flexi-sig. So it sounds to me like prep/fasting is not necessarily needed.

How long were you undiagnosed? (You have a diagnosis now, though, right?) I first became severely ill in Oct 2009, so going on 4 years for me. I have an unofficial diagnosis of IBD, but nothing official and no idea which type of IBD. I was never a bleeder up until this May, so my GI said it's not UC as you tend to bleed with UC. So likely either Crohn's or microscopic colitis. He's treating me generally for IBD, I was on Entocort and did a short couple of runs of pred and was on Asacol and now Delzicol. I had 2 years in remission thanks to those treatments, so I can't complain too much about being in undiagnosed limbo, because at least I'm being taken seriously and receiving treatment for the presumed IBD. But yes, it would be nice to know for sure and to have a name for the monster, and to maybe try something stronger than mesalamine, since it hasn't kept me from flaring up apparently.

 

[UnXmas]

I don't even have an enema before the test, so I'm really not sure.

I started getting sick when I was thirteen years old. I was twenty seven when my neurological, rheumatological (connective tissue disease - they're not sure which type!) and Crohn's disease were diagnosed. My ovaries failed to develop properly, but in 2010 I started getting other hormonal problems and these still haven't been diagnosed, and some of my neurological symptoms don't fit with any of the diagnoses I have.

So maybe I'm partially diagnosed?! I don't know, I've given up caring about diagnoses. I think now that I just have my own unprecedented illness, and even the ones that I do have accurate diagnoses for in my head I usually just refer to it all as "my illness". It's too complicated for me trying to work out which symptoms are from which, especially with my gastroenterological symptoms as besides the IBD I have motility problems and have had rectal prolapses and possibly nerve problems with my rectum.

 

[723crossroads]

I ended up going on protonics which is really expensive, but thankfully my insurance covers most of it. I can say it helped a little. I have always had a very acidic system. When I was a child, I had uclers in my mouth alot and I didn't tolerate acidic food or drinks without having diarrhea. I still wonder if my IBD has gone on for many yrs. I talked to my Gastro about this unending heartburn that will occasionally go away for a few days and then for no reason at all, flare up. He says it is the sphincter muscle and all he could offer was surgery. But he also doesn't recommend it unless it becomes intolerable, because all surgery is a risk. I try to avoid acidic foods and especially orange juice and similar fruits and juices.If I eat spaghetti sauce, it usually kicks everything up too. Diet does seem to play a roll. Hope this helps someone.

 

[Offramp]

There are better drugs for Reflux out there.. Zantac is over the counter and I used zantac 150 after being recommended by an emergency room doctor but found it lacking.. My GI specialist did a scope of my throat and found evidence of scarring of my esophagus and prescribed Tecta for me and it works well. I don't seem to have it as bad as some of you who cant exercise normally as I don't have any such difficulty. Tecta has basically removed the sensation in my throat of swelling and pain and I can drink wine again!!!. You might want to ask about it...

Hi.. From what I was told by my pharmacist zantac takes out 70% of the acid, whereas Tecta addresses over 90% of the acid you get from reflux and usually 1 pill per day does the trick... Tecta is not available over the counter.