Runner's diarrhea? Help!

[crohnsinct]

Hi everyone. Parent of a 16 year old distance runner with crohns. She was dx'd 4 years ago. Ever since we got her to remission no problems. Last spring she started getting d in her long runs(8-10 miles).

Fall xc season slow runs, fatigue, loose bm's maybe a bit if blood and increase in d on runs (all out accidents in her pants) Even shorter runs (4-5 miles).

Gi pulled fc test. Elevated to 460 but he wasn't concerned. Increased weekly mtx by 2.5 msg

Bm's shaped up but she is still fatigued and now gets d in her pants on short runs. Even as short as a mile sometimes.

We have tried the not eating a few hours before..no difference. Making sure super hydrated...no difference. Today she even went to the bathroom before she left to run and she had her worst attack ever.

Is this just runner's diarrhea? What on earth do you do for it? Or do you crohn's runner's find when the disease is kicking up the runner's diarrhea gets worse?

We are desperate to find a solution for her. Her xc season was in the toilet (pun intended) and now she is in indoor track season and trying to get recruited for college and not able to train and feeling very sad about it.

Any help would be greatly appreciated.

 

[hawkeye]

I have never had it. You may want to post a link to this thread in three fitness section as there are a few runners there. Also you may want to check out some running sites to see if they can provide any insight

 

[crohnsinct]

Thanks! I didn't realize there was a fitness section. Will post there.

We have checked numerous running sites. That is where we learned it could be dehydration, or eating too close etc. But none of the changes they recommend have made a difference for her. We also consulted with a registered dietician and nothing!

 

[hawkeye]

Google "runner's trots" this is what it is commonly called

 

[crohnsinct]

Thanks for the suggestions...

Yep! Did that and still all we get is don't eat up to two hours before running, make sure you are hydrated and low fiber, low fat foods the few days before a run. All things we have tried.

She is on the track team at school so the changing the diet before the run would mean change her diet every day. However, Gi has her on an anti inflammatory diet which is primarily vegetarian with loads of fiber. She has been on this diet for years and not had a problem with runners trots.

GI gave her approval to use Immodium before long runs (8-10 miles). But now it is happening before short runs even.

Think it is time to email GI and let them know what is going on. I just can't believe that people with Crohn's just have to accept that they can't run like everyone else.

 

[crohnsinct]

gi says ok to use Imodium once a day before running and also pull a fecal calprotectin test to see where her numbers are.

 

[Scipio]

For me it helps to hydrate with water instead of anything with carbs in it. Especially not orange or other fruit juices. When you sweat a lot the body rushes replacement water from the stomach and small bowel into the large bowel where much of the water absorption occurs. If the water is rushed in too fast there hasn't been sufficient time for the sugars to be broken down in the small bowel, so sugary water gets dumped into the large bowel. And sugar in the large bowel often results in gas, cramps, and diarrhea.

Sometimes I can get away with sport drinks that contain glucose as the only carb, since it is already in very simple form and thus can be metabolized very quickly. But fruit juices with or sport drinks with slightly more complex sugars such as sucrose metabolize a little slower and thus cause me diarrhea problems when running.

 

[crohnsinct]

Wow! Super interesting. Thanks for the explanation.

She only drinks water all day at school and mostly water at home but I will double check with her. I guess being a teen she could be buying something and me not know it.

Yesterday morning she had a toilet full of blood and lots of blood on the toilet paper. Rest of the day fine and so far this am fine. Not sure what is going on now.

 

[shamrock15]

My urologist mentioned to me that slight traces of salt in the water can help water absorb. As I start to get a little more aggressive in my work outs I am noticing a return to diarrhea as well though.

 

[shamrock15]

The blood is an issue though - at that level it should be checked to see what the source is.

 

[crohnsinct]

Thanks for the info Shamrock! I will see if that might help her.

I have been annoying her GI since September about her. Her times are slowing and she doesn't look good when she runs. Fatigue was one of her first signs pre dx. He ran an FC on her an it was 450 and he said her fatigue wasn't from Crohns. I called yesterday about the blood and haven't heard back. Maybe Monday. Just weird the way it disappeared like that. To top it off she ran in a meet last night and looked the best she has in months! No idea abut times as it was a relay. Also no D while running the past week. Just a big old mystery.

 

[hawkeye]

Found a blog online -google "ali on the run blog". Good running blog written by someobe with Crohn's

 

[crohnsinct]

Thank's hawkeye that is a great blog.

So I have a question for all you more experienced types.

I emailed the doc with the happenings from last Friday. He emailed back with questions. Abdo pain? Rectal pain? Bright red? I answered no pain and darker at first but then later brighter.

I haven't heard back since and she also hasn't bled since.

Just so happened to be at the ped's office for my other daughter and mentioned it and he said, "probably an internal hemorrhoid or polyp".

So my question for you are:

Have you ever had blood like that to return to normal right away? What was it? If she had a hemorrhoid that bled that much wouldn't she have felt something with it?

When she was dx'd she was a bleeder but once it got fill the bowl bad it stuck around...and she had diarrhea with it.


We are doing an FC test in two weeks so I guess if it is her Crohn's we will know but the whole thing combined with the running accidents, fatigue and 450 FC has me wondering.

 

[shamrock15]

I normally am trace amounts. I have had a couple fill the bowl examples - strangely enough I never felt any sort of pain with them. I may have had at most two consecutive obvious bleeding days and then it was occult. They definitely weren't hemorrhoids and it was the start of 3 years of anemia for me.

Please monitor her energy levels well. As I mentioned I only rarely showed obvious bleeding and yet I required over 60 units of blood in 3 years along with I don't know how much iron by infusion. Low energy and shortness of breath may be the only indications. If you are concerned, don't let the doctor push it aside.

 

[crohnsinct]

Thanks Shamrock. That is an insane amount of units of blood!

At dx she was severely anemic, but her blood test results at Remicade infusion are returning fine. I know some people get normal sed rate and CRP values even when inflamed but not sure about iron levels.

 

[Gmama]

Hi CIC,
I am so sorry to hear about all of this! I know you are super sharp with all of this & her FC is up but do you think it could be C Diff? We have been down the road if thinking LJ was in a flare of some sort but missing the fact that he had C Diff...just trying to come up with something. It's so hard to see your kid struggle:ghug:

 

[crohnsinct]

Hey girl! Saw you resurfaced again and psyched to have you back.

In my obsessive googling I read about Cdiff and bleeding but she doesn't have diarrhea or pains or anything else. Plus no blood since Friday. Do you think it could still be c.diff? Just so darned puzzling!

 

[hawkeye]

Have you ever had blood like that to return to normal right away? What was it? If she had a hemorrhoid that bled that much wouldn't she have felt something with it?

Yes I have had a few (2 or 3) instances of this over the years, but unfortunately cannot explain it - not sure if it was something food borne or not.

 

[Catherine]

Have you had iron levels checked?

 

[crohnsinct]

Her Hgb and Hematocrit were checked with her last infusion about 6 weeks ago and she was within range. She has her next infusion next Thursday so we will see.

 

[Catherine]

You are going to need to iron studies or iron panels ran. They should tell you more information.

With blood loss the ferritin will fall first, but this doesn't always happen as ferritin can also act as a marker of inflammation. This why you need an iron studies not just ferritin. Note Sarah ferritin has never been out of range, even when GI said her iron stores were zero and dx her with IDA and concurrent ACD.

 

[shamrock15]

Pardon me if I have missed it. Have you had her B12 levels tested? The reason I ask is this. I ran out of my sublingual B12 over a month ago. Decided I would try injection again. I noticed an increase in watery stool over that time. In the days that I have resumed sublingual 12 I seem to be returning to better movements. I do know that B12 is important for bowel function and is easily depleted in crohn's patients. It may be worth looking into, and don't just accept "normal" as an answer from a doctor. It is a pretty wide range for a lot of these vitamins and I am not sure that the lower level of acceptable is a good place to be.

 

[crohnsinct]

thanks Catherine I will ask for those tests.

Shamrock: yes we tested her b12 and she was solidly normal. We were vegetarian for years so are on top of b12. But I didn't know the connection with diarrhea!

Her thyroid was also tested and perfectly normal.

D was low at 26 but not enough to explain the type of fatigue we were seeing.

Also folate levels were tested as she admitted missing folic acid some days and again normal.

She is looking more energetic these days but Saturday ran a meet and had a tiny accident during her mile race. Also got a terrible time. Ran 40 seconds slow.