Spring is finally upon us and those of us who participate in sports events find ourselves emerging from what seems like a yearlong Covid hibernation. Groups are meeting up again, races that were postponed due to the pandemic have been rescheduled, training plans have been carefully prepared and we’re raring to get our Lycra clad bodies, with their few extra lockdown pounds, back out there. For some athletes though this means the return of toilet issues before and during a race.
My main sport is running and I have found that fellow runners are refreshingly open in sharing information about their bladders and bowels. I am also an RGN and, having worked in the field of incontinence for over ten years, find that talking about wee and poo on a daily basis has become the norm. I’ve often thought that having the initials “WC” meant I was destined to work in the world of incontinence.
Generally, it’s not a sexy subject. It’s embarrassing. It’s taboo. When someone non-clinical asks what I do for a living, I can usually kill the conversation dead in five seconds flat. People were far more interested when I worked in Trauma and Resuscitation. There was a glamour about these specialities. Not so much glamour now that I work mainly with issues from the waist down. Our toilet habits are simply not something we like to talk about and yet elimination of bodily waste is a function of daily living that affects us all. This, however, does not put off the runner who’s quite happy to talk about the subject as standard.
Many a long training run has been halted for a “wild wee”, or the start of a run delayed as a member of the group is not feeling “bowel confident” (usually due to the ill-considered spicy dinner choice from the previous night). I remember a complete stranger feeling it important to tell me at the start of a marathon, “I always go three times before a race”, like three was her mystical magic number and that if she didn’t go three times, it would be inevitable that she would re-enact Paula Radcliffe’s unfortunate roadside incident of runner’s trots from 2005.
Runners have a certain special camaraderie. We spend longer with our marathon training buddies than we do with our own families and, because we wear a uniform of brightly coloured Lycra, that makes it ok to discuss such matters.
I heard recently on the radio that we spend over three years on the toilet in our lifetime. I’m sure you could double that figure for runners, such is their preoccupation with their bladders and bowels.
Can you even call yourself a runner if you don’t get to a race ridiculously early to join the huge snaking queue for the portaloo? Do you find that when you get to the front and you’ve been for a wee, within five minutes, you want to go again? Off to the back of the queue you trudge for a second, then third, maybe fourth emptying of your highly overactive bladder. This may be due to drinking too much or drinking at the wrong time before a race but it may also be psychological, as we are training our bladders to empty when they’re only half full. If we regularly do this, our bladders start to shrink.
A top tip I’ve discovered is to get to the front of the queue then let the person behind you go ahead of you. Keep doing this until you really feel like your bladder is full and you really need to go rather than keep going “just in case”. Not only will the person behind you be eternally grateful, providing you with a warm fuzzy feeling that will help you through the race, but you’ll be doing your bladder a favour too.
It’s a difficult habit to get out of. Most of us have been conditioned to go to the toilet “just in case” from an early age. Whose mum didn’t ask, “Have you been to the toilet?” before you left the house in the morning before school or before a long trip in the car? I still go “just in case” at the tender age of 51¾ when heading out on a long car journey for work, but that’s fine so long as it doesn’t become a daily ritual.
You might be wondering what you should eat/drink before a race to help prevent unwanted bladder and bowel issues? Well, each person is different but, after nearly thirty marathons and ultramarathons, I’ve found that I’m pretty safe eating a plain meal of simple carbohydrates such as white pasta or rice the evening before a run, a high carbohydrate meal no less than three hours before a run and having a final drink (300mls of decaffeinated tea or water) not less than an hour before. Drinks that are caffeinated, carbonated or contain citrus fruits have an irritant effect on the bladder, so these are best avoided before an event.
Once the race starts, having a few sips at each mile marker, whether feeling thirsty or not, will help to keep you hydrated as, when urine becomes concentrated, this too causes the bladder to become irritated. It also gives you something to focus on other than the tens of thousands of steps before you. It’s tempting to gulp gallons of water, especially if it’s hot, but there’s a fine line between being hydrated and becoming overhydrated, which can lead to hyponatraemia (dangerously low sodium levels).
I don’t personally use gels, but if you’re considering them during a race, it’s best to practise with a few different ones on training runs, as some people find they can’t tolerate them and they suffer from stomach upsets. A case of runner’s trots is the last thing you want when hundreds of spectators’ eyes are on you!
So, what is the main cause of the dreaded runner’s trots? Well, adrenaline is produced before a race and when we run which speeds up bowel emptying. This is quite normal and doesn’t mean that we have irritable bowel syndrome. When our poo moves quickly through our bowel, there is less time for water to be reabsorbed and so it becomes watery and explosive. The blood supply to the bowel is also reduced, as our blood prioritizes travelling to our muscles during a race, affecting the function of the bowel. The physical up and down movement, which we experience during a run, irritates the bowel and causes it to want to empty too.
Exercise-induced urinary incontinence is also common amongst runners. It is a type of incontinence experienced, particularly in road running, caused by increase in the pressure on the pelvic floor muscles. Strengthening these muscles with exercises can help with being able to hold your wee. From my clinical experience, I find that men are sometimes unaware that they, as well as ladies, have a pelvic floor. We hear about it more in ladies as the muscles become stretched during pregnancy and childbirth. Childbirth is traumatic! I’ve been through it twice so feel qualified to say that. For those of you who haven’t experienced it, try pushing a Jaffa orange up your nostril…..actually DON’T! I digress. This sling of muscle prevents all our pelvic and abdominal contents, including our bladder from falling out, so it’s important for men to have a pelvic floor too!
Discreet pads for light incontinence may help with the containment of small leaks of urine. These are easily available from supermarkets, pharmacies and online. They are designed to wick urine away from the skin rather than allowing urine to stay in contact with the surface of the skin, causing irritation and potentially incontinence-associated dermatitis (IAD). More confidence may be given to the runner also if they wear darker coloured running shorts and tie a jacket around their waist to help to hide any accidents.
Just one final thought to those considering running a mile or a marathon, please don’t be put off from exercising due to bladder or bowel issues. They are far more common than you may think and advice is out there from your GP and other health care professionals. They will have seen people with similar issues many times before, so there really isn’t any reason to be embarrassed.
Wendy Cole, Clinical Nurse Advisor, Medicareplus International Ltd.