How I’ve learned to cope with my Exercise-Related Transient Abdominal Pain

About a year ago I was “diagnosed” with Exercise-Related Transient Abdominal Pain, which basically means that when I run long distance I feel a side stitch like pain in my lower abdomen.   It sucks a lot which is why last year I actually went to the doctor and had a check up to figure out exactly why I was experiencing this pain.

Long story short, and if you want the long story you can check out this blog post here, but it’s just a stabbing pain in the abdomen caused by physical activity. There’s not a lot of research on what causes it or what to do about it which makes it a really frustrating diagnosis.

That being said, it’s been about a year now and I’ve finally started to figure out how to handle it for myself. And although I haven’t yet mastered running without any pain, I do experience more good runs than I do bad runs. So today, I want to share with you how I have learned to combat my ETAP incase you’re having trouble figuring it out yourself.

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Fiber

After doing a lot of research outside of what the doctor gave to me regarding ETAP, it seemed like a lot of people seemed to think that their symptoms were linked with irritable bowel or constipation.  It seemed to make a lot of sense to me and tracking my own running history, it seemed like a logical explanation.

So I decided to add some extra fiber into my diet to make me more regular.  Not only do I think it’s helped with my running (and making sure I’m cleared before I run), but I really think it’s helped with how I feel overall.  My new doctor (I also changed doctors) told me she thinks everyone could benefit from some more fiber in their lives.

I haven’t added too much, just 6 extra grams of fiber in a chewable tablet.  I take 3g in the morning and 3 grams in the evening.  The days leading up to a race I take 7.5g of extra fiber.  This seems to work really well for me, though everyone’s system and diet is a little different!

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Back to Basics

One of the biggest things I did to help combat my ETAP symptoms was to kick it back to where I started with running.  When I first started running, I learned slowly on a treadmill and overtime worked on my stamina.  So when my doctor told me that I may never be a long distance or a fast paced runner, I really questioned if I couldn’t just start to slowly retrain myself to get to a place where I was going longer or going faster.

So I hit the treadmill back up. I started again doing a mile at a time with taking breaks in between until I was consistently reaching 5k without pain and then I started to slowly work on increasing my speed.  I haven’t had any cases on the treadmill recently where I have been in pain so that’s one step for me.  At least I know that I still can work out and exercise without being in excruciating pain.

I do still experience pain sometimes when I am outside running.  I know when I’m outside I’m not always keeping a steady pace and I tend to push myself more.  Hopefully with more training I’ll be able to work out those pains just like I did while on the treadmill.

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Breathing

Along with retraining on the treadmill, I worked on retraining my breathing technique.  I used to only breath out of my mouth when I was running.  Not only was that a terrible way to get air into my body while running, it also made me able to focus more on how tired I was and pay more attention to the length of the run instead of the quality of the run.  Instead now, I focus on controlling my breathing while I run so that way I am distracted by making sure I am following the right breathing instead of other things.

Although I know the technique for running is breath in for 3 steps, exhale for 2 steps, I’ve found myself doing more of a long inhale through the nose with 2 short breaths out of the mouth.  It seems to help me a lot with my running, although as I worked more towards my goals, I might try to learn more about breathing techniques.

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Running with water

My doctor suggested that I run with water available at all times and take a few small sips throughout my run in order to keep hydration in my body.  I definitely tend to get really overheated during summer runs and having the option to rehydrate or event to dump water on my head helps me with my runs so much.   It hasn’t magically taken the stitches away, but it definitely helps.

And it’s helped me to shave a solid thirty seconds of my running time since I don’t feel the need to slow down for water stops!

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Compression

I started wearing a compression belt around my abdominal almost immediately after my doctor explained ETAP to me.  It was one of the most highly recommended things to help combat the symptoms.  Not only does it compress the abdomen to help alleviate the cramping, but it also helps to fix posture!

I started with wearing it all the time to help out, but now I only need it when I do outdoor runs.

It has it’s downsides.  It’s very hot and not very breathable, and I definitely need to invest in a tighter one now.  But overall, I am pretty happy with having the option for compression while I run!  They even make compression shirts and pants now that help with the same issues!

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The pain is temporary

The biggest thing that has gotten me through ETAP is knowing that after I finish running and I sit down for a few minutes, the pain is going to go completely away.  There are no lingering side effects , I’m not in pain for hours or days, and it’s not going to affect me in the long run.  I just have to push through it and I’ll be fine.

This helps me so much during races because even though I want to stop and I want to give up sometimes, I know the finish line is coming closer and if I just run a little bit longer I’ll get there.

This thinking had me crossing the finish line at my last race with my best time ever and I couldn’t be prouder.

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Despite all the pain from ETAP, I wouldn’t give up running for the world.  I love doing it. I love participating in 5k races, and I love the feeling of accomplishment after a race.  ETAP is just an annoying little hurtle I have to work to get over.  It pushes me to work hard and overcome my obstacles.  I know without it I would be a force to be reckoned with, I just have to work to get to that point.

I have 5 more races scheduled for this summer (but I may participate in more depending on how the summer goes) and I want to be crossing the finish line at 29minutes by my last one.  Follow Kat Classics on instagram to keep up with how my races are going!

Are you participating in any races this summer?  What’s your goal time?  Let me know in the comments below.  And let me know if you ever experience ETAP and what you do about it!  I love to hear from you guys!

Until next time,

Kat

 

Why do I have Abdominal Cramps When I run? ETAP

I’ve been having a lot of problems with cramping up in my lower abdomen while running lately.   It’s been pretty bad.  The pain comes when I’m between one and two miles into my run and it’s a pretty debilitating pain.  It feels very similar to a menstrual cramp, and sometimes I just cannot work my way through the pain and have to stop my running and sit down for a while wherever I am. Usually it goes away within a minute or two of stopping activity, but sometimes it lasts longer than that. As you can imagine this is not the ideal situation for a person who is trying to participate in multiple races over the year.

Of course, I turned to google searching when it came to trying to figure out why I was experiencing so much pain during every single one of my runs.  However, when searching for “menstrual like cramps while running,” I wasn’t very successful in figuring out WHAT was going on.  It became very clear to me that many, many women experience this issue when it comes to running, but none of them really seemed to have an answer as to why the pain occurs. Some suggested it had to do with endometriosis, others thought it had to do with irritable bowel syndrome, while others simply thought it was dehydration. Whatever the case, no one had an answer as to what to do about it and how to help.

So the next place to go looking for answers was my doctor’s office.  I figured if it was any of the above things, I would need some sort of test done.  Long story short, I came back kind of disappointed from my surprisingly short doctor appointment with an attempt at an answer, although I’m not really convinced it’s the tell all answer.

So today,  I want to tell you guys about my diagnosis from the doctor,  what she told me I have, what it means for me, and what I’ve tried to do about it.  Next week, I’ll tell you what I actually think is the cause for my cramping and what I’ve done about that.  And if you guys are experiencing similar issues, you can decide for yourself what you think the problem may or may not be.

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Exercise-Related Transient Abdominal Pain (ETAP)

That’s the fancy term for what my doctor told me I was “suffering” from.  What that really is, is a fancy term for a “stitch”, like a side stitch, but apparently it can happen on any area of the abdominal region, though the lateral aspects of the mid abdominal (or the sides of the mid abdomen) is the most commonly affected area.  It’s said to feel like a sharp, stabbing pain when it is at its worst, but a dull ache when it’s less severe.

Areas affected by ETAP and commonness of affliction (.ncbi.nlm.nih.gov)

It’s especially prevalent in activities that use a lot of torso movement such as running or horseback riding.  In fact, 70% of runners report experiencing the pain at some point in their lives.   And although it is most common in young athletes, not even experienced runners are immune to the sensation of feeling ETAP.

A few research studies have taken place looking into the pain, severity, and prevalence of Exercise-Related Transient Abdominal Pain.

In about 80% of all cases of ETAP, the pain was localized in one area of the abdomen, reaching everywhere from the lower abdomen to the sides near the ribcage.  Right side pain is reported to be twice as common as it is on the left side.  Again though, pain can be present anywhere on the abdominal area.

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What causes Exercise-Related Transient Abdominal Pain?

It’s actually not known exactly what causes ETAP.  There are a few theories out there that researches think may contribute to the pain, but it’s not known completely what is happening to cause the body to cramp up and ache so severely during exercise.

Several of the theories include inadequate blood supply to the diaphragm, stress of the supportive ligaments that attach abdominal organs to the diaphragm, inadequate blood supply to the intestines, compression of the celiac artery, aggravation of the spinal nerves, and irritation of parietal peritomeum (lines the abdominal and pelvic cavities).

Of these theories, researchers believe that the latter is the most likely cause of the pain, as the pain described from those with ETAP most similarly relates to this.  Similarly because of the stretch of the lining (from abdominal cavity to pelvic cavity) this pain could occur in many areas of the abdomen.

In fact, a study by Mole et al. found that people who suffer from ETAP actually have thinner transverses abdominis and less functional core stability than those who do not experience ETAP, which suggests the above may be to blame.

However, more research is needed to determine if this is actually true in all cases.

I am going to link the research article that I was given by my doctor which talks more about Exercise-Related Transient Abdominal Pain and all the research that took place about it.  This article goes deeper into information about each of these theorized causes and why they were each proposed.  If you’re curious about the biology of what is happening, I suggest you check it out!

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How often does ETAP occur?

Exercise-Related Transient Abdominal Pain is different for every runner.  According to a study of 600 athletes by Morton and Callister, ETAP occurred in less than 10% of physical activities.  82% of these people indicated that the pain occurred no more than 20% of the time.  I’m personally really jealous of these people, because I would say I experience the pain around d75% of the time.  Yuck!

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Who gets ETAP?

As I said earlier, no one is immune to Exercise-Related Transient Abdominal Pain.  All athletes can experience it no matter age or sex. However, several studies have shown that ETAP is more common in individuals younger than 40.  Both occurrence and severity seem to decrease with increasing age.

There isn’t any definitive proof that shows whether ETAP is more common in men or women, however some studies seem to slightly suggest women experience ETAP more often.  It’s also very important to note though that these studies don’t find this statically significant considering the small fraction of women studied.

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What else might affect ETAP?

• Activities where torso movement is common such as running or swimming
• More intense exercise, although less intense exercise like horseback riding may cause ETAP as well
• Consuming food or drink before exercise
• Ingestion of hypertonic fluid (Studies suggest that isotonic solution during running provokes the least amount of ETAP cases. Water, a hypotonic solution came next in number of ETAP cases, while hypertonic solution was associated with the most cases of ETAP.

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What can I do about ETAP?

If you suffer from Exercise-Related Transient Abdominal Pain, don’t fear, it might not be the actual end to your exercise career.  At least, to this day I hope not.  There are actually several things that you can do to help yourself get over this little road bump in your aims to become a better athlete.

For starters, you should avoid eating and drinking large volumes (or any volumes) at least 2 to 3 hours before exercise.  Hypertonic beverages should be avoided all together but small amounts of isotonic or hypotonic fluids can be regularly consumed during exercise to help combat ETAP.

You should also try to support and restrict torso movement when working out.  It’s suggested that wearing a wide supportive belt around the waist can help.  However, the biggest suggestion is to work on core strengthening to prevent ETAP all together.  Research also suggests to improve posture while exercising.

Thankfully, ETAP has been shown decrease with experience and fitness level so you may actually be able to work your way out of it with time and patience.

For me personally, I wear a belt now and I run with a water bottle, making sure to take in regular amounts of fluids while I run.  I was able to compete in my last 5k with minimal issues, but I do plan to take a month or so off of the running to work solely on my core strength (which honestly I’ve needed to do lately anyway).

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Is there anything I can do when I do experience ETAP?

When you’re experiencing ETAP symptoms the most common technique seems to be deep breathing.  For some people they’re able to continue their activity and simply breathe through it, while others need to completely stop and take some time to let their breathing catch up.  I personally feel like this has to do with your experience level.  If you’re not a seasoned runner, this is a good time to stop and walk it off for a little bit.

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So that’s the breakdown of Exercise-Related Transient Abdominal Pain.  I’m honestly to this day not really sure if that’s what I have or not, and I’m not really sure if I’m ever going to be running at 100% if it is the case, but I have hope that I’ll figure this thing out and that if you’re suffering as well, so will you.

So let me know in the comments below, have you ever experienced pain that may be ETAP?  What do you do about it?  I’m really curious to know your own story.

And again, check out the link to the full article I was give so you can read more for yourself in you’re curious to know more!

Until next time,

Kat