Exercising with IBS: A Guide for Athletes

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that causes abdominal pain as well as changes in bowel movements (constipation, diarrhea, or both). It affects an estimated 10-15% of people in the United States, and in addition to physical symptoms, it is associated with impaired quality of life and mental health. Exercising with IBS can improve symptoms to an extent, but when it comes to high-intensity exercise, IBS can be an enormous source of discomfort during workouts with the potential to affect energy levels and recovery. If you are an athlete who struggles with IBS, read on to learn about how training with IBS impacts symptoms as well as tips for managing IBS.

Does Exercising With IBS Improve Symptoms?

IBS symptoms are highly individualized, so the short answer to this question is that it depends. Several studies indicate that increasing low to moderate-intensity exercise may help improve IBS symptoms, particularly in constipation-predominant cases.

However, it is important to note that patients who already met or were close to meeting the physical activity guidelines for Americans (a  recommended minimum of 30 minutes 5 days a week) were excluded from these studies. If you’re regularly active, you are already reaping at least some of the benefits to be had from exercise.

One form of exercise that is a particularly promising therapeutic option for IBS patients is yoga. A review study that included over 250 IBS patients total found that participation in yoga was linked to decreased IBS symptoms, severity, and anxiety as well as improvements in quality of life. Evidence indicates that stress plays a role in IBS by impacting signaling between the brain and the gut. By helping to regulate stress, yoga can therefore have benefits that extend to both the mind and body for patients with IBS.

The great thing about yoga is that there are many different styles, such as Vinyasa, Hatha, Iyengar, and Restorative, as well as a variety of levels. This means that even if you don’t enjoy the first yoga class you try, there are plenty of other options to explore! I personally never would have pegged myself as someone who could or would enjoy yoga since I have a fairly short attention span and typically gravitate towards faster paced workouts, but after trying numerous styles of yoga and different instructors, I found the ones that fully engaged me. Now I find the level of focus and the rhythmic breathing in yoga to be very calming and always feel rejuvenated after spending time on the mat.

Does Exercising With IBS Make Symptoms Worse?

While yoga and moderate exercise can help improve IBS symptoms, high-intensity exercise is linked to increased GI symptoms. GI symptoms are especially common in endurance athletes and can be explained by several physiological changes that occur during exercise, including decreased blood flow to the intestines.

While IBS is generally caused by abnormal signaling between the brain and the gut, the physiological changes that affect athletes broadly during exercise can trigger additional GI symptoms in IBS patients, too. This means that people with IBS, who have a sensitive GI system as it is, may see a spike in symptoms during intense exercise. 

Exercising with IBS symptoms like bloating, gas, nausea, constipation, and the urge to defecate can be extremely uncomfortable, and discomfort can make it difficult to perform to the best of your ability. That’s why if you’re an athlete who struggles with IBS, it’s a good idea to talk to a doctor and a sports dietitian about what changes you can make to help you feel better both in general and during exercise specifically.

5 Strategies for Managing IBS in Athletes

If exercising with IBS has been aggravating your symptoms and interfering with your workouts (and life), it may be time to consider adjusting your pre-workout meal timing, improving your hydration strategies, implementing stress management techniques into your daily life, talking to your doctor about supplements, or working with a dietitian to make dietary changes. In this section, I’ll share details on each of these strategies for IBS symptom management to support athletic performance.

1. Meal Timing for Athletes With IBS

Meal timing is key for all athletes, but if you have IBS and are extra susceptible to GI disturbances during your workouts, it’s even more important to dial in on. If you’re planning on eating a full meal before you workout, it’s best to do so a minimum of 2 hours before to give your body time to digest. This is by no means a hard and fast rule and will look a little different for everyone. For some, a minimum of 3 hours may feel more comfortable so be open to experimenting with meal timing and take note of how your body feels.

When it comes to pre-workout snacks, fuel up at least 45 minutes before exercise and stick to foods rich in carbohydrates, the easiest macronutrient to digest and the quickest source of energy for exercising muscles. Foods high in protein, fiber, or fat take longer to break down, so it’s best not to consume them too close to a workout.

Eating large meals can trigger symptoms for some. If this is the case for you, mini-meals may be better tolerated at times, but bear in mind that if you’re eating smaller meals you’ll need to eat more frequently to meet your energy needs! Everyone is different, but the key here is to honor your hunger throughout the day so that you’re not starving when you realize it’s time for a pre-workout snack, which leaves you with two bad options: (a) being under fueled or (b) feeling overly full during your workout.

2. Hydration for IBS Management

In addition to fueling considerations, adequate hydration is also critical in IBS management. Dehydration can have a range of negative effects on your health, including worsening constipation. For athletes who are sweating out excess fluids in their daily workouts (and who have decreased sensitivity to thirst during exercise), this is even more important to be aware of.

Additionally, while coffee does contribute to your daily fluid intake, caffeine can increase motility. If you struggle with diarrhea-predominant IBS, skipping coffee before your workout may help you avoid unplanned bathroom breaks.

3. Stress Reduction for IBS

Adding strategies for stress management into your daily life can also help keep your IBS symptoms under control. As I mentioned above, yoga can play a positive role in symptom management. There are also plenty of other ways to de-stress, such as meditation, deep breathing exercises, and journaling. Additionally, gut-directed hypnotherapy is a relatively new technique that focuses on getting patients into a relaxed state and guiding them through visualization exercises and has had promising results so far.

Life gets busy and you may not always have the time for a full yoga class or an hour-long meditation session, but even setting aside 5 or 10 minutes a day can make a big difference. There are even apps you can download to use for quick guided meditations and even gut-directed hypnotherapy.

4. Supplements to Reduce IBS Symptoms

Enteric-coated peppermint capsules

Though there is sparse evidence for the use of regular peppermint oil capsules in IBS, enteric-coated peppermint capsules are specifically designed to remain intact as they travel through your stomach so that they act specifically on the lower GI system, where they may be effective in reducing gas, bloating, and abdominal pain. A common brand of enteric coated peppermint capsules in the US is IBgard.

Fiber supplements

Fiber supplements can improve stool consistency and help keep you regular. Different types of fiber can have somewhat different effects, so it may take some experimenting to see what works for you. Gastroenterologists and GI dietitians are typically well informed on the different types of fiber and will be best equipped to provide personalized guidance. Two of the more popular brands that are commonly recommended for IBS are Metamucil and Citrucel.

Enzymes

There are a variety of enzymes that can be taken in pill form to aid in digestion. Lactase, sold under the brand Lactaid, is one of the more widely used enzymes and can be taken to improve tolerance of dairy.

Alpha galactosidase, sold under the brand name Beano, is designed to improve tolerance of legumes and other foods containing galacto-oligosaccharides. There is some promising research supporting its use for symptom reduction in IBS, although the evidence is mixed; other studies found no benefit.

Probiotics

Probiotics are another supplement option that has mixed evidence but may be helpful in some individuals with IBS. It’s worth noting that the American Gastroenterological Association recently issued guidance advising against the use of probiotic supplements in most digestive disorders, citing high cost and insufficient evidence of efficacy.

While the cost of probiotics is indeed a significant barrier, some probiotics can be obtained at a lower cost with a prescription from your doctor. Furthermore, research on probiotics is still in its infancy. There are certainly knowledge gaps and while no definitive statement can be made about the efficacy of probiotics, there have been some promising studies thus far and stronger evidence may very well emerge.

If you are interested in giving probiotics a shot and it’s feasible for you financially, some reputable brands include Align, Thorne, and VSL#3. Since the impacts of specific bacterial strains are not yet fully understood, a degree of trial and error may be necessary. Be sure to monitor whether a specific probiotic is improving your symptoms or not before deciding whether to continue it in the long-term.

5. Dietary Intervention for Athletes with IBS

Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) are a class of carbohydrates that are poorly absorbed in some individuals. The low FODMAP diet is a dietary intervention used specifically for IBS and other gastrointestinal disorders. It occurs in three phases: 

1. Elimination, where high FODMAP foods are removed from the diet
2. Reintroduction, where high FODMAP foods are strategically added back in and tested
3. Integration, where a long-term plan is created based on individual FODMAP tolerance

The low FODMAP diet is the gold standard in terms of dietary interventions for IBS and been shown to improve symptoms in 50-80% of IBS patients. If your symptoms are persistently interfering with your day-to-day life and other strategies for symptom management are not working for you, it’s worth considering a low FODMAP diet, but keep in mind that it’s not the right approach for everyone. It is not recommended in children, the elderly, or people with a history of disordered eating.

Due to its complexity, I highly recommend consulting with a dietitian to determine whether this is the right approach for you and if so, to guide you through it. In the meantime, to learn more about FODMAPs and what foods they are found in, check out this FODMAP checklist from Kate Scarlata, a dietitian who specializes in IBS.

Because the low FODMAP diet eliminates a long list of foods, it is important to find appropriate foods to swap in to avoid nutrient deficiencies and energy deficits. This can be a challenge for athletes in particular due to their demanding training schedules and high energy needs. To further complicate things, many sports drinks and bars that athletes rely on contain high FODMAP ingredients such as fructose, high fodmap fruits, and inulin. Since meeting nutritional needs before, during, and after exercise is critical for athletic performance and recovery, I cannot stress enough the importance of seeking out resources and support from a dietitian before making serious dietary changes.

Exercising with IBS: Final Thoughts

Some forms of exercise may improve IBS symptoms while others may exacerbate them; the key is to learn what works best for you and to listen to your body. If you are in the midst of a major IBS flare up, taking a rest day may be the best thing you can do. And last but not least, although talking about your pooping habits with a stranger may not sound like your idea of a fun afternoon, if IBS is persistently interfering with your life, it’s a good idea to get professional help so you can find strategies to keep your symptoms under control.

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