Ischemic colitis in marathon runners

27 Mar


the GI system is put under stress during both training and the actual race.  GI complaints include:

  • abdominal cramping,
  • rectal incontinence,
  • gastrointestinal bleeding.


most extreme manifestation of this: ischemic colitis.

  • reported incidence of occult blood: ranges from 8–85% (great)
  • As many as 16% of runners in one study reported having bloody diarrhea on at least one occasion after a race or hard run
  • incidence of ischemic colitis in endurance athletes is not known.  


  • can be from upper or lower GI sources.
  • Endoscopy of subjects after a race has found a high rate of gastritis


delay from onset of symptoms to presentation ranged from 8-24 h.



extreme manifestation of the common phenomenon of exercise-induced decrease in mesenteric blood flow.

Some have compared this pattern of ischemia to a shock state

unclear if this is…due to decreased perfusion or if a repetitive trauma may contribute to the development of right-sided colonic ischemia. 




  • fluid resuscitation,
  • pain control,
  • antiemetics as needed. 
  • Bowel rest
  • Nasogastric lavage should be considered, as hemorrhagic gastritis is another possibility. (editor’s note: I have gone away as much as possible from NG tubes in these patients, given its limited utility and that its one of the more painful procedures)  

Most patients will have  complete resolution of their symptoms with no further interventions. 


Submitted by Heather Reed-Day.


References:  Leon D. Sanchez, Jason A. Tracy, David Berkoff, Ivan Pedrosa. Ischemic colitis in marathon runners: A case-based review. The Journal of Emergency MedicineVolume 30, Issue 3April 2006Pages 321-326.; picture



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