Staying physically fit is a constant struggle for Stephanie Horgan, who, like millions of Americans with gastrointestinal disorders, has to plan her diet, her exercise routines, and her entire life around her condition.
"I'm really active now, doing kickboxing, jogging, Spinning at the gym, and eating whatever I want," says the 26-year-old Chicago resident, who was diagnosed with Crohn's disease at age 18 and had three surgeries within a year. "But you never know when you're going to have a flare-up. And when you have a flare, everything revolves around going to the bathroom and taking care of your body. Most social situations are out of the question."
Crohn's is one of two major types of inflammatory bowel disease (IBD). The other is ulcerative colitis (UC). Both cause abdominal pain, diarrhea, weight loss, lack of energy, and sudden bathroom urges that can lead to incontinence when sufferers sneeze, cough, laugh, or lift heavy objects.
Some of IBD's symptoms -- pain, bloating, cramping, and diarrhea -- are also common in people with irritable bowel syndrome (IBS), which is an entirely different condition, says Shanthi Sitaraman, MD, PhD, associate professor of digestive diseases at Emory University in Atlanta.
Diagnosis involves excluding IBD with a colonoscopy, she tells WebMD. "The GI tract has a nervous system of its own, just like the brain," she says. "The system perceives stress, makes bowels go faster or stand still.''
Exercise, too, can pose specific challenges for people with IBD or IBS, but the positives of getting in shape typically outweigh the negatives.
Most doctors who treat problems that cause incontinence say many people often don't feel like working out, but should try anyway to reduce stress, get their symptoms under control, and avoid diarrhea.
Cedric Bryant, PhD, chief science officer for the American Council on Exercise, says people with GI disorders like Crohn's disease, ulcerative colitis, and IBS need to exercise as much as they can because it can help them maintain a more normal body weight and aid digestion.
Exercise can also induce feelings of well-being, says Greg Sayuk, MD, a gastroenterologist at Washington University in St. Louis.
Scott Cole, a fitness instructor based in Palm Springs, Calif., agrees. He's found that yoga, tai chi, and breathing exercises have helped many of his clients.
"When you are sick or worried, you tend not to breathe fully, which kind of makes these things worse," he tells WebMD. "Some good mental energy works."
Despite the benefits, people with GI disorders do face some obstacles when it comes to getting -- and staying -- in shape. Here are seven tips for making exercising easier when you have a GI disorder.
1. Minimize Impact. Bryant, who is also a fellow of the American College of Sports Medicine, recommends "low-impact activities that aren't going to require a great deal of jarring and jostling. Try yoga, tai chi, Pilates -- exercises with a movement component but a focus on rhythmic breathing. Exercising strengthens the pelvic floor muscles in both men and women and makes exercising safer."
2. Go Uphill. People with incontinence should walk, not run, on treadmills, and increase the track's elevation, Bryant tells WebMD.
3. Map Out the Restrooms. Whether you're in the gym or walking the park, scout out the bathrooms before beginning your workouts. GI conditions vary, but the one commonality is that everyone with leakage "knows where all the bathrooms are," says Sander Binderow, MD, a colorectal surgeon at Saint Joseph's Hospital in Atlanta.
4. Plan Potty Breaks. Use common sense, says Bryant, by going to the bathroom before you start exercising.
5. Choose Your Sports Wisely. Golf, Bryant says, is a lot safer than basketball or jogging.
6. Listen to Your Body. "I'm single and dating and feel fortunate to be in remission so that it doesn't interfere with my life," says Horgan, who is working on her master's degree in social work. But when she feels a flare coming on, she doesn't push herself physically.
7. Keep Your Doctor in the Loop. Don't be shy about talking to your doctors about what happens when you exercise. Additionally, if you are fatigued, unable to eat, or having persistent diarrhea or bleeding, see your doctor, says Ernesto R. Drelichman, MD, director of the Inflammatory Bowel Disease Center at the University of Alabama at Birmingham.
When Medications Make You Feel Sick
Both ulcerative colitis and Crohn's disease often can be controlled with medication, though surgery is still performed when drugs don't work, Drelichman tells WebMD.
In many cases, he says, medications can lessen symptoms of diarrhea, abdominal cramping, and bloating. Some medications, however, can cause problems themselves, such as weight gain, lack of energy, bone weakening, and dehydration "to the point where you feel like you have a constant hangover," Drelichman says.
Unfortunately, that means exercise can be out of the question. If patients don't feel like exercising because of side effects from their medication, they should take it easy and lay off the physical activity, say all the GI doctors interviewed.
The best time for exercise? Between flare-ups, when people have more energy and feel well enough to exercise.
That's been Neal Patel's strategy. The drugs the 25-year-old Decatur, Ga., resident takes to keep his ulcerative colitis under control cause lethargy and weight gain. He gained 30 pounds while taking medicine.
In an effort to shed the extra weight, he went to the gym whenever he felt up to it and recently lost 15 pounds. "I lift weights, jog on the treadmill, and things are good," says Patel, who is between flares.
Now a medical student, Patel says his disease caused him to change his specialty from obstetrics to gastroenterology.
"I know how hard it is for young people to cope," he says, "and I want to help them."