THE CLINIC: Bloating and Ischemic Bowl Disease

Thu, 13 Sept. 2012 - 1:36 a.m. MT
Credit: ARA Staff - American Running Association

I am an avid 68-year-old marathoner. At the Boston Marathon this year I
suddenly developed a swollen abdomen from the navel down. My doctor suspected a hernia and sent me to the ER. The CAT scan was negative for abnormal growths, all blood tests were normal including liver function tests and salmonella poisoning, and I have seen several additional doctors to no avail. My urinalysis was negative.
There is normally no pain, but perhaps a slight discomfort at times. My abdomen feels like a water-filled balloon rather than a firm muscle. My bowel habits are pretty much the same. A colon cleanse with magnesium citrate did not reduce the swelling. 
The bloating has been constant, even when not running, yet it does not seem to affect my daily running, biking, or weight training. I have been taking Testim for my low testosterone for one year. I would like to get this resolved before getting a colonoscopy. Any thoughts?
Paul Thuring
Cambridge, MA
I have thought about it and asked one of my gastroenterologist colleagues, 
who is also a marathoner, and this is what we think. 
One cause is serious and should be evaluated; it would not have shown up on the tests you’ve done so far. This is ischemic bowel disease, which is basically inadequate arterial blood flow to your intestines during a high stress time such as a long run, and where a lot of blood is shunted away from your gut to your skeletal muscles. It is basically 
like having heart disease in which you have inadequate flow to heart muscle due to plaque in the heart arteries, but this is disease in your gut arteries. 
It is easy to overlook; the best way to detect it is a colonoscopy right after the event, in which the GI physician sees the inside of your colon and looks for poor coloration of the tissue on the inside. Still, you need a colonoscopy even this much later. 
Also check the usual heart disease risk factors, such as blood sugar, blood pressure, and cholesterol, and if your colonoscopy is normal, you might work up to a long run again, then go see the doctor the next day. 
Pete Mendel, MD
Woodbridge, VA

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(RUNNING & FITNEWS® September / October 2009 • Volume 27, Number 5)

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