THE CLINIC: Bloating and Ischemic Bowl Disease

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

QUESTION:
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
 
ANSWER:
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

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

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




Latest News
Luxury Cruise Fitness: It Can Be Done
Luxury Cruise Fitness: It Can Be Done

Aug 02 1:02 p.m.

Article by: Jeff Venables

Comrades Ultra - Loose and Fun = Success
Comrades Ultra - Loose and Fun = Success

Jun 04 12:26 p.m.

Article by: Rick Ganzi, M.D.

Young Milers in Anaheim CA love running
Young Milers in Anaheim CA love running

May 15 3:03 p.m.

Article by: Jeff Venables

Catch Them If You Can
Catch Them If You Can

Apr 08 7:22 p.m.

Article by: Jeff Venables

New Roles of Sports Chiropractic
New Roles of Sports Chiropractic

Feb 21 11:15 a.m.

Article by: Jeff Venables