Irritable Bowel Syndrome is Underdiagnosed and Ineffectively Managed Among Endurance Athletes

Killian LA1, Lee SY2. Appl Physiol Nutr Metab. 2019 May 7. doi: 10.1139/apnm-2019-0261. [Epub ahead of print]


Author information

University of Illinois at Chicago College of Medicine, 12247, Division of Nutritional Sciences , 905 South Goodwin Avenue , 486A Bevier Hall MC-182 , Urbana, Illinois, United States , 61801 ; lkillia2@illinois.edu.

University of Illinois at Urbana-Champaign, Department of Food Science and Human Nutrition, Urbana, Illinois, United States ; soolee@illinois.edu.


Lower gastrointestinal (GI) symptoms are common among endurance athletes and can impair performance. Symptom characteristics are similar to irritable bowel syndrome (IBS). No previous research has examined IBS diagnosis (medically or by diagnostic criteria) within this population. The objectives of this study were to determine the prevalence of IBS among endurance athletes and examine their GI symptom management strategies. A previously validated, online questionnaire assessed IBS diagnosis, fit to IBS diagnostic criteria (Rome III or Manning), general GI symptoms, and symptom mitigation strategies of endurance athletes. The questionnaire was distributed to U.S. athletes completing a marathon, ultra-marathon, half-distance triathlon, or full-distance triathlon. Medically diagnosed IBS was reported by 2.8% of endurance athletes. The total prevalence of IBS (n=430) was 9.8% (medical diagnosis and Rome III). Athletes with IBS experienced more frequent symptoms during exercise as well as at rest; however, only 47.6% had consulted a medical professional. Over 56% of athletes experienced at least one symptom sometimes or more during training and competition and 18.6% had symptoms that sometimes or often interrupted/prevented training. Almost half (45.8%) of athletes and 80.0% of athletes with IBS reported trying nutritional modifications to help ease symptoms while 20.6% and 52.4% used over-the-counter medications, respectively. • Most endurance athletes who suffer from IBS are undiagnosed, while even more experience GI symptoms but do not fit diagnostic criteria. • Despite using various symptom management methods, endurance athletes are still experiencing symptoms and could potentially benefit from current IBS-mitigating strategies.

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