Definition
Abdominal pain during running is common among runners, beginners and experienced alike. It can take different forms: side stitch, colicky pain, digestive discomfort or abdominal cramps.
In most cases, this pain is benign and related to diet, hydration or the mechanical stresses of exercise. It does not necessarily indicate a serious digestive disorder, but recognising and preventing it can improve comfort and performance in both training and competition.
Anatomy
Several structures in the abdomen can be involved in this pain: the diaphragm and its suspensory ligaments (particularly involved in side stitch), the digestive tract (stomach, bowel), and the abdominal wall and trunk muscles.
During running, repeated impacts make the digestive organs move, which can irritate the bowel, while breathing and the tension on the ligaments connecting the diaphragm to neighbouring organs can cause the classic side stitch.
Epidemiology
Exercise-related abdominal pain is a common complaint among runners of all levels. The side stitch in particular is one of the best-known and most frequently reported types of abdominal pain during running.
Causes & risk factors
Several factors explain the onset of abdominal pain during running: incomplete digestion, inappropriate hydration, poorly controlled breathing, insufficient core strength, or running at too high an intensity. A combination of several of these factors greatly increases the risk of pain.
Side stitch
It usually presents as a sharp pain on the right or left side of the abdomen. Possible causes include irregular breathing, an overly full stomach, ongoing digestion, or tension on the ligaments of the diaphragm.
Diet-related digestive pain
Some foods or drinks consumed before running can cause abdominal pain: unfamiliar energy drinks, high-fibre foods, dairy products, or an overly large meal before exercise. This pain often takes the form of abdominal cramps or a feeling of bloating.
Mechanical colic pain
During running, repeated impacts can cause digestive pain known as mechanical colic pain: the repeated jolts make the digestive organs move, which can irritate the bowel.
Symptoms
A side stitch causes a sharp pain localised on the right or left side of the abdomen. Diet-related digestive pain tends to present as abdominal cramps or a feeling of bloating. Mechanical colic pain, for its part, causes diffuse abdominal pain, a need to go to the toilet and general digestive discomfort.
In the vast majority of cases, this pain remains moderate, appears during exercise and disappears quickly after adjusting pace or breathing.
Treatment
What to do immediately if pain appears during a run
In the event of a side stitch, it is advisable to slow down, control your breathing and press gently on the painful area. More generally, if abdominal pain appears during exercise: slow down, breathe deeply, press gently on the painful area, and walk for a few minutes if necessary. In most cases, the pain disappears quickly.
When to see a health professional
Running-related abdominal pain is generally benign. However, a consultation is recommended if the pain is very intense, if it persists after exercise, if it is associated with nausea or vomiting, or if it occurs on every run. A doctor or sports health professional can then look for an underlying digestive or muscular cause.
Prevention
Adapt your diet
Avoid heavy meals in the 2 to 3 hours before running, limit fatty or high-fibre foods, and try out energy drinks in training rather than in competition.
Manage your hydration
Drink in small sips, avoid very sugary drinks, and never try a new drink on race day.
Improve your breathing
Work on abdominal breathing and maintain a regular breathing rhythm, which limits the onset of side stitch.
Strengthen your core
A stable trunk limits the stresses on the digestive organs: the abdominal plank, side plank and diaphragm work are useful exercises.
Frequently asked questions
Why do I get a side stitch when I run?
Can you run after eating?
Can energy drinks cause pain?
Key points — Institut Basque du Coureur
Abdominal pain during running is common and generally benign. It is most often related to digestion, hydration or breathing. Good management of diet and exertion makes it possible to avoid it in most cases.