Talking about this common ailment can seem taboo, but it’s important to get the answers you need.
The more time one spends in triathlon, the more body oddities they encounter: toes that swell up like Vienna sausages post-race, sneezing fits in the pool, and monster headaches after a tough workout. But perhaps none are more befuddling—and more terrifying—than seeing blood in the toilet bowl during or after a workout. The discovery can cause all sorts of panic—Is it possible that you’re working so hard you’re…pooping blood?
Probably not, says Dr. Ellen H. Bailey, Teaching Faculty in Colon and Rectal Health at Mt. Carmel Medical Center. More likely, you’ve got hemorrhoids, or swollen vascular cushions in your anus or rectum. Believe it or not, they’re quite common in endurance athletes, thanks to a perfect storm of pressure, irritation, and dehydration.
“Everyone has internal hemorrhoids,” explains Bailey. “In some people, the hemorrhoidal tissue can lengthen and present outside the anal canal—these are external hemorrhoids.”
Bleeding during bowel movements is the most common sign of hemorrhoids, a result of straining during bowel movements (which often happens when dehydrated) and/or increased pressure on the veins.
“Both cycling and running are filled with repetitive motions that can irritate the perianal skin and hemorrhoidal tissue,” says Bailey. “This can cause a flare-up of external hemorrhoids, which can result in swelling, burning and hurting.”
The pain can be enough to sideline a runner or cyclist—think a really, really uncomfortable case of chafing. Like any other injury, hemorrhoid flare-ups need to heal before resuming a regular exercise protocol. “I always counsel my patients that if it hurts, they should not do it,” says Bailey, who advises a gradual return to training after the body has healed.
To keep symptoms at bay, managing dehydration is key. Drinking at least 64 ounces of caffeine-free beverages per day—more during periods of heavy training or hot weather—is a major aid in preventing flare-ups. Athletes with symptomatic hemorrhoids may also find pre-medicating with Tylenol or Ibuprofen before workouts can help mitigate pain and swelling. There are also topical applications: “Some patients find salves containing witch hazel to be soothing, so applying this before a workout is worth a try,” says Bailey. “There are also over-the-counter lidocaine ointments that can bring temporary relief to sensitive areas.”
If symptoms reoccur, or if they do not improve over several weeks, it’s best to make a visit to the doctor. “Anorectal bleeding is always an appropriate issue to bring to your primary care provider’s attention,” says Bailey. “Most of the time, this will be related to hemorrhoids or some other anal canal pathology that is benign. But depending on your age, family history, or other risk factors, there may be additional workup to consider.”