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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, smelling ammonia after a run, 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 training 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. Hemorrhoids (also known as “piles”), happen when veins in the anus and lower rectum swell, similar to varicose veins. Believe it or not, hemorrhoids are 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.”
Can running cause 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. That doesn’t mean you need to give up all training – only certain forms.
Can I exercise with hemorrhoids?
If you are currently experiencing painful hemorrhoids, weight lifting is definitely not recommended, as it can make your symptoms worse and prolong the healing process. Other exercises to avoid with hemorrhoids might also include cycling and running, especially intense efforts that can irritate the external skin. However, other forms of movement such as walking, stretching, or even a yoga class are fine, and may even relieve some of the symptoms. Let your body be your guide. “I always counsel my patients that if it hurts, they should not do it,” says Bailey.
After the hemorrhoids have healed, Bailey also advises a gradual return to training. 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.” After ruling out more severe causes of your symptoms, you may be referred to a physical therapist, who can provide the best abdominal and pelvic floor exercises to treat and prevent the underlying causes of hemorrhoids.
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