Irritable bowel syndrome is underdiagnosed and ineffectively managed among endurance athletes

Appl Physiol Nutr Metab. 2019 Dec;44(12):1329-1338. doi: 10.1139/apnm-2019-0261. Epub 2019 May 7.


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, the meeting of IBS diagnostic criteria (Rome III or Manning), general GI symptoms, and symptom mitigation strategies of endurance athletes. The questionnaire was distributed to United States 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 1 symptom sometimes, often, or always 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. Novelty 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.

Keywords: athlete performance; athletes; athlètes; course à pied; epidemiology; nutrition; performance des athlètes; physiologie; physiology; running; épidémiologie.

MeSH terms

  • Adolescent
  • Adult
  • Athletes*
  • Female
  • Humans
  • Irritable Bowel Syndrome / diagnosis*
  • Irritable Bowel Syndrome / therapy*
  • Male
  • Middle Aged
  • Missed Diagnosis / statistics & numerical data
  • Physical Endurance
  • Prevalence
  • Running
  • Surveys and Questionnaires
  • United States
  • Young Adult