Thorn in Your Side or Thorn in Your Head? Anxiety and Stress as Correlates of Exercise-Related Transient Abdominal Pain

Clin J Sport Med. 2022 Sep 1;32(5):471-475. doi: 10.1097/JSM.0000000000001000. Epub 2021 Dec 7.


Objectives: The etiology of exercise-related transient abdominal pain (ETAP) is not congruent among researchers notwithstanding numerous studies on the matter. No pursuit has sought to correlate ETAP with factors such as anxiety, stress, sleep dysfunction, and pain sensitivity that are linked to other gastrointestinal (GI) disturbances in athletes.

Design: Cross-sectional observational study involving an anonymous survey.

Setting: Online.

Participants: One hundred sixty-eight male and female adults running at least 10 miles/wk.

Assessments of risk factors: Age, body mass index, years of running experience, GI symptoms, the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Perceived Stress Scale (PSS)-14, Sleep Problems Index-I, and Pain Sensitivity Questionnaire.

Main outcomes: Exercise-related transient abdominal pain prevalence over the past month as well as ETAP severity and frequency.

Results: Exercise-related transient abdominal pain occurred in 39.9% of participants at least once in the past month. Exercise-related transient abdominal pain-positive runners were significantly younger and less experienced than ETAP-negative runners. Exercise-related transient abdominal pain-positive runners demonstrated higher resting and running-related GI symptoms, PSS-14, and STICSA scores compared with ETAP-negative runners. After accounting for age and experience, the ETAP-positive group had STICSA and PSS-14 scores that were 3.4 [95% confidence interval (CI), 1.0-5.8] and 4.1 (95% CI, 1.2-6.0) points higher, respectively, than the ETAP-negative group. State-Trait Inventory for Cognitive and Somatic Anxiety scores were significantly, modestly correlated (ρ = 0.27, P = 0.03) with ETAP frequency but not severity in runners who were ETAP-positive.

Conclusions: In runners, this is the first investigation to reveal that anxiety and stress are associated with the presence of ETAP.

Publication types

  • Observational Study

MeSH terms

  • Abdominal Pain / epidemiology
  • Abdominal Pain / etiology
  • Adult
  • Anxiety
  • Cross-Sectional Studies
  • Exercise*
  • Female
  • Humans
  • Male
  • Running*