Last weekend, an athlete won the women’s elite race at HYROX Beijing in just over an hour. Somewhere around the halfway mark, her bowels gave out. She kept going. Through the burpee broad jumps, the rowing, the wall balls. Then she won.
The internet has since split into two camps. One thinks it is the most committed thing it has ever seen. The other would like to know who is paying for the next competitor’s dry cleaning.
I race Hyrox myself, and I have spent a long career listening to women describe symptoms they have never said out loud to anyone else. So I have a third view. It is less interesting on social media and more useful everywhere else: this is common, it is largely preventable, and very few of the people it happens to ever tell their doctor.
More common than anyone admits
Depending on which study you read, somewhere between a third and the large majority of endurance athletes report gut trouble during hard exercise. Cramping, urgency, diarrhoea. Runners have had a polite name for the last one for decades — “runner’s trots” — which tells you how often it comes up in the changing room, and how rarely it comes up anywhere else.
Most of it never makes the news. It happens in a portable toilet at kilometre six, or it almost happens, and the athlete spends the rest of the race in private negotiation with herself.
Why the gut gives up before the legs do
When you exercise hard, your body decides where the blood goes. Muscles and skin win. The gut loses. At high intensity, blood flow to the intestines drops substantially, and a gut that is short of blood stops behaving normally.
Then there are the mechanics. Running jostles everything. So does jumping. And Hyrox, in fairness to its designers, could hardly be better engineered to provoke a digestive incident if that had been the brief: eight kilometres of running broken up by sled pushes, sled pulls, lunges, wall balls and burpees, each one a spike in pressure inside the abdomen.
The usual accelerants:
- Caffeine shortly before the start
- Energy gels, especially concentrated ones or those containing sugar alcohols
- A high-fibre or unfamiliar meal the night before
- Dehydration and heat
- Anti-inflammatory painkillers such as ibuprofen, which make the gut lining more vulnerable under stress
- Nerves. Race-morning adrenaline speeds things along in a way nobody asked for.
Why women carry more of the risk
There is a quieter part of this conversation, and for most of my readers it matters more than who won in Beijing.
The pelvic floor does a great deal of work that nobody notices until it stops. Pregnancy and vaginal birth can weaken it, and some women sustain an injury to the anal sphincter during delivery that is never picked up at the time. High-impact training loads it over and over. Then through perimenopause and menopause, falling oestrogen changes the tissues that hold everything in place.
So leakage during exercise is common in women who train, including very fit ones. Urine far more often than stool, but both. A great many women quietly stop jumping, or skipping, or running, and assume that is simply what happens after children or after fifty. Very often it is treatable. (Perimenopause has a habit of arriving unannounced in other ways too — I have written about that here.)
I should be clear that I do not know what happened in this particular athlete’s case, and it would be unprofessional to guess. Exercise-induced diarrhoea and a weak pelvic floor are different problems with different fixes. That is precisely why this is worth a proper assessment rather than a diagnosis borrowed from a viral video.
When to stop, and who else is on the course
Now for the part that made everyone so cross.
Finishing a race while unwell is an athlete’s decision, up to a point. That point is usually where it starts to affect other people. Faeces carry bacteria and viruses that spread readily on shared surfaces, and a Hyrox course is essentially a sequence of shared surfaces: rowing handles, sled handles, and mats that the next competitors will be throwing themselves onto for burpees, often with grazed hands and knees.
The organisers disinfected the equipment and replaced sections of the flooring afterwards, and asked that the athlete not be blamed. I think that is fair. With adrenaline running, a podium in sight and possibly no idea how visible the problem was, the person racing is the least well placed to decide whether to stop. That is exactly what officials and medical staff are for.
“A win is a win” is a perfectly good philosophy. Until you are the next person on that rower.
What actually helps
If this has happened to you, or you have been avoiding hard sessions in case it does, these make a real difference.
Train your gut as well as your legs. Rehearse your race-morning food, fluids and caffeine in training. The gut adapts. Race day is not the day to try a new gel.
Reduce fibre for a day or two before a big effort, and keep the pre-race meal modest and familiar.
Time your caffeine so there is a proper window to use the toilet before the start.
Skip ibuprofen before and during hard exercise, unless a doctor has advised otherwise.
See a pelvic floor physiotherapist if you leak when you exercise. Not an app, and not a few squeezes on the sofa. Someone who can assess how your pelvic floor behaves under load, because under load is when it counts.
Consider magnetic stimulation alongside the exercises, not instead of them. Most women struggle to find and fire the right muscles, which is hardly surprising, since they are invisible and nobody teaches this at school. Functional magnetic stimulation contracts the pelvic floor far more times in one session than anyone could manage voluntarily, while you sit fully clothed and do nothing more strenuous than scroll your phone. At SW1 we offer it as Magnetic Muscle Sculpting, and there is more detail on how it works for the pelvic floor here. The evidence is strongest for urinary leakage. It will not stop exercise-induced diarrhoea, and it will not repair a sphincter injury. As part of a proper strengthening plan, it is genuinely useful.
See a doctor if the symptoms are new, if they happen at rest or at night, if there is blood, if you are losing weight without trying, or if bowel cancer runs in your family. Exercise can cause gut symptoms. It can also take the blame for something else. Past a certain age, I would rather rule that out than assume.
The part nobody wants to say
What happened in Beijing was only unusual because it was filmed. The same problem sits quietly with a great many women who train hard and never mention it to their coach, their partner or their doctor.
I would rather they mentioned it. It is a much shorter conversation than most people fear, and considerably less public than the alternative.
I compete in Hyrox myself, and have written about racing at 51 and the limits we invent. For more on women’s health, ageing and the evidence behind both, visit my YouTube channel. I see patients at SW1 Clinic in Singapore, where you can book a consultation.
