Joanna Wietrzyk’s HYROX incident: Why intense exercise can affect bowel control

Joanna Wietrzyk’s viral HYROX incident has put bowel control in focus. Gastroenterologists explain why intense exercise can trigger urgency or leakage.

At the HYROX event in Beijing on September 12, an unprecedented situation saw an Australian athlete losing bowel control mid-race, but winning at the finishing line. Footage of Joanna Wietrzyk showed her continuing high-intensity routines like running, rowing, sled pushes and wall balls, with faecal matter visibly running down her legs. The incident drew global attention, triggering a social media debate about the event’s hygiene standards, and how athletes should react in such situations.

Joanna Wietrzyk’s HYROX incident has put an awkward fitness problem in the spotlight. (X)

While the event’s rules have since been updated, athletes and fitness enthusiasts cannot run away from the fact that intense exercise can actually affect the gut, say experts.

“Bowel leakage during intense exercise is multifactorial. During prolonged or high-intensity activity such as HYROX, blood flow is redirected from the gastrointestinal tract to the working muscles. Repeated running, increased abdominal pressure and changes in gut motility can contribute to urgency or loss of bowel control,” says Dr Rajnish Monga, Chairman - Gastroenterology, Paras Health, Gurugram.

While bowel incontinence is often seen as an older person’s problem, doctors say runner’s diarrhea is common, says gastroenterologist Dr Amit Mittal, Marengo Asia Hospitals, Gurugram. “During intense exercise, the body redirects blood away from the digestive system towards the muscles and heart. This can affect how the gut works. The constant impact of running can also jostle the bowel and stimulate the urge to go, while stress hormones released during exercise can increase bowel contractions.”

In fact, surveys of runners and endurance athletes suggest that around one in three experience an urgent need to open their bowels during hard training, points out gastroenterologist Dr Vikrant Panwar, Shalby International Hospital, Gurugram. “Actual leakage is much rarer, but it does happen. Sometimes, running itself can make matters worse. The bowel can also become more irritable and speed up during intense effort.”

The role of the pelvic floor

The pelvic floor is essentially a hammock of muscles that helps keep the back passage closed. Running and rowing repeatedly load these muscles and also stir the bowel - a combination that can overwhelm the body’s normal mechanism, says Dr Amit Mittal. “The muscles around the back passage have to work harder when pressure builds up in the abdomen. During intense exercise, these muscles can become tired. If the stool is loose, it can then become harder to hold it in, and leakage can happen. But one such episode during a particularly intense workout or race does not necessarily mean the exercise has damaged the pelvic floor,” says Mittal.

When should you worry?

For an athlete who has one episode during an unusually long or intense event, doctors say there may not be reason to panic. “If there is an obvious trigger such as a long race, heat or a new gel, a single episode is often a one-off,” says Panwar. But repeated leakage should not simply be written off as part of being fit. “Recurrent episodes deserve a check-up. Blood in the stool, weight loss, persistent abdominal pain, night-time symptoms or a significant change in bowel habits are all reasons to seek medical attention,” he says.

What can trigger fecal incontinence?

What an athlete eats and drinks before a race can matter almost as much as the workout itself. Dr Monga says these can trigger bowel urgency:

• Large or heavy meals too close to exercise
• High-fat or high-fibre foods
• Caffeine
• Sugar-free sweeteners
• Too many or highly concentrated sports energy gels
• Drinking a large amount of fluid at once
• Dehydration
• Heat
• Pre-race nerves

How to manage fecal incontinence?

Dr Pawar suggests:

• Keep a simple food-and-bowel diary to spot your triggers
• Eat your main meal two to three hours before exercise
• Choose low-fibre, low-fat food on training mornings
• Avoid caffeine and sugar-free sweeteners beforehand
• Sip fluids steadily rather than gulping
• Empty your bowel before you start
• Practice pelvic-floor exercises – ten slow squeezes, three times a day

If symptoms persist, a gastroenterologist can offer fibre supplements, stool-firming medicines, biofeedback training and a few simple tests.