Introduction

It's all too easy to misinterpret abdominal pain when running as being the dreaded stitch but there are a number of other problems that can feel like a stitch.

Summary

• The stitch runners can experience when running does not yet have a conclusive explanation (in last week's blog, we looked at what the research suggests are the most likely causes)
• Stitch-like pain can actually be a result of something else going on
• In this article, I present 10 possible alternatives that can create a similar pain
• This is not a fully comprehensive list, but is based on my experience and/or research - always consult your Doctor if you are experiencing unexplained symptoms

Read The Article

Last week, I wrote an article about the “6 Most Likely Causes Of A Stitch (According To Research)”, but there are also a number of other problems that can also “feel” like a stitch.

I’ve learned from experience that it’s all too easy to misinterpret abdominal pain when running as being the dreaded stitch. This article will hopefully give you an overview of some other problems that can appear to be a stitch but have completely different causes.

If you suspect that your stitch could be something else, then this is definitely worth checking out. And if you are worried that it could be something other than a regular stitch, please ask your Doctor or another medical professional for advice.

I have tried to create a fairly comprehensive list of possible alternatives to a stitch, but it is by no means an exhaustive list of all problems.

So here goes… By the way, if you have experienced any of these or any other problems that felt like a stitch, I’d love to hear from you. Please drop me a comment or get in touch via ([email protected]).

1. Gallbladder Problems (Chronic cholecystitis)

I’m starting with this one as it is something that I have seen happen with a running client who experienced regular stitch-like pain upon increased exertion during running.

Pain in the upper right of the abdomen, high up under the ribs, could be due to problems with the gallbladder. These problems could be due to undiagnosed gallstones, or adhesions between the gallbladder and surrounding organs (liver or colon) or tissues (abdominal wall). This condition usually requires the removal of the gallbladder.

The running client I mentioned earlier would regularly experience a stitch-type pain the in the upper right area just under her ribcage. The pain would appear during each run when the pace increased beyond a certain limit. This client also started to experience pain in the same area outside of running that then seemed to be associated with eating fatty foods.

Later investigations revealed the presence of 3 stones in the gallbladder that was resolved with the removal of the gallbladder through laparoscopic surgery, which also eliminated the previous stitch-like symptoms experienced with running.

Surgery in this particular case did have a very good outcome, as was demonstrated 7-weeks post-op, when this client completed back-to-back 10-mile Tough Mudder events over one weekend.

2. Stress Fracture of the Ribs

This one could be experienced anywhere over the chest area but it can be easy to misinterpret a stabbing pain in the lower rib areas as being a stitch. However, the pain could also be due to a stress fracture of the ribs.

As with all of the problems mentioned in this article, this is best examined and diagnosed by your Doctor.

3. Intercostal Muscle Strain

Similar to the pain associated with a stress fracture of the ribs, the pain may actually be due to a strain of the muscles in between the ribs, known as the intercostal muscles.

This is one that I have experienced myself in the past after a bad chesty cough actually resulted in a strain of the intercostal muscles. I wasn’t actually running at the time as the cough was preventing me, but the pain experienced for a couple of weeks after the strain was very painful and one that I could understand being interpreted as a stitch.

4. Chronic Constipation

Cases have been reported of runners experiencing a mild form of constipation due to the jarring movements associated with running. A simple and effective treatment is to improve fibre intake with a regular intake of psyllium (e.g. in capsule form (https://amzn.to/3xH4br4), or as a powder (https://amzn.to/3SmVSJa) that can be easily added to foods, shakes or smoothies).

It’s worth noting that the opposite can also happen to some runners, in that the jarring movements actually result in a bout of diarrhoea and a sudden “need to go”. I talked more about this in a previous blog article: Oh Sh*t! What Happens If You REALLY Need To Go Poop?

5. Abdominal Wall Muscle Strain

Pain experienced in the upper middle part of the abdomen could possibly be a muscle strain.

I haven’t experienced a strain in this area, but I have experienced DOMS (Delayed Onset Muscle Soreness) after some particularly challenging core workouts. The pain is generally localised quite centrally to the midline of the body and high up just under the ribcage.

6. Kidney Stones or Renal Failure

If you are experiencing severe pain in the sides, especially if it also radiates down to the groin, then you may be experiencing kidney stones. If the pain is on both sides at the same time, then it could possibly be one of the two types of exercise-induced acute renal failure: myoglobin-induced acute renal failure, or acute loin pain after anaerobic exercise (ALPE).

7. Problems with the Spleen

Enlargement of the spleen, which is common in people with Glandular Fever (mononucleosis) may cause pain in the upper left side of the abdomen, as can a restricted blood flow to the spleen (splenic infarction).

8. Exercise Associated Intestinal Ischemia

Pain in the lower areas of the abdomen that is accompanied by diarrhoea may actually be experiencing a form of ischemic bowel disease and should be checked out by a Doctor.

9. Adhesion of ascending colon to the anterior abdominal wall

It is possible for adhesions to develop between the ascending colon and abdominal wall. The pain associated with this condition can be severe and is especially prevalent during higher levels of exertion. This condition can usually be resolved with surgery once a diagnosis has been made.

10. Median Arcuate Ligament Syndrome

Recurrent pain in the upper abdominal area along with diarrhoea could also be indicative of compression of the coeliac artery by the median arcuate ligament and can be resolved through surgery.

So, as you can see, there are a number of other potential problems that can present with similar pain to a stitch. Some have a very clear location where they are always experienced, such as the upper right abdomen pain of gallbladder problems, or the upper left pain of spleen-related problems. Some have accompanying problems like diarrhoea, as is the case with Exercise Associated Intestinal Ischemia or Median Arcuate Ligament Syndrome.

The point I am hopefully making with this article is that just because it feels like a stitch, doesn’t mean it actually is a stitch. If you have any doubts about a pain you are experiencing when running and/or that pain doesn’t seem to get resolved, then please speak to your Doctor for further advice.

As always, I hope you’ve found this article interesting and useful. If you have ever experienced a stitch, whether that’s turned out to be just a stitch or something else, I’d love to hear your story. Please drop us a comment or get in touch privately if you’d rather not share publicly.

Happy running

Coach Barrie

BE Fit Coach

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