Running Ultramarathons with a Stoma and a Parastomal Hernia

Before I had a stoma I had completed half a dozen ultramarathons and it had my favourite race distance but when I had surgery in January 2019 I wasn’t sure how having a stoma would affect running those distances.

I soon discovered that having a stoma didn’t affect running in general so why should it affect running an ultramarathon? As soon as I able to get back into running without any complications in May 2020 my goal was to train towards running my first ultramarathon again and by early 2021 I had completed that goal and proved that having a stoma, and a parastomal hernia, does not prevent you from achieving your goals.

How to Prepare for an Ultramarathon with a Stoma

When I had my stoma installed back in January 2019 I would change my colostomy bag multiple times a day sometimes in the comfort of a toilet, other times out in the open. Whilst I didn’t do much running in 2019 I did experience a mid-run change of bag on at least one occasion. Throughout the year I didn’t get on with changing the bag so my stomach nurse recommended irrigation and whilst I was pretty certain I was going to switch to it the clincher was a comment on an irrigation support group where someone said that if I want to run ultramarathons irrigating will be ideal. I was completely sold. I would be committing to devoting a portion of my day many days a week but there would be occasions when I would reap the rewards.

I’ve been irrigating for over a year and have a regular part that fits in with my training schedule. I tend to run Tuesday, Wednesday, Thursday, Saturday and Sunday and irrigate Monday, Wednesday, Friday and Saturday. Saturday is my day for long runs so I’ll either irrigate before running or the night before if I need an early start.

16 months irrigating and I still haven’t mastered it (and probably won’t) so sometimes I can irrigate at 5:30am and at 8:30am when I’m in work I could still be experiencing output whereas other times I could be empty in 45 minutes. Based on this if I want to have a long run on Saturday (eg 20+ miles) I’ll opt to do it on Friday night so that I can just get up and go.

Most runs are uneventful and I don’t need to change the bag as I can last between 24-48 hours with no and then little output. I do still take supplies with me which usually consists of a spare colostomy bag, a dry wipe, wet wipes and black bag. It’s pretty minimal and I do take it with me on almost every run I do just in case.

However, going minimal has resulted in me being caught out on two occasions. The first was around 13 miles into a 20 mile run when I hadn’t irrigated either on the morning or before the run and had a big bag leak. That was a messy one and with only a single dry wipe and a couple of wet wipes I couldn’t clean properly but I still managed to get the 20 miles completed. The second time was recently running 26 miles where I managed to catch the leak early at 19 miles and cleaned up but just two miles later I sprung another leak and could only plug the gap in the bag with some leftover wet wipes. from that day forward I was going to ensure I carried more than enough supplies.

Running an Ultramarathon

Since having a stoma I’ve completed ultramarathon distance 24 hour challenges spread over but they’ve started and finished at the house so had all the supplies I needed but I’ve also completed a 44 mile self supported out and back run in 2021. For that run I irrigated the night before so that I could have a 7am start and took the minimal kit with me (this was before the second leak I experienced).

Things went perfectly and I was able to get up and ensure my kit was all in order without having to worry about using the toilet and then when out I completely forgot about the stoma and just focused on trying to complete the distance. This was exactly what I had signed up for when I started irrigating. During past ultramarathons I’ve had to get up extra early to try and kick start my body into going to toilet or heading out for a run until the runner’s trots appear. The first ever marathon I ran before having a stoma involved getting up 3 hours before the start time of 7am (I was only 20 minutes away from the start line) and not being able to convince my body to go to toilet. 13 miles into the race it decided that it needed to go! Those days are hopefully long gone.

Running with a Parastomal Hernia

When the parastomal hernia made its first appearance around 4 months after my initial surgery in 2019, I struggled with it a lot. I was very conscious about it protruding from my body and was torn between whether I should have it operated on or not. This went on for many months throughout all of 2019 and into 2020 but eventually I learned to live with it and even though I always know it’s there and can always feel it sticking out, I’ve accepted that it’s now part of my body and doesn’t hinder my running.

Whenever I head out for a run, I always wear a hernia support belt which is a wide stretchy belt that can be made as tight or as loose as you want using velcro. The aim of the belt is to keep the hernia close to the body to prevent movement and it does a pretty good job.

I was quite surprised by how having a hernia didn’t effect my running and how running didn’t effect the hernia. Even running for long distances has no effect. It’s reassuring to know that by doing something I enjoy I won’t be jeopardising my future health.

The Benefits of having a Stoma when Running an Ultramarathon

Having a stoma does have some distinct advantages and all are related to poop. At the start of a race the queues for the toilets are usually quite large so arriving with your own little toilet bag attached to your body means there’s no need to worry about squeezing in a last minute number 2 before the start. Granted the ultramarathons usually have less starters than other races but the toilets can still get busy.

Before I had a stoma I was plagued by the dreaded runner’s trots and frequently as soon as I started running my body was ready to poop and when you have Crohn’s or Ulcerative Colitis you don’t have long to find a toilet, or a bush. That’s where the colostomy bag comes to the rescue. You will still need to change the bag but you have control over that and can either continue of the output is small or change it.

If you decide that irrigation is for you (only those with a colostomy can irrigate) the benefits can be even greater as I found out on my first ultramarathon with a stoma. I ran for 8 hours and didn’t need to do anything with the colostomy bag as well as before and during the post-run beers.

The Downsides of having a Stoma when Running an Ultramarathon

Like the benefits, the downsides are all poop related. The biggest risk I experience when running are leaks from the colostomy bag and occurs when instead of going down into the bag the poop ‘pancakes’ and spreads outwards ultimately leaking. Wearing a tight hernia support belt increases the risk of pancaking by preventing the poop from moving down in the bag. There are sometimes warning signs such as smells but sometimes that could be wind escaping from a crease in the bag and I’m usually too focused on running so keep on going. If that warning sign is genuine, like it was during my last leak, then the next step warning is a warning sensation. By this point it’s usually too late and the poop has started to escape and there’s going to be a cleanup operation, it’s just how much you’ll have to cleanup, and how well prepared you are with the supplies.

Mid-run bag changes are also a downside but as long as you are happy changing a bag on the side of a road or behind a tree it’s more of a minor inconvenience, unless you are chasing a PB but this is never the case for me in an ultramarathon — stopping to take a hundred photos along the way killed off any chances of getting a PB. Most with Crohn’s or a stoma will have a trusty Radar key with them so can always use it to get into a disable toilet if running past one.

Preparation can also be a downside if you irrigate due to needing to plan around a run or a race. So far I’m yet to run an ultramarathon race since starting to irrigate and depending on the location and time of the race would need to plan whether I do it the night before or on the morning of the race. And if you are staying in a hotel prior to the race you need to make sure you have all the irrigation equipment with you. I have had experience irrigating away from home so this shouldn’t be an issue when I do next travel to a race.

What’s Next?

My ultramarathon journey is just beginning and I’m already training for my next challenge which is to run the circumference of the county of Newport. It’s approximately 72 miles and will be by far the furthest I’ve run. I’m currently 8 weeks into a 100k training plan and it’s going really well so I’m confident that I’ll be able to give it my best shot in the summer.