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Abdominal Pain After a Workout

by
author image Dr. Tina M. St. John
Tina M. St. John runs a health communications and consulting firm. She is also an author and editor, and was formerly a senior medical officer with the U.S. Centers for Disease Control and Prevention. St. John holds an M.D. from Emory University School of Medicine.

Working out is supposed to make you feel good, in addition to keeping you healthy. So the development of abdominal pain after working out might seem counterintuitive and leave you scratching your head. Abdominal pain during or shortly after a workout is relatively common, especially with prolonged and vigorous physical activity. This symptom occurs for a variety of reasons, some relatively minor and others more concerning. Possible causes include abdominal wall ailments, reduced blood flow to the intestines and dehydration.

Delayed-Onset Muscle Soreness

Virtually any workout engages your abdominal wall muscles, some more than others. Abdominal pain that develops 8 to 24 hours after a workout might be due to delayed-onset muscle soreness (DOMS). This type of pain usually develops if your workout included new abdominal exercises, or increased reps or intensity of familiar exercises. Characteristic symptoms include muscle soreness, tenderness and stiffness, along with temporarily reduced strength. Symptom intensity ranges from mild to severe, depending on the level of muscle overexertion. Generalized pain on the sides of your abdomen occurs when DOMS involves your oblique muscles. Frontal abdominal pain develops with involvement of your rectus abdominis muscle. Side and frontal pain occur with overexertion of both your obliques and rectus muscle. DOMS symptoms typically peak within the first day or two and gradually resolve over 5 to 10 days.

Abdominal Strain

Workouts featuring intense, strenuous abdominal exercise may result in an abdominal strain -- especially if you're pushing yourself. This injury involves tearing of abdominal muscle or tendon fibers, usually one of your obliques or the rectus muscle. Pain and tenderness typically develop in a specific location rather than being more diffuse. An oblique strain usually causes side tenderness and pain arising from your lower rib cage. A rectus strain most often causes discomfort a couple of inches below your navel. You might notice the pain while working out, although delayed discomfort is relatively common with mild abdominal strains. Coughing, sneezing and other activities that stretch the injured muscle aggravate the pain. With rest, pain from a mild abdominal strain gradually diminishes over 10 to 14 days. More severe strains might take up to 10 weeks to resolve completely.

Temporary Digestive System Changes

A vigorous workout triggers temporary digestive system changes that can lead to upper or lower abdominal pain, as well as nausea, vomiting and diarrhea. These symptoms can occur during or after your workout, or both. Although many factors contribute to these digestive system changes, reduced blood flow to your stomach and intestines appears most influential. When you exercise, your body preferentially directs blood to your muscles, heart, lungs and skin. This results in diminished blood and oxygen delivery to your digestive organs, which can provoke abdominal pain and other gastrointestinal symptoms. The degree of blood shunting away from the digestive system increases with exercise intensity and duration and varies among individuals. Additionally, younger adults appear to be more significantly affected than seniors. Abstaining from large meals and foods high in fat, fiber or protein for 2 to 3 hours before your workout might prevent the development of digestive symptoms by reducing the demands on your gastrointestinal system while exercising.

Fluid Loss and Dehydration

A high-intensity workout can potentially lead to dehydration and overheating, especially in hot, humid conditions. As you exercise, your muscles generate large amounts of excess heat, which increases your body temperature. This triggers profuse sweating to cool your body as the perspiration evaporates from your skin. Fluid lost during exercise reduces the volume of water in your circulatory system, which can further reduce blood flow to your digestive organs and trigger abdominal pain and other gastrointestinal symptoms. Ensuring you're well hydrated before beginning your workout and sipping water while exercising can help reduce the likelihood of dehydration and this mechanism of abdominal pain.

Nonsteroidal Antiinflammatory Medication Use

Many active adults take nonsteroidal antiinflammatory drugs (NSAIDs) -- such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve) -- to fend off or relieve minor exercise-related aches and pains. But NSAID use may contribute to abdominal pain during or after a workout. Through complex mechanisms, these medicines can aggravate reduced digestive system blood flow during exercise, potentially tipping the scales toward developing abdominal pain and other symptoms. Additionally, these medicines can directly or indirectly damage the lining of the stomach and first portion of the small intestine, leading to inflammation or ulcer formation. Upper abdominal pain is a common symptom of inflammation of the stomach lining, or gastritis, and peptic ulcers. Although this pain can occur at other times, it might be provoked by exercise, especially if you take an NSAID before your workout.

Other Causes

Although conditions and factors previously noted account for most cases of post-workout abdominal pain, other possible causes exist. For example, a bulging or herniated spinal disc or a bone abnormality in the lower portion of your thoracic spine -- from roughly the lower tip of the shoulder blade to the waist -- might cause referred pain in your upper abdomen. Stones in the urinary system, including the kidney or bladder, also sometimes cause pain in the abdomen, back or groin associated with exercise. Rarely, tumors in the abdominal wall or the pelvic or abdominal cavity cause belly pain, which could be aggravated by the jostling that occurs with a workout.

It's also possible that abdominal pain occurring after a workout is unrelated to the physical activity, and the timing amounts to nothing more than a coincidence. This is certainly plausible, especially given that abdominal pain is a very common symptom that occurs with many conditions and diseases.

Next Steps, Warnings and Precautions

Mild abdominal pain after a workout that occurs infrequently and goes away relatively quickly typically doesn't represent a significant threat to your health. Adjusting the intensity of your workouts, ensuring adequate hydration and avoiding eating too close to vigorous exercise might eliminate the problem. However, if you experience frequent, persistent or worsening pain, see your doctor as soon as possible. Seek immediate medical care if your abdominal pain is accompanied by any warning signs and symptoms, including:
-- Confusion, dizziness, lightheadedness or fainting.
-- Nausea, vomiting or bloody or black stool.
-- Fever, chills, paleness or clammy skin.
-- A persistent, painful bulge in your abdomen or groin.
-- A rapid heart or breathing rate that continues after resting.

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