Exercise is supposed to be good for you, so when it starts causing you abdominal pain it might make you question its value. Side stitches are the most common cause of abdominal pain during a workout. However, muscle cramps, indigestion and a muscle strain can also be to blame. Plus, it's always possible that sharp pains could be the sign of a more serious condition requiring medical attention.
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Abdominal pain during a workout could be caused by cramps, digestive issues, side stitches or muscle strain.
Good Old Side Stitches
Almost everyone who exercises has experienced the pain of side stitches at least once. Also known as exercise-related transient abdominal pain (ETAP), it can be felt in the side of the abdomen or the lower abdomen.
According to Berkeley Wellness, side stitches occur most commonly during vigorous exercise that includes repetitive movement of the torso. They also tend to be felt on the right side of the abdomen.
The pain from a side stitch can be dull or achy, or it can be sharp and stabbing. It often starts out as a dull, cramping or pulling sensation and intensifies to more severe pain.
Causes of Side Stitches
No one is quite sure what causes side stitches, but there are several theories:
- Friction between the layer of abdominal tissue covering the organs and the lining of the abdominal wall. This occurs because of an increase in the amount or thickness of fluids that lubricate the stomach, reports New York City-based dietician Natalie Rizzo.
- Consuming food or beverages before exercise.
- Poor posture.
- Improper breathing technique, including shallow breathing and not inhaling from the lower lung.
Some people are at a higher risk of experiencing stomach pain during exercise from side stitches, including:
- Younger athletes. The frequency and intensity of side stitches decreases with age.
- Females, who may be four times more likely than men to experience side stitches, according to a 2015 article in Sports Medicine.
- Deconditioned individuals.
Treating and Preventing Side Stitches
Side stitches go away on their own, but there are a few steps you can take to speed up the process:
- Stop or slow down your activity.
- Inhale deeply and exhale slowly.
- Stretch your abdominal muscles.
- Gently press your fingers into your abdomen where you feel the pain and bend forward slightly.
You can prevent side stitches in the future by:
- Increasing your fitness level. The fitter you are, the less prone you are to side stitches.
- Improving your posture by strengthening your back and core muscles.
- Avoiding large amounts of food and beverages within two hours of activity. Take small sips of water before and during exercise.
- Avoiding high-fat and high-fiber foods and sugary drinks before working out.
- Decreasing the intensity but increasing the duration of your workouts, especially if you're new to exercising.
Abdominal Muscle Cramps
Muscle cramps can feel similar to side stitches, but they're not the same. These involuntary muscle spasms occur seemingly for no reason, but they're more common in athletes. During a muscle cramp, you may feel a very sharp pain as the muscle seizes up. The muscle may also become hard and tight.
Common reasons for muscle cramps include:
- Insufficient warmup and stretching before exercise
- Exercising in the heat
- Overexertion and muscle fatigue
When a muscle cramp strikes, stop your activity and gently stretch and massage the abdominal muscle with your fingertips. The pain should dissipate quickly on its own. You can apply heat to loosen tight muscles and ice to reduce any lingering soreness.
Prevent muscle cramps in the future by warming up and stretching before each workout. Don't overdo it, and take frequent breaks if you're exercising in hot weather. Also be sure to drink plenty of water before, during and after your workout.
Read more: Causes of Abdominal Pain and Fatigue
Gastrointestinal Stomach Pain During Exercise
Gastrointestinal distress is common in athletes, according to Boston-based gastroenterologist, Dr. J. Thomas Lamont. This is due to physiologic alterations to enteric nervous system activity, circulating gut hormone levels, intestinal blood flow, nutrient and electrolyte absorption, intestinal secretion and motility.
Digestive upset during a workout is often caused by eating within a few hours of the workout. Lamont says dehydration and the use of analgesics is also associated with GI distress during exercise.
Long-duration exercise and intense exercise may be more likely to cause abdominal pain. As with side stitches, limiting the length and intensity of your workouts may reduce gastrointestinal distress. You should also avoid eating a large meal within three hours of your workout. Instead, have a light snack containing carbohydrate and protein — but not too much fat, which can increase the risk of stomach upset. Additionally, be sure to properly hydrate before and during your workout.
Pain From Abdominal Strain
Overstretching of or trauma to the abdominal muscles can result in a muscle strain, causing the muscle fibers to tear. The result is often a sudden, sharp pain. Depending on the severity of the strain, there may also be swelling, bruising, muscle weakness or loss of muscle function.
Abdominal muscles can become strained from direct impact, from overstretching or from being overworked. Frequent causes of abdominal muscle strain include:
- Sudden twisting movements
- Very intense exercise
- Improper weightlifting technique
If the pain is severe and/or there's a complete loss of muscle function, you should see your doctor, because it may indicate a complete tear. Otherwise, most strains can be treated at home by:
- Resting the abdominal muscles as much as you can.
- Applying an ice pack for 10 to 15 minutes at a time, on the hour, to help reduce swelling.
- Wearing an abdominal binder or wrapping an elastic bandage around your abdomen to help reduce movement and swelling.
Continue this treatment for 48 to 72 hours after the injury. Return to your normal activities gradually only when the pain and swelling have subsided.
What Else Could It Be?
There are many other potential causes of stomach pain during exercise. If it's a one-time event and there are no other symptoms, it's likely nothing to worry about.
But if it happens frequently, or is accompanied by other troubling symptoms, it's best to make an appointment with your health-care provider. Hernia, gallstones, kidney stones, Crohn's disease and irritable bowel syndrome are just a few of the causes of stomach pain that could be exacerbated by exercise.
Is This an Emergency?
- Food & Nutrition: The Dreaded Side Stitch: What Causes It and How to Prevent It
- Berkeley Wellness: Side Stitch: Causes and Treatments
- American Osteopathic Association: Coping With Muscle Cramps: Why You Don’t Have to Live With This Common Pain
- UpToDate: Exercise-Related Gastrointestinal Disorders
- Precision Nutrition: Workout Nutrition Explained.
- Healthline: Everything You Need to Know About Abdominal Strain
- WebMD: Abdominal Pain: What You Should Know
- Sports Medicine: Exercise-Related Transient Abdominal Pain (ETAP)