dpIt was the viral moment which shocked everyone apart from the athlete who sparked it.
Hyrox world record holder Joanna Wietrzyk became a global phenomenon this week after soiling herself during an elite event in Beijing. Organisers would later apologise to those affected both “directly or indirectly” by the incident, which saw faeces smeared across communal equipment.
Yet Wietrzyk herself seemed remarkably blase about the incident. Not only did she carry on and win the race in China, in her only public statement on the story — a social media post which was later deleted — she simply said: “Go hard or go home, they say… A win is a win.”
The nonchalance with which the Australian greeted the apparent mishap speaks to an evident truth. Faecal incontinence is much more common amongst athletes than might be expected.
Greg LeMond, Michael Jordan, and Dame Paula Radcliffe have all been affected by the issue — which remains under-researched. Here, The Athletic explains the condition, and why it is so common in elite sport.
What causes it?
From dozens of academic studies, there is a consensus that faecal incontinence is a combination of multiple factors, rather than a simple cause and effect. Fundamentally, it boils down to the body’s gastrointestinal system coming under extreme strain during intense efforts.
In these circumstances, blood flow can be diverted away from the small intestine in order to prioritise the muscles needed for movement. That, in turn, means it is much more difficult for digestion to occur.
One 2017 study from Finnish researchers found that intense running activity for 90 minutes can temporarily damage the intestine, affecting the transmission of its contents into the bloodstream. Other research has suggested that bacteria levels and nutrient uptake are also significantly impacted.
The Mayo Clinic, one of the world’s leading academic medical centres, also cites the “physical jostling of the organs”, provoked by the up and down motion of running, as a major contributing factor. The theory goes that the motion, allied with the lack of digestion occurring due to limited blood flow, causes substances to pass through the bowels more quickly than would otherwise be expected.
It has been suggested that the higher prevalence of faecal incontinence amongst runners over cyclists — to the extent that it is informally known as ‘runner’s trots’ — demonstrates the significance of the running motion.
Once matter passes through the bowels, the effectiveness of the anal sphincter is also thought to be affected by intense exercise. The sphincter has two rings — first, a less powerful, outer, voluntary ring, and second, a more powerful, inner, involuntary ring. As other parts of the body are prioritised during all-out efforts, this involuntary ring weakens — and triggers the final, messy repercussion of faecal incontinence.
Diet and nutrition also play a significant role. One of the most famous examples came via former world record runner Radcliffe, who defecated on the road en route to winning the London Marathon in 2005.
“I probably ate too much last night,” she told reporters post-race. “It was my usual gluten-free pasta and grilled salmon but I probably stuffed too much down me. It was just that I needed to go, and then I was fine.”
Paula Radcliffe had to break off during the 2005 London Marathon (John Gichigi/Getty Images)
Wietrzyk, meanwhile, posted online that she had eaten street food in Beijing one day before the race. Unfamiliar substances, either in volume or composition, can affect the body’s ability to properly digest — heightening the risk of incontinence.
This area also covers the use of substances such as caffeine gels, which increase energy and alertness during competition. But they also come with latent risk, with numerous academic studies covering their laxative properties, which both speed peristalsis (the bowel contractions that push matter through the intestines) and relax the sphincter.
In recent years, one trend amongst athletes has been to cut out caffeine in the build-up to a race — so that when it is taken, the benefits are felt more keenly by the body. The same goes for the negatives.
Why does it disproportionately affect female athletes?
This year, Dutch researchers published a widespread qualitative study on recreational runners who suffered from faecal incontinence.
They reported that women faced an increased risk of the issue as a result of “pelvic floor dysfunction” — the pelvic floor referring to the ‘hammock’ of muscles running from the pubic bone to the tailbone that supports the pelvic organs.
In general, women face a far higher risk of pelvic floor issues due to structural anatomical differences, childbirth, and hormonal changes associated with menstruation and the menopause.
“Increased intra-abdominal pressure due to reactive forces on the pelvic floor during activities like jumping and running is believed to deform pelvic floor structures, potentially impacting continence mechanisms,” they wrote.
During the menstrual cycle, the luteal phase (the period between ovulation and the beginning of the next period) has been identified by several studies over the past 30 years as provoking more gastrointestinal problems in some women — further raising the risk of faecal incontinence during extreme exercise.
How common is it?
More than might be expected. One 2014 study found that 30 to 90 per cent of endurance runners had experienced gastrointestinal complaints of varying severities while competing.
Bill Rodgers won four straight editions of the New York City Marathon between 1976 and 1979. “More marathons are won or lost in the porta-toilets than at the dinner table,” he famously said.
Radcliffe is the most famous example, but this year’s winner of the renowned Comrades Marathon in South Africa, George Kusche, suffered faecal incontinence during the latter stages of the 86km ultramarathon, crossing the line with diarrhoea seeping down his legs.
In the 2016 Rio Olympics, race walker Yohann Diniz experienced gut issues during the event and fainted on several occasions, but continued to finish in eighth place.
Two years ago, top U.S. triathlete Taylor Knibb was leading a race in Dubai by over two minutes when she turned and asked a camera operator on live television: “I just s*** myself. So can you not get my ass?”
It also happens in other sports — by very high-profile athletes. Former England striker Gary Lineker admitted to soiling himself against the Republic of Ireland in Cagliari during their opening game of the 1990 World Cup.
“I’d not been very well the night before, but I didn’t tell anyone because I wanted to play,” he said on the BBC’s Match of the Day podcast. “Fifteen minutes into the second half I start cramping and I think: ‘Oh Christ, I’m in a s*** load of pain here’.
“The ball goes out on their left-hand side and I kind of did a lunge at it, and as I did that I kind of relaxed and it’s just gone boof, and I’ve gone, ‘Oh my God’. I’m sat there on the ground and it’s all there.”
Elsewhere, three-time Tour de France winner LeMond blamed a bout of explosive stomach trouble on “a bad peach”. On stage two in 1986, with almost 100km still remaining, he stuffed a team cap into his shorts and defecated into it, rather than pull over and lose time to his rival Bernard Hinault. LeMond ended up winning the yellow jersey, the first ever won by an American rider, by three minutes.
Another rider, Dutchman Tom Dumoulin, was wearing the leader’s pink jersey at the 2017 Giro d’Italia when he was forced to pull over on the Umbrio Pass while leading Stage 16. His lead was cut to just 31 seconds — but like LeMond, he managed to win the race.
In Game 5 of the 1997 NBA Finals — known as the Flu Game — a wincing Jordan played through bouts of vomiting and diarrhoea and put up 38 points as the Bulls beat the Utah Jazz on the way to wrapping up their fifth title in seven seasons with a 4-2 series win.
In weight-lifting, urinary incontinence is extremely common amongst female participants — largely due to the strain placed on the pelvic floor muscles during heavy lifts. A 2018 study found that almost 75 per cent of elite powerlifters had experienced it during a repetition.
What preventative strategies can athletes take?
Any amateurs worried about the potentially messy repercussions of attempting a personal best over the coming weeks should fear not. There are steps that can at least minimise these risks.
Some are simple, such as avoiding new foods before competition. Avoiding dehydration is another. If the digestive system does not have enough water, carbohydrates can become concentrated in the stomach — increasing the likelihood of gastrointestinal distress as the body seeks to expel the build-up. Salts which are lost during sweating are also important in the process of absorbing energy through the gut, meaning that the use of electrolytes plays a role.
Over recent decades, sportspeople have also begun specific “gut training”. For example, 20 years ago in elite road cycling, the top professionals used to only be able to absorb around 60g of carbohydrates per hour without encountering stomach issues.
Now, the top riders are able to consume at least double that amount — with Australian rider Cameron Wurf reporting that he took in 200g per hour en route to setting the fastest bike split in Ironman history last year.
Cameron Wurf set a new record for a split bike time in an Ironman race, fuelled by huge amounts of carbs (Jasmin Walter/Getty Images for Ironman)
Writing in cycling publication Escape Collective, sports dietician Dr Alan McCubbin described the area as a “Wild West” as nutritionists attempt to move faster than published academic research on the topic.
In general, however, he describes a process in which athletes gradually consume slightly more than their typical food and fluid intake before a session, waiting until exercise takes place without discomfort before upping intake.
Effectively, this process helps elite athletes’ gastrointestinal systems absorb energy rather than simply wanting to expel it as faeces — reducing the chances of incontinence.
