by Julia
(Sydney, Australia)

Hi there - sorry for the long post, however this problem has come on over a relatively long period of time.

I am 30-year-old female, competitive long distance runner. I began running at about 16 years old, and in the first four or five years of running, occasionally experienced sharp diaphragm, stitch-like pain (only when in a race).

I used to just put it down to that - a stitch, and would make sure to do lots of abdominal and flank stretching before a race so that it wouldn't come on. Approximately five years ago, I began experiencing the pain more frequently in races, which also started to come on a bit lower down, in the right quadrant (about midway). I used to think this was my ascending colon, as when I pushed against it, the pain would feel very sharp (but I couldn't understand why, as I didn't get any real symptoms when eating or at rest). Over the next couple of years I began getting the pain randomly in slow training runs and still in races. It would feel extremely tender to press in that area for a few days (and I couldn't run in these few days without the pain returning), and then it would seemingly return to normal.

I decided to see a physio, who recommended I have an ultrasound, which came back with normal results (other than a mild fatty liver). The doctor said this probably wasn't the cause of my pain, and along with my physio recommended I have a month of complete rest, which I did, and plenty of stretching. I returned to running, however the pain returned with it. I decided to just keep training and 'live with it', and for the next few years the pain just remained a sporadic occurrence. However, over the last two years the pain has become so chronic that I can't even run more than one to two minutes without it. About 18 months ago it also began coming on more midline, in the area of the stomach/gallbladder/liver area.

I was taking Ibuprofen and Voltarol for about 18 months before every race, so that I could get through it, and then realized it was only masking the pain and the condition was getting worse. It is also important to mention that approximately 18 months ago, I was very tender in the mid-line area, telling my partner how sore it felt, and then I moved funny on the lounge, and the pain seemed to shoot into my upper chest/shoulder-tip area - making it very difficult for me to breathe, lie on that side, laugh, do anything basically. I also seemed to have a fever with it - I took lots of aspirin, which calmed it down for the night.

The doctor said it sounded like pleurisy. Ever since, I have also had pain in the same chest/shoulder-tip area when running. I often get a sore right quadratus lumborum muscle, but not when running - it just feels tender to press.

Over the last two years I have had a CT scan (clear), laparoscopy (clear), abdominal and chest MRI (clear), angiogram to check blood flow from the phrenic artery to the diaphragm (clear), lung function tests (higher than average), and thoracic spine MRI (Scheuermann's changes). I am currently seeing a musculoskeletal specialist and respiratory specialist, who are considering possible nerve referral from the ribcage, or some sort of diaphragm dysfunction (however for me, this does not explain the pain lower down). I am booked in for an endoscopy and colonoscopy in one month's time.

This sharp, cramping pain mainly occurs with activity that has impact (i.e. running, skipping, horse-riding). Swimming, cycling and walking are generally fine and don't bring on the pain, so over the last year I have been doing mainly these activities - only running to see how the pain's going, but so far is just as bad, if not worse.

The pain also seems to be worse when my stomach is empty - I once did a bowel cleanse and had cramping all over the right side the following day when walking around! The upper right quadrant is always tender when pushed deeply, especially into the side of the duodenum/ascending colon areas. I don't suffer from constipation, diarrhea, bloating or sickness after eating, however do have a bit of difficulty swallowing after eating (it feels as though there is a lump in my throat), and need to clear my throat. A GP once told me it could be a bit of acid reflux. I also get quite short of breath at random times, including when lying down. I am wit's end with this pain. I know there is something definitely wrong - firing all this pain away that debilitates me from doing what I love - but as yet, no one can put their finger on it. I feel as though it's something that gets irritated with impact, but the fact that it's now migrated to three different places makes me think - what???

I know runners often struggle with stitch problems, but this is beyond the ridiculous! Any ideas/advice on what the problem could be would be greatly appreciated!

Thank you

Hello Julia.

I can "see" that you are terribly distressed by this yet to be diagnosed right to midline pain that has been ongoing since the last decade and a half.

Thanks for your very detailed story.

I strongly think the pain you are describing might be musculoskeletal in origin. It sounds like you most likely have one of these rare hernias called interstitial hernia. That explains the pain that arises with exertion. Interstitial hernias, like epigastric hernias are very rare hernias known to occur in "sport" individuals (though also in the obese). There are often due to sudden strain tearing the interlacing fibres of where muscles join one another or where blood vessels pass through into a muscle.

You might benefit from another detailed and more defining ultrasound scan.

Adjusting your lifestyle mean while might be the only way of coping with this debilitating pain. Could you concentrate on other types of sports that does not bring this pain on, while it is being investigated?

Please accept our profound empathy and be sure our prayers are with you that we come to the bottom of this pain and get through with it so that you can lead your normal life again. That is why this site was put up: To Help Unravel the causes of abdominal pain.

Please keep us posted with developments as you go.

Thanks again for stopping by.

Dr. Edema

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Aug 16, 2013
Colonic Spasms
by: Anonymous


Research colonic spasms. I had the same type of pain for over 20 years before diagnosed by my internal specialist. Remedy is a reduction in certain types of food and medicine. Weird part of the reduction in certain types of foods included rice, raw veggies, lettuce, etc. Healthy foods that I would not normally watch out for to cause such severe stomach pain.

A 2nd suggestion is if you have had heavy menstrual pain (does not have to be the entire cycle - could be the first day only), I would recommend having checked for Endometriosis (Endo for short). Endo growths can also cause problems in the intestines and bladder. A Laparoscopy is the key to finding if Endo is present and for removal.

Sending you prayers for a healthy and pain free life.

Nov 23, 2011
by: Anonymous

Hi u sound very much like me get the hospital to do a hida scan as I had 2x MRI 2x ct an a large number of xrays I suffered for nearly 2years at it worst an I even had surgeons note on my file that it was not a surgical matter an not to send me to them but every couple of days I was being rushed in by ambulance as my oxynorm an oxycontin pills did not seem to help but eventually I went to an dr drop in clinic an a dr there done a letter an called the hospital an I was admitted this aug final the hida scan was done an they found a stricture in my gall bladder an operated so it's not always stones some times it's the function but it's worth checking it's 3 months on having my op has helped but I'm still on the meds an I'm still in a lot of pain but now I get a few days pain free so even though they said it's going take a while to settle a day or two with out pain is better then none

Aug 03, 2011
sounds familiar!
by: pete

Hi Julia

I am a 53yo male, not into sport at all but normally very active.

i've had ultasounds, ct, blood tests, you name it.

i've tried nexium, zantac, etc nothing works.

the pain is like a "stitch", and is exacerbated by bending over, also by driving. (i am a school bus driver).

tying shoelaces has become traumatic. leaning forward while sitting causes severe cramps.

no painkiller provides any effective relief.

pete vk6fun@gmail.com

Feb 06, 2011
Thank you...
by: Julia

Hi Dr Edema,

I don't think it's likely to be an ischemia problem, as I seem to only get the pain with impact, or anything with jarring. For example, I get this pain with horse riding, and I wouldn't think that would have anything to do with blood flow. I've had an angiogram to check blood flow to the diaphragm, and it was normal.

I have a friend, also a runner, who is beginning to experience the same (or a very similar) problem to me - just not as chronic, and she said her physio told her it could be some of her ribs pressing together and pinching on nerves, therefore referring pain into the abdomen. In her last race she strapped her ribs along the muscle, and also underneath the rib cage, and rubbed dencorub on them. She also does a lot of core strength.

I'm having the gastroscopy and colonoscopy in a week's time, to rule out gastrointestinal, and am back to see the specialist a few weeks after that. I am going to mention the ribcage theory, and also the intramuscular hernia theory to him and see what he says.

Thank you very much for your help and support... I would like to believe that this is something I can get on top of, though am starting to think I'll have to live with it for the rest of my life and will never be able to run again... which is very depressing :(

I will keep you updated.

Thanks again :)

Jan 31, 2011
exercise related transient abdominal pain
by: Dr. O Edema MBBS MSc DRCOG, WebMD and Director, AbdoPain.Com

Another very common cause of unexplained abdominal pain in runners and indeed swimmers is an entity doctors call ETAP. ETAP is an acronym for Exercise related Transient Abdominal Pain.

This is a well not understood condition, yet very common in elite runners, especially long distant runners. It is characterized by moderate to severe side abdominal pain, occurring only during races. The pain could be sharp and stabbing. It could be very uncomfortable, causing many runners to abandon their race. It is also referred to as "stitches".

The exact cause remains unknown, but it is thought to be due to strain on some ligaments, or reduced blood supply to the diaphragm and sometimes colon occurring during running, due to diversion of blood to the muscles.

Exercise related transient abdominal pain is a diagnosis that is made only by suspicion from the history given by sufferers.

If the pain is due to reduced blood supply to the colon during running, an MRI angiography may show some "ischemia" (poor blood flow).

Could this be the cause of your pain Julia?

Why not discuss this with your doctor. Look into the possibility of ETAP yourself, by doing more research / reading on this topic and see if it matches your symptoms.

Please let us know the outcome.

Meanwhile, we all here at the abdominal pain center wishes you a quick resolution of this enigmatic pain and well as complete recovery.

Dr. O. Edema.

Jan 22, 2011
Thank you
by: Julia

Hi Dr Edema,

Thank you very much for your response and recommendations. I've been doing some reading on interstitial hernia, and it does sound as though it could be likely... I also tend to think the pain is of muscular origin, but without anything showing up in scans so far, it's hard to know what and how to treat it.

I will propose this to the muscular specialist I've been seeing, and hopefully he can suggest some further ultrasound tests to do. It does seem unfair that I can be in so much pain, and yet nothing can be seen on CT or MRI... Are there specific ultrasound tests that can check for this type of hernia?

Also, are you aware if there is any treatment options for this condition, or is it something chronic that I will just have to manage?

My next port of call is endoscopy and colonoscopy (though my GP suspects they will likely be normal) in a few weeks, and also a diaphragm function test (though I suspect this will also be normal). The specialist has talked of nerve blocks, but this will be last resort, and obviously a bit risky, so I don't know if I want to go down that line. I have also had suggestions from various people that I should work to strengthen my core, as this can prevent stitch-like pain - however, I have been avoiding this over the last couple of years thinking it might make it worse. I used to do a lot of core work when I first started running, but as I got busier with work, life, etc, it did fall by the wayside a bit...

Yes, in the meantime I'll be doing lots of swimming, walking and work on spin and elliptical trainers (non-impact).

Thank you so much again for your advice and sympathy... this is a fantastic website for people such as me who think that no one understands.

Kind regards
Julia :)

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