Returning to running after stoma surgery
*This article was first written by me and published in the journal of the Ileostomy and Internal Pouch Association. Reproduced in an edited version here.
There’s no reason at all why you can’t get back to running when you have a stoma. I’ve now completed 35 marathons and various ultra distance runs, back to back multiple marathons and stage runs, and I know of many other ostomates who love running too, so if you've just had stoma surgery, you can certainly feel positive about your running future.
That said, there are still some considerations and factors to take into account before you lace your trainers back up. It’s important to take a balanced approach, listen to your body and take it steady.
When returning to running after stoma surgery there are a number of things we need to consider.
Even at a slow pace, running is a high impact activity which places load on the core muscles and pelvic floor. We need to be ‘fit and ready’ to run, so a phase of rehabilitation and conditioning needs to occur before running is resumed.
Consequently, there are two important things to remember:
1. Running must be treated with respect and return to running done gradually and intuitively
2. Rehabilitation and retraining MUST be done for the core muscles and pelvic floor, especially if your surgery involved the pelvic floor as well as the abdominal wall. This is for everyone.
Some people will need to take a much more considered approach than others, depending on a number of factors.
These include (and are not limited to):
· The type of surgery you’ve had and why you had stoma surgery. Did you have keyhole or open surgery? Keyhole surgery is generally a faster recovery.
· Have you had radiotherapy in the pelvic area? This can sometimes damage tissue and cause issues with the pelvic floor muscles
· Are you having chemotherapy? This can cause fatigue and other issues such as peripheral neuropathy, which could make running more challenging
· Did you have any complications/post op infections? Delayed recovery? The longer your illness/time in hospital, the more rehab and training work you need to do as you transition back to running
· How is your diet and hydration status? Are you eating well or is your diet restricted? Lowered energy levels, dehydration and malnutrition will all affect your ability to recover to have energy for running
· Did you have a full rectum/anus removal? And how well is this area healing? This can often take the longest time to heal and the pelvic floor needs to be rehabilitated
· How fit you were before your surgery? How much were you running and when did you stop prior to surgery? The fitter you were close to your surgery, the faster you’ll recover and be able to return to running
· Do you have any other issues such as pelvic organ prolapse (POP) or pelvic floor dysfunction? In this case, running may be unwise at the moment and you should see a women’s health physiotherapist
· Did your surgery include extensive pelvic floor surgery or reconstruction? Again, this needs special rehabilitation, and you should be referred for physiotherapy
· Have you also given birth within the last 12 months? Pregnancy and childbirth PLUS stoma surgery, especially involving the pelvic floor will require specific rehabilitation and extra caution when returning to running. Ideally get referred to a women’s health physio.
Thinking through these questions will help you understand the impact of your illness and surgery. It will help guide you in how soon you can resume running, how much you do and what else you may need to do to rehabilitate first.
In a nutshell, the more complex/extensive your surgery or illness has been, the more cautious you should be in your approach to running return, particularly if your surgery involved the pelvic floor/rectum removal.
If you've had APR surgery this will have involved removal of your rectum, anus and some of the small muscles around the anus in the pelvic floor. This will impact your return to running more than someone who didn’t have this procedure as part of their stoma formation. And it’s therefore vital that full healing has occurred – at your stoma and abdominal wound sites, but more importantly the perineal and anal wounds.
However, everyone has a different journey and there is no ‘one size fits all’ in terms of when and how to get started.
I’m a huge fan of running and I know how important it is to get back out there for our mental and physical health. So try to balance caution and a sensible approach with confidence and enjoyment. My advice is to do your rehabilitation exercises so that you can return to running sooner.
Remember you need to be ‘fit to run’.
When can I start running?
Whilst there is no ‘one size fits all’ approach, I will try to offer a basic framework of how and when you can safely return to running.
It’s impossible to put a timeframe on when you can start, as I’ve said everyone is different.
However this provides something of a guideline:
Potential earliest timeframe to resume running*. Depending on one of the following 3 scenarios:
(By 'running'* I mean a jog/walk approach similar to 'couch-5km beginner plan'.)
1. Least complex surgery, minimal complications. Fit prior to surgery.
Around 2-3 weeks post-op with a cautious approach in conjunction with core rehab exercises
2. Open surgery, more unwell, less fit prior to surgery, complications post op.
Around 6-8 weeks post-op in conjunction with core rehab exercises
3. Highly complex surgery, pelvic floor involvement, unwell or lengthy illness/additional treatment.
Around 3-6 months post-op following rehab in conjunction with core rehab exercises or after physiotherapy
During recovery your priorities should be:
2. Gradual return to activity – starting with walking, build up to 30 minutes of brisk walking at least 3-4 times per week, before you start running. When you start to run, run like a complete beginner with a 'jog walk approach'. 15 minutes total - repeating 1 minute jog/2-3 minutes walk.
If you have any of the following, get assessed by a physiotherapist, nurse specialist or doctor before you start running:
· Feeling of fullness, bulging, heaviness or pressure in/around your rectum, vagina or pelvic floor areas
· Incontinence – weeing when you laugh or cough for example
· Signs of a hernia or bulging, pain or pressure – either at the stoma or other incision
· Significant pelvic pain or other musculoskeletal issues relating to the pelvis and lower limbs
The most important thing for EVERYONE after any type of stoma surgery is a phase of abdominal and pelvic floor rehabilitation. Restoring function of the core and pelvic floor muscles is essential and will reduce your risk of hernia, other musculoskeletal injuries and provide the foundations on which to build your fitness. This should be standard practice for every ostomate.
This can be done as soon as 3-4 days post surgery (in line with ASCN clinical nursing guidelines) if you feel well enough. However it’s never to late to do this rehab work and you can do it whenever you’re ready. Equally if you’ve had your stoma for years, but are starting running for the first time, then it’s important then too.
Clinical Pilates is an excellent way to restore core function, and I offer group classes, 1:1s’ and pre-recorded videos for ostomates on my website www.theostomystudio.co.uk. Or use the excellent me+recovery programme that I developed for Convatec which is free and available online or by calling the me+recovery team 0800 467866
Walk before you run
As a basic guideline initially after surgery, it’s important to get walking again first. Build this up gradually, until you’re at the point of being able to walk for 30-45 mins without fatigue or any pain/discomfort and you’ve been doing this regularly for a few weeks. THEN you can start to think about introducing some running.
Start like a beginner again. The initial return to running should be a gentle ‘jog walk’ approach – even if you were an elite marathon runner before. Start very gently with short sections of running/jogging within a walk. Something like 60-90 seconds of jogging, with equal (or longer) walk breaks for no more than 15-20 minutes in total. Following something like the ‘couch-5km’ programme can be helpful, but use it a guideline and listen to your body. Stop whilst you still feel good. Then assess. See how you feel the next day and take stock. Did you do too much? Or have your recovered ok with no ill effects? Start with 2-3 sessions per week to begin with and see how you feel.
As you build up, be hyper aware of your core, pelvic floor and stoma and watch out for feelings of pressure, pain or bulging – this means the muscles aren’t yet strong enough to tolerate the load that you’re placing on them. Keep working on your core exercises and Pilates and ensure you feel strong enough to run.
Get help from a physio if you develop any pain or running related injuries. Changes to your biomechanics through your surgery, may increase your risk of running injuries, so keep a close eye on training load, mileage and injury risk. Work harder on glutes, hip stability and leg strength.
The only other thing to think about is hydration. If you have an ileostomy, you are more likely to be dehydrated and this can affect your energy, recovery and ability to run, so choose drinks with high electrolyte concentration and start your run well hydrated.
Article I've previously written about hydration:
I love running and I know lots of other people with stomas who love running, and some are professional athletes performing at the highest level (that’s not me!).
Having a stoma does not stop you running, nor does it stop you from achieving amazing things. Running can be whatever you want it to be in your life and it’s certainly not something to be afraid of.
However, as you return to running post-surgery, just be sure to adopt a balanced approach, build up slowly and don’t’ forget to do your core exercises.
Enjoy and good luck.
Sarah Russell MSc
Clinical Exercise Specialist
Clinical Pilates Teacher
Runner - Ostomate
Founder of The Ostomy Studio