What causes right upper abdominal pain during running?

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Last updated: April 30, 2025 • View editorial policy

From the Guidelines

Right upper abdominal pain during running is most likely caused by mechanical trauma to the gut, including repetitive gastric jostling and gut ischemia, as a result of the high-impact mechanics of running, as suggested by the study published in Sports Medicine in 2014 1. This type of pain can be exacerbated by factors such as posture, nutrition, and dehydration. Some key points to consider include:

  • Mechanical causes of gastrointestinal problems are more common in runners than in cyclists, likely due to the repetitive high-impact mechanics of running 1
  • Posture can also play a role, with increased pressure on the abdomen in certain positions, such as the 'aero' position on a bicycle 1
  • Nutrition can also influence gastrointestinal distress, with high-fiber, high-fat, and high-protein foods potentially causing problems, as well as dehydration and high-osmolality beverages 2
  • Preventing gastrointestinal distress can be achieved by avoiding high-fiber foods, aspirin, and NSAIDs, staying hydrated, and practicing new nutrition strategies before competition 3 Some potential strategies for managing right upper abdominal pain during running include:
  • Slowing down pace and taking deep breaths, focusing on exhaling when the left foot hits the ground
  • Applying gentle pressure to the painful area while bending slightly forward
  • Avoiding large meals 2-3 hours before running and staying well-hydrated throughout the day
  • Gradually building up exercise intensity and performing proper warm-up routines It is essential to note that if the pain is severe, persistent, or accompanied by other symptoms like fever, nausea, or jaundice, medical attention should be sought as it could indicate a more serious condition requiring specific treatment.

From the Research

Possible Causes of Right Upper Abdominal Pain During Running

  • Abdominal pain is a common complaint among participants in endurance sports, and it may be severe, recurrent, and resistant to treatment 4.
  • The cause of right upper abdominal pain during running can be attributed to various factors, including congenital supernumerary ligaments binding the gallbladder to the abdominal wall, which can lead to chronic cholecystitis 4.
  • Gastrointestinal problems, such as reflux, nausea, vomiting, and gastritis, can also contribute to upper abdominal pain during running 5.
  • Gallbladder disorders, including cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, and gallbladder cancer, can cause right upper abdominal pain 6.

Relationship Between Running and Abdominal Pain

  • Exercise, particularly running, can alter esophageal motility and worsen gastrointestinal symptoms such as reflux and nausea 5.
  • The physical stress of running can also lead to stress ulceration and bleeding in critically ill patients, highlighting the importance of acid suppression therapy 7.
  • However, the use of antacid therapies, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), can have varying effects on gastrointestinal health, with H2RAs potentially reducing the risk of advanced fibrosis in patients with non-alcoholic fatty liver disease 8.

Diagnostic Considerations

  • The differential diagnosis of abdominal pain in athletes should include various gastrointestinal and gallbladder disorders, as well as other potential causes of abdominal pain 4, 5.
  • A comprehensive review of the patient's medical history, physical examination, and diagnostic tests, such as laparoscopy and histopathological examination, can help determine the underlying cause of right upper abdominal pain during running 4.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.