Ali Feller, 38, was seven years old when she was diagnosed with Crohn’s disease, a chronic, inflammatory digestive condition that can cause frequent diarrhea, abdominal pain and cramping, and heavy fatigue, among other symptoms.
For Feller, a flare-up means she has blood and mucus in her stool, deals with dozens of bathroom trips per day, physical pain, embarrassment, and frustration of not being able to plan her life. When things get that bad, it also obviously means rigorous exercise is out of the question.
Feller, who hosts the popular Ali on the Run Show podcast, fell in love with running in her 20s and completed her first marathon in 2011. By her sixth stab at the 26.2-mile distance in 2016, her body was begging for a break.
From that point forward, she stuck to shorter distances, unsure if she’d ever do another marathon. But for the first time in seven years, Feller took on the distance again at the Eugene Marathon in Oregon on April 30, where she toed the line more confident in her fitness than ever. Here’s how she tackles marathon training while keeping her Crohn’s symptoms in check, as told to health and fitness writer Pam Moore.
Before the Eugene race in April, the last 26.2 that I completed was the New York City Marathon in 2016. I ran it in the middle of a flare, which came on right after a 16-mile training run and threw a major wrench in my preparation. I ended up running the first 10 miles feeling great, and then made the decision to run/walk with a friend for the final 16—I felt like that’s what I needed to do to reach the finish line. I actually had so much fun that day, despite all the walking.
But a few days later I remember thinking, I don’t know if I’m cut out for this. I didn’t even consider another marathon for the next few years. I kept running, but I rarely raced, and I started spending a lot of time doing Orangetheory Fitness classes, which combine running, rowing, and strength training. I launched my podcast, had my daughter in 2018, and two years later, our family moved from New Jersey back to my hometown, Hopkinton, New Hampshire.
Last summer, when I spent time in Eugene working on the media operations team at the World Athletics Championships, I started thinking about marathons again. Eugene was a gorgeous place to run, and I was already logging up to eight miles a day and doing a 10-miler most weekends. Plus, I was feeling really good, Crohn’s-wise. I got the itch to try again, and it wouldn’t leave me alone, so I signed up for the Eugene Marathon.
It was actually the second time I was slated to run it: The first was in 2012—it would have been my second marathon. I was so excited to do it, but between injuries, a bout of the flu, and a Crohn’s flare that came on while I was training for it, my body clearly had other plans, and I made the difficult decision to bail on the race.
It’s hard to say whether marathon training contributed to those flare, but my doctor and I agree that they’ve historically happened at high-stress times. Going off to college, studying abroad, getting a promotion, and moving all brought on symptoms.
Marathon training can obviously fit that bill, but I wanted to give it another shot. I hadn’t had a major flare in a few years, mainly because I found a medication that works for me. I also have an amazing gastroenterologist, who’s actually a fellow marathoner. He understands how important running is for me, for both my physical and mental well-being, so we’ve worked together to figure out when I really need to back off and when it makes sense to keep running.
I’ve also identified my trigger foods (corn kernels, popcorn, and jicama, which is actually one of my favorite foods), and I prioritize getting enough sleep, which for me, is seven to eight hours each night. I think running helps, too. Just being outside does wonders for my mental health.
But even when my Crohn’s is completely under control, it’s something I have to think about every single day. It’s been that way my whole life. Having gotten the diagnosis when I was seven, I don’t even know what it would be like to just wake up and leave the house, worry-free. And this is even more true regarding running.
Say, for example, I’m starting my morning with an eight-mile run. On a normal day, even when I’m feeling good and not experiencing a flare, I’ll generally poop two or three times before I leave the house, and I’ll usually make at least one bathroom stop on that run. It’s just guaranteed that I’m going to stop then because that’s when my stomach is most active. I might go again once I get home, but by lunchtime, I’m generally good for the day.
It’s definitely taken some trial and error to figure out what works for me. And while I think everyone needs to experiment to find out what works for their situation, these are some of the strategies I come back to that help me continue to lace up with Crohn’s.
Bring your own bathroom essentials.
Being prepared is non-negotiable. I’m not talking about “normal” things like dressing for the weather or making sure you have enough water. They’re important too, of course, but for me, I need to consider everything I might need just in case I need to go to the bathroom when there are no facilities in sight.
I always bring paper towels and a ziplock bag to put them in, just in case there’s no way I can make it to an actual bathroom and have to go outside. Unfortunately, that does sometimes happen, and I hate it. I don’t think it’s funny or cute, but it’s not going to stop me from running.
In the winter, carrying my bathroom gear is easy; I put it in the pockets of my running vest or jacket. In the warmer months, I put it in my shorts’ pockets if they’re roomy enough. If not, I stuff it in my Koala Clip, which is designed as a carrier for your phone, but it works really well as a place to stash other things too.
Research the route ahead of time.
My pre-run prep also includes route reconnaissance. Other runners consult maps to check mileage and elevation, but I’m scouting bathrooms. I’m not just trying to figure out where the public restrooms are—I also need to know the details. Do you need to request a key or a passcode? Is there likely to be a line? Is it just a single restroom versus several stalls?
One of the reasons we moved to New Hampshire was the lack of public restrooms where we lived in New Jersey. On every run, I had constant anxiety that I wouldn’t be able to get to the bathroom in time. I enjoy my runs so much more knowing that public restrooms are much more available now.
Schedule runs around your stomach and swap workouts as needed.
In an ideal world, I’d run at 8:30 a.m. By then, my stomach has settled down quite a bit, and that means far fewer bathroom stops. Oftentimes, though, I have to get out earlier, and am out the door by 5:00. I actually don’t mind running in the dark because if I have to make an outdoor pit stop, I’m not out on full display. I feel really lucky to have a flexible schedule that typically lets me run at the times of day that work best for my body.
And if things aren’t settling down? I’ll swap my run for an easy ride on the indoor cycling bike or a walk. I don’t mind making a bathroom stop or two, but as soon as I’m making the same number of stops as miles I’m running, that’s just not worth it to me.
Experiment with fueling and hydration to determine what’s best for your body.
Changing my nutrition strategy has been a game-changer for me. I used to run on an empty stomach and never ate any gels during my long runs. But in my preparation for Eugene, I started working with sports dietitian Meghann Featherstun, who helped me figure out that a lot of my bathroom stops were actually because I was dehydrated and underfueled. So I tried eating something small before exercising, and it worked for me right off the bat.
For my long runs, I’ll eat one or two pieces of toast with Nutella beforehand and take a gel every 30 minutes during. I’ll typically make a bathroom stop a few miles in, and then I’m good. If I’m doing a shorter pre-dawn run, I’ll have what I call “bathroom grahams”: a couple of graham crackers I eat in the bathroom while I’m getting ready.
Strip away the stressors to bring back the joy.
I didn’t go into Eugene with a time goal because that would have sucked the joy right out of the race. I actually stopped running with a watch in 2016 because it became a source of stress. Since then, I’ve PR’ed in every distance I’ve raced. I only started wearing a watch again when I started working with my coach, Kaitlin Goodman in preparation for the marathon, just so she could use the data. Her coaching business is aptly named Running Joyfully, which I love. I was very clear from the start that I needed the process to be fun.
The training ended up being both fun and super effective. I ended up achieving a 10-minute PR with a finish time of 3:41:10. My training showed I could maybe, on a dream day, qualify for the Boston Marathon, which for women in my age group means running another marathon in a time of 3:40 or faster. But that day in Eugene, I wasn’t focused on that. If that was my goal, even one bathroom stop would have derailed my race plan, and that would have made it a stressful experience. (To my surprise, I didn’t end up needing to stop for the bathroom one single time.)
All I wanted to do was enjoy the race and—hopefully—run a personal best. And I did. Even though it was super challenging at times, including some walk-running in the last five miles, I’m really happy with how I did. I know I gave it my all.
My mantra is, “Plan for the worst, hope for the best.” That means always being overly prepared for the worst-case scenario and being ready to celebrate your wins, big and small. I always keep a towel in my car because accidents do happen. I’m also open to the possibility that I might make it through an eight-mile run without a bathroom stop. And if I do, I’m definitely going to use that as the title of the workout when I upload it to Strava.
Seriously though, talking about poop can be embarrassing. I really don’t like talking about accidents and the fact that I can’t always make it to an actual bathroom, but that’s my reality. I know it’s worth being open about it though, because whenever I share the realities of running with Crohn’s, I get messages from people who are dealing with the same thing, saying they’re so grateful to know they’re not alone.
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