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I often get sinusitis. I usually just keep running through it and sometimes this seems to help.

A Sinuses are hollow air spaces in your facial bones, the main ones being the frontal sinuses (in your forehead) and the maxillary sinuses (in your cheeks). They are lined with respiratory epithelium (see here) that produces mucous which drains away through small passages into the nose and throat. When sinuses become inflamed it’s called sinusitis – ‘itis’ is the Greek word for inflammation. This can happen because of infection, which is usually viral, more rarely bacterial or even fungal. It can also be triggered by allergies. Sometimes cold air can aggravate sinuses too. Commonly, sinusitis is a one-off event, usually following a cold. This is called acute sinusitis, but if it lasts more than 12 weeks it’s called chronic sinusitis and other causes such as nasal polyps (non-cancerous growths) need to be considered. When the sinuses become inflamed and swollen, the holes draining the mucous away get blocked and mucous builds up in the sinuses, causing facial pressure, tenderness and congestion. Sinusitis can also cause a headache, toothache or earache and a sore throat. It may make you feel tired, dizzy and sometimes, with acute sinusitis, feverish.

When you run, adrenalin causes some of the small blood vessels in your body, such as those in your sinuses, to contract. With less blood flow to the area, the tissues become less plump and swollen and this may temporarily reduce your nasal congestion. Of course, the exercise itself can give you a feeling of wellbeing too. However, if you don’t feel well in yourself, can’t breathe properly or have a fever, then you shouldn’t run. Thankfully, viral sinusitis usually clears on its own within three weeks. You can use pain killers, decongestants and steaming to ease your symptoms. To steam, simply fill a sink with very hot water. Make a tent by placing a towel over your head. Inhale the hot, trapped, moist air. You can add some menthol crystals or a few drops of olbas oil to make it more effective. Have a chat with your pharmacist about whether nasal steroids or antihistamines might benefit you. Chronic or recurrent sinusitis and symptoms that are just on one side of the face should be assessed by a GP, because a referral for further investigation might be needed.

Did you know?

The urge to breathe is mainly driven by rising carbon dioxide levels in the blood rather than by low oxygen levels. Sensors in the brain, and in the aorta and carotid arteries (major blood vessels), monitor levels and adjust breathing rate accordingly.

Top tips for healthy runner’s lungs

• Don’t smoke and avoid passive smoking too.

• Maintain a normal weight.

• Exercise regularly at a variety of paces.

• Eat a healthy, varied diet.

• Practise diaphragmatic breathing (see here).

• Avoid rush hour running to minimise exposure to air pollutants if you experience symptoms or have lung problems.

• Maintain a good running posture (see here) to allow your lungs to expand freely.

• Consider Pilates to help control breathing, strengthen muscles and improve posture.

FURTHER HELP AND ADVICE

Pollen counts and the Air Quality Index – Met Office: www.metoffice.gov.uk

British Lung Foundation: www.blf.org.uk

Asthma UK: www.asthma.org.uk

Allergy UK: www.allergyuk.org

British Thoracic Society guidelines: www.brit-thoracic.org.uk/quality-improvement/guidelines/

NICE guidelines: www.nice.org.uk

Chapter 4

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The Gastrointestinal System

Of all the body’s systems, it’s the gastrointestinal system that seems to cause the most frequent (and embarrassing) problems for runners. From vomiting to diarrhoea, stitches to piles, there are lots of issues that can crop up and stop you in your running tracks. But regular running has many important benefits for the gastrointestinal system, for example, helping prevent constipation and lowering your risk of bowel cancer by up to 50 per cent, so it’s important to know how to overcome problems and keep going. This chapter features lots of tips and advice to make sure you’re not always running towards the toilet!

The gastrointestinal system allows us to extract energy from food and get rid of waste products through digestion and excretion. Digestion begins in the mouth where food is chewed, mashed up and mixed with digestive enzymes in saliva. It’s parcelled up into small packages called food boluses, which are propelled down the oesophagus (gullet) by a process called peristalsis, a series of involuntary muscular contractions. The sphincter (muscular ring) at the top of the stomach relaxes, allowing food into the stomach, where further enzymes continue to break it down and stomach acids destroy any harmful bacteria. There is a further sphincter at the bottom of the stomach which relaxes intermittently to allow small amounts of the stomach’s contents to pass into the small intestine (small bowel).

Most of the digestion and absorption of nutrients occurs in the small intestine. Food meets enzymes from the pancreas and fats are digested by bile squirted in from the gall bladder. The lining of the small intestine is specially designed to absorb nutrients into the bloodstream. It is lined with small finger like projections called villi which each have microvilli covering them. This creates a huge surface area over which nutrients can be absorbed. What’s left of the food then travels on to the large intestine (large bowel), where our healthy gut bacteria break it down further and water is reabsorbed to make a formed stool. The stool is held in the rectum until the time is right for it to be expelled through the anus.

Having knowledge of our basic gut anatomy and physiology helps us to understand why things can sometimes go wrong and what we can do about them. Let’s move on to answer the questions most frequently asked by runners. We’ll start at the top and work our way down from mouth to anus.

Q Why do I always need to spit when I run?

A Saliva is designed to lubricate our mouth and throat, and helps to keep germs out. The amount and consistency of our saliva, which is controlled by our nervous system, changes frequently. Exercise increases the flow of saliva,

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