Training in the Heat - How to Avoid Internal Bleeding

 

FYI Lessons Learned -Training in the Heat

A word of caution . . . and things to consider to avoid internal bleeding.

I went on a long hard run on yesterday in the heat of the day and was a bit alarmed afterwards to find out I was bleeding internally. After talking with several people and some research, here is what I believed happened. While this may be TMI for some, I thought it was worth sharing with my triathlon and running friends.

For the past several years I have participated in the Ironman 70.3 Hawaii triathlon. One of the biggest challenges of this race is the heat. This is especially true for a heavy sweater like me. Each year, for a month or two prior to the race I purposely subject myself to long intense training sessions in the heat to prepare for this race. This year I did something a little different and learned a valuable lesson that I will not soon forget.

In years past I have done long runs in the heat, but I have talked my son into setting up a little aid station with cold water and Perform along the 1 mile loop around our house so I could hydrate every mile. This year I thought I was tough enough to go out and face 10 miles of heat armed only with my Fuel Belt. In retrospect, that may have been a mistake.

Prior to going running I completed two hours of cycling on a trainer in the hot garage. Although I drank a lot of water my personal sweat rate is definitely towards the high end. I have weighed myself before and after an hour of running in hot conditions, and I am cable of losing 5-6 pounds in an hour (and that does not take into account the small amount of water I am able to drink while running).  After I finished cycling, I quickly swallowed some salt pills in an effort to ward off cramping, voided my bladder and then went out to run. I purposely timed my run to take place at the hottest part of the day. It was in the 90’s, but I have certainly run in hotter weather. I took my Fuel Belt with two bottles of water and two bottles of Perform. I also carried one disposable bottle of water in my hand. I also ate three high sodium Cliff Shot Blocks while I was running. My goal was to stay on pace despite the heat. Every year the Hawaiian heat has cut into my pace during the run segment of the triathlon. I told myself I was going to suffer whatever it required to stay on pace for 10 miles. That became quite painful for the last three miles and with two miles to go my body was beginning to resist my constant command. My running form was deteriorating on a muscular level towards the end of the run, but I was able to stay on pace. I finished on pace, but immediately felt a bit off and I became wobbly walking.

I drank a bottle of water and took a shower to cool down. Don’t tell my wife this, but I always take a cold shower after a hot run and something about the cold water usually induces me to want to urinate. When I looked down, I was a bit alarmed. I was peeing what looked like pure blood. Even the water from the shower was doing very little to dilute the blood on the floor of the shower. Needless to say this prompted a few telephone calls and some research. I am not a doctor, and I am not giving medical advice, but this is what I think happened:

The medical term for this is called exercise-induced hematuria. While there are several theories on what happens, and no one is exactly sure, this tends to occur in individuals during particularly long and intense runs where dehydration and heat are factors. Basically what happens is that when your body becomes severely dehydrated, the bladder can collapse in on itself. During the jarring repetitive motion created by running the walls of the bladder begin to rub and hemorrhage at the points of friction filling the bladder with blood. The trauma to the bladder walls might intensify and have an earlier onset if you start dehydrated and with and empty bladder. Dehydration will cause a greater degree of blood being shunted from the kidney as well.

In my case I am convinced I started by dehydrating myself while cycling for two hours in the hot garage. To make matters worse and then voided my bladder before I went out to run. (which I never do) The amount of water I was able to take with me, was a very small percentage of the water I lost during the near hour and half it took me to run the 10 miles. Looking back at what I know now, I set myself up for type of internal bleeding.
I just wanted to share this, because it is the first time in over three years of triathlon training that this has happened and it can be a bit alarming. So if you are going on a long hot run, you might want to consider starting well hydrated, don’t void your bladder completely and make sure you are able to get your hands on some water out there.

From a psychological perspective, Is there something wrong with the fact that I am a little bit proud of the fact that I now possess the discipline to push myself to stay on pace in the heat until I am literally bleeding internally?