Ask the Coach: Marathon incontinence

Q. I just completed my first marathon. My training went well and I almost always felt good during my long training runs (we ran up to 20 miles). During the actual race, I felt great up until mile 14, but then my breathing became irregular and I began to feel nauseated.

I pushed myself to keep running and during a few of my walking breaks I actually couldn't control my urination. I had lost color in my face by mile 20 and began to have goose bumps even though I wasn't cold. Needless to say, I was in bad shape and had to walk most of the six miles left. It was a real disappointment since I felt so strong during all of my training runs.

Before the race I only had a piece of toast with peanut butter (which is about all I would normally eat before my long training runs) and at mile six I had a Gu gel (which I used during training) and drank most of my GU liquid drink. I also took two Tylenol before the race (which I normally never used but thought it would help). It was a cool morning and I don't remember sweating all that much for the first 13 miles but I drank most of my liquids by then. I've heard of over hydrating -- could that be what happened?

A. I think you need to check with your doctor on this one. I'm suspicious of the Tylenol simply because it stands out as something you normally don't do during training. I haven't heard of Tylenol causing incontinence problems, but your doc may have more information. When you chat with your doc, go armed with the following information:

  • What you ate the day before the race and race morning. Your breakfast seems really light to me (only a couple hundred calories or so), but you say this is normal for you.
  • A list of all supplements and drugs you took the day before the race, race morning and during the race. Sometimes drug interactions can cause problems.
  • Hydration rate, fueling rate and contents. You note that you drank most of your GU liquid drink. Was that 8 ounces, 16 ounces, 32 ounces, how much? Your doc will want to know the electrolyte content of the GU drink, so take the label along. In particular, he or she will want to know how much sodium is in the GU drink, per serving. How many calories per serving of GU did you have, or in other words, how many calories did you consume in that first 13 miles? (Be sure to add the gel into the equation.) Did you eat anything else in the first half of the race? Did you drink any water (or anything else) in addition to the GU drink? If so, how much?
  • What happened after mile 13? You don't comment if you took any more fluids or fuels in after mile 13.
  • What was the severity of incontinence? Some women will notice some urinary leakage when their bladders get full, with laughing, sneezing or other similar types of "pressure situations." Some have more problems around their menstrual cycles. Was your issue a leak or a bigger problem?
  • Getting the issue sorted out with your doc will help you be confident that it won't happen again.

    Do you have a specific training or sport related question? Have world-renowned coach Gale Bernhardt answer it! Send your questions to

    Gale Bernhardt was the 2003 USA Triathlon Pan American Games and 2004 USA Triathlon Olympic Coach for both the men's and women's teams. Her first Olympic experience was as a personal cycling coach at the 2000 Sydney Olympic Games.

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