Stitches - Causes and Treatments
What is a stitch?
A stitch is a localised pain experienced beneath the ribcage on the side of the body. Like cramps, they can vary in intensity of pain and duration and more painful episodes tend to last for longer. They more commonly occur in activities where there is vigorous upright, repetitive movement of the torso (such as horse riding or in sports involving running) but can occur in other types of sports too.
What causes a stitch?
Myth: reduction in blood supply to diaphragm
The diaphragm is a large muscle involved in breathing. It was originally suggested that it receives less blood during exercise as the moving muscles receive more. This theory has now been disproven on the basis that the diaphragm receives more blood as it also works harder during exercise. Also it does not explain why some people feel pain in the lower abdomen which is further down from the diaphragm.
Myth: pain is caused by pulling ligaments
Another belief is that jolting during exercise causes ligaments to pull on organs, for example on the ligament that attaches the gut to the diaphragm. However, this does not explain why stitches can occur in sports that do not involve a jolting action such as swimming.
Fact: irritation of the parietal peritoneum
The parietal peritoneum attaches part of the abdomen to the abdominal wall. When the stomach is full and stretched, friction can occur between contents of the abdomen and the parietal peritoneum. This temporarily irritates the parietal peritoneum which causes the pain in the region.
Fact: dehydration
Dehydration causes a reduction in the amount of lubricating fluid next to the parietal peritoneum, causing more irritation and pain.
Shoulder pain
Some people find that shoulder pain can accompany their stitch. This is because the parietal peritoneum is attached to the phrenic nerve which sends pain to the shoulder tip region. Therefore the same prevention factors can be used to prevent shoulder pain and stitches.
How can I avoid a stitch?
Avoid eating or drinking large amounts within 2 hours of exercising so the food has time to move into the small intestine. This prevents food from bouncing around in the stomach, causing irritation.
Drink water or sports drinks rather than more concentrated drinks such as soft drinks, fruit juices or cordial. This is because more concentrated drinks tend to leave the stomach at a slower rate, leaving it full for longer and increasing the likelihood of friction occurring.
Consuming small amounts of fluid frequently during exercise rather than large amounts infrequently prevent the stomach from becoming too distended.
Treating a stitch
The most effective way to treat a stitch is to bend forward and push on the area in pain while breathing deeply. Alternatively, lying down while lifting your hips into the air can work well but if the stitch is mild, just slowing down and reducing the intensity of the exercise can be enough for it to pass.
