Aerophagia: Swallowing Air While Swimming

author : AMSSM
comments : 2

Member Question from Tastice

"I've been training for a HIM and I've been trying to swim three to four times weekly, the first several months I've focused 100% on skill and form. I've improved my stroke from night to day, now I'm trying to focus on getting my endurance down. I swam 2000 meters which was a lot for me, I was feeling good everywhere except the horrible stomach pain from getting air in my stomach creating a lot of gas. I hurt for about 30 minutes afterwords. I thought it was what I had eaten so I took note and moved on. Well, this morning I swam 3000m and again I got horrible stomach problems with lots of air or gas build-up. What am I doing wrong that is making this happen, is it nutrition or how I'm swimming?"

Answer From Dena Florczyk, MD
Member AMSSM

Aerophagia, or swallowing air, is not an uncommon cause of bloating or belching in swimmers, and can also result in stomach pain, cramping and flatulence. Swallowing air while you swim may be technique related- such as pocketing air in your cheeks, or not fully exhaling underwater prior to taking your next breath. It is important to keep a steady and rhythmic breathing pattern.  I suspect your breathing pattern will improve with more time spent in the water.
    
Everyone swallows a small amount of air with eating and drinking, but this can be exacerbated in situations where one gulps down sustenance or breathes rapidly and deeply. In the upright position, air rises above other liquids in the stomach and is expelled in a belch. In the horizontal position, such as when you are swimming, air may get trapped behind fluid in the stomach and propelled into the small intestine which can cause pain and subsequent flatulence.  Other physiological reasons for increased belching and stomach pain with exercise include reflux or heartburn due to increased abdominal pressure with exercise in combination to decreased lower esophageal sphincter tone (this is the primary barrier between stomach and esophagus). Furthermore, as an athlete increases the level of intensity or if they become dehydrated, the emptying of food out of the stomach can be delayed. Another common cause of stomach discomfort in endurance athletes which may be associated with gastrointestinal symptoms such as nausea, belching, and flatulence is the “side stitch” or exercised-induced transient abdominal pain. This occurs more often when doing activities that have the torso in an extended position like running or swimming, as opposed to cycling when the torso is in a flexed position.

Nutrition can also be a culprit when it comes to stomach pain and exercise. Chewing gum and drinking carbonated beverages can increase aerophagia. A large pre-exercise meal or food with high concentration of simple sugars can cause enhanced gas production and may increase chances of developing exercise-induced transient abdominal pain. Additionally, greasy foods, caffeine, chocolate, and mints can decrease lower esophageal sphincter tone which can result in increased reflux or belching.

Talk with your swim or triathlon coach about your breathing technique in the water. Keep a food diary to identify any triggers to your episodes of stomach pain. If you continue to have episodes of severe abdominal pain and gas, I would recommend you schedule an appointment with your sports medicine physician for further evaluation.

Hope this helps and good luck with your training!

Dena Florczyk, MD

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date: March 15, 2010

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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