What causes a stitch in your right side when not exercising

What causes a stitch in your right side when not exercising

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Almost everyone occasionally gets side stitches, painful side cramps during exercise--although some people seem more prone to them than others.

A side stitch is a cramp or spasm in your diaphragm--a dome-shaped muscle that separates the organs in your abdominal cavity from the heart and lungs in your chest cavity. As you inhale and expand your lungs, the diaphragm sinks down. When you blow out a breath, it expands upward. So far, no problem.

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What causes a stitch in your right side when not exercising

But your liver is attached to the diaphragm by two ligaments, and sometimes running or even brisk walking--which can mean almost 200 pounds of force with each foot strike--can yank the diaphragm downward even as it is expanding upward with each exhalation. The result: a sharp twinge below your ribs, usually on the right hand side, where the liver is located. A full stomach can have a similar effect.

No-Stitch Exercise

You can avoid stitches by minimizing stress on the diaphragm. Here's what experts recommend:

Belly Breathe If you consistently take shallow breaths, your diaphragm remains in the "up" position, so your connective ligaments don't get a chance to relax. Instead, breathe evenly and deeply, drawing air deep into your lungs so your belly rises, your diaphragm dips, and your ligaments get a rest.[pagebreak]Go Easy on the DownhillWalking or running downhill increases the force on your body with every foot strike. Avoid long downhill routes if side stitches are a recurrent problem for you.

Eat LightlyAvoid heavy meals for 3 hours prior to your workout. If you need a light snack, have it 1 hour before heading out the door. Continue drinking fluids, however. They leave the stomach quickly and hydrate you, thus helping to prevent cramping.

Ease UpSometimes stitches are the result of too much too soon. If you start to feel a stitch coming on, slow your pace and relax your body until the feeling subsides. Gradually increase your effort until you can walk or jog pain-free.

Reach for the SkyStretching your diaphragm muscles is as important as stretching your hamstrings. Raise your right arm straight overhead. Then bend your torso to the left. Hold 20 to 30 seconds. Switch sides. Perform this stretch daily.

Switch Sides Many people fall into a rhythm of always exhaling as the same leg strikes the ground. For instance, they start inhaling during their left foot strike, and four footsteps later, begin exhaling when their right foot comes down. Consistently exhaling on the same side can contribute to side stitches. Try inhaling one extra beat than you exhale (inhale 1-2-3, exhale 1-2), so you alternately breathe in and out on opposite legs.

Rub It OutWhen a stitch strikes, massage or press on the area where you feel pain, while bending forward slightly. If the pain persists, stop exercising, and massage and stretch the area until the cramp subsides. Continue on at a lower intensity.

Purse Your Lips A popular method for both avoiding and alleviating side stitches is to purse your lips (as though blowing out birthday candles) while you exercise. No one knows exactly why it works, though it may help you focus on your breathing, especially on deep exhalations and inhalations that allow the diaphragm to move through its full range of motion.

A side stitch is an intense stabbing abdominal pain under the lower edge of the ribcage that occurs during exercise. It is also called a side ache, side cramp, muscle stitch, or simply stitch, and the medical term is exercise-related transient abdominal pain (ETAP).[1] It sometimes extends to shoulder tip pain, and commonly occurs during running, swimming, and horseback riding. Approximately two-thirds of runners will experience at least one episode of a stitch each year. The precise cause is unclear, although it most likely involves irritation of the abdominal lining, and the condition is more likely after consuming a meal or a sugary beverage. If the pain is present only when exercising and is completely absent at rest, in an otherwise healthy person, it does not require investigation. Typical treatment strategies involve deep breathing and/or manual pressure on the affected area.

Causes[edit]

The precise cause of ETAP is unclear. Proposed mechanisms include diaphragmatic ischemia (insufficient oxygen); stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament under the diaphragm; aggravation of the spinal nerves; or, most likely, irritation of the parietal peritoneum (abdominal lining).[1][2]

Although the diaphragm is mostly innervated by the phrenic nerve, and thus could explain referred pain to the shoulder tip region, the main evidence against diaphragmatic ischemia is that ETAP can be induced by activities of low respiratory demand, such as horse, camel, and motorbike riding, where ischemia of the diaphragm is unlikely. In a study using a fluoroscopic technique, diaphragmatic movements during an ETAP episode have been shown to be full and unrestricted.[2] In another study, researchers analyzed flow-volume loops from subjects who were experiencing ETAP and found no compromise in any measures of breathing, suggesting that the diaphragm is not implicated directly in the causation of ETAP.[3]

Some have proposed that this abdominal pain may be caused by internal organs (like the liver and stomach) pulling downwards on the diaphragm,[4] but this hypothesis is inconsistent with its frequent occurrence during swimming,[1] which involves almost no downward force on these organs.

Frictional irritation of the parietal peritoneum has been suggested as a cause of ETAP.[1] The parietal peritoneum is the outer layer of the peritoneum that adheres to the abdominal wall and underside of the diaphragm. Because the portion of the peritoneum that underlies the diaphragm is innervated by the phrenic nerve, it could explain the shoulder tip pain.[5][6][7] The parietal peritoneum traverses the entire abdominal wall, which could account for the widespread distribution of ETAP; the tension in the parietal peritoneum is increased with torso extension; children have a proportionally larger peritoneal surface compared to adults, which could explain the increased prevalence of ETAP in younger individuals;[2][8] and pain arising from the parietal peritoneum relieves quickly on removal of the stimulus,[5] similar to what is observed for ETAP when activity is ceased.[3] After a meal, distention of the stomach could increase friction between the visceral and parietal layers of peritoneum,[1] and sugary beverages could provoke ETAP due to slower emptying of the stomach.[9] In fact, the fluid in the peritoneal cavity is highly responsive to osmotic gradients between it and its vascular supply.[2]

In the absence of a clear cause, any treatment techniques are uncertain. Typical strategies involve deep breathing and/or manual pressure on the affected area.[2]

Occurrence[edit]

Side stitches occur in every level of athletes from school-aged children, weekend exercisers, or elite athletes, although they are more common in younger people. Activities that use upper body twists, like running, swimming, and horseback riding, report this affliction more often. Approximately two-thirds of runners will experience at least one episode of a stitch each year.[10]

See also[edit]

  • Precordial catch syndrome

References[edit]

  1. ^ a b c d e Morton, Darren P.; Callister, Robin (February 2000). "Characteristics and etiology of exercise-related transient abdominal pain". Medicine & Science in Sports & Exercise. 32 (2): 432–438. doi:10.1097/00005768-200002000-00026. PMID 10694128.
  2. ^ a b c d e Morton, Darren P.; Callister, Robin (January 2015). "Exercise-Related Transient Abdominal Pain (ETAP)". Sports Medicine. 45 (1): 23–35. doi:10.1007/s40279-014-0245-z. PMC 4281377. PMID 25178498. S2CID 18088581.
  3. ^ a b Morton, Darren P.; Callister, Robin (December 2006). "Spirometry Measurements During an Episode of Exercise-Related Transient Abdominal Pain". International Journal of Sports Physiology and Performance. 1 (4): 336–346. doi:10.1123/ijspp.1.4.336. PMID 19124891.
  4. ^ Collins, Andrew (2009). On Running on Lessons from 40 Years of Running. Bloomington, IN: Authorhouse. p. 148. ISBN 9781438936246. Retrieved 12 October 2015.
  5. ^ a b Capps, Joseph A.; Coleman, George H. (1 December 1922). "Experimental Observations on the Localization of the Pain Sense in the Parietal and Diaphragmatic Peritoneum". Archives of Internal Medicine. 30 (6): 778–789. doi:10.1001/archinte.1922.00110120097004.
  6. ^ Jackson, S. A.; Laurence, A. S.; Hill, J. C. (May 1996). "Does post-laparoscopy pain relate to residual carbon dioxide?". Anaesthesia. 51 (5): 485–487. doi:10.1111/j.1365-2044.1996.tb07798.x. PMID 8694166. S2CID 35371138.
  7. ^ Narchi, P; Benhamou, D; Fernandez, H (December 1991). "Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy". The Lancet. 338 (8782–8783): 1569–1570. doi:10.1016/0140-6736(91)92384-E. PMID 1683981. S2CID 22742711.
  8. ^ Esperanca, Manuel J.; Collins, David L. (April 1966). "Peritoneal dialysis efficiency in relation to body weight". Journal of Pediatric Surgery. 1 (2): 162–169. doi:10.1016/0022-3468(66)90222-3.
  9. ^ Morton, Darren Peter; Aragón-Vargas, Luis Fernando; Callister, Robin (April 2004). "Effect of Ingested Fluid Composition on Exercise-Related Transient Abdominal Pain". International Journal of Sport Nutrition and Exercise Metabolism. 14 (2): 197–208. doi:10.1123/ijsnem.14.2.197. PMID 15118193.
  10. ^ Wetsman, Nicole (2017-10-20). "When you get a stitch in your side, what's really going on?". Popular Science. Archived from the original on 2017-11-13. Retrieved 2019-08-02.

Further reading[edit]

  • Stewart & McKenzie (2002). "The human spleen during physiological stress". Sports Medicine. 32 (6): 261–269. doi:10.2165/00007256-200232060-00002. PMID 11980500. S2CID 24607294.{{cite journal}}: CS1 maint: uses authors parameter (link)
  • Otto et al. (2010). "The effect of exercise on normal splenic volume measured with SPECT". Clinical Nuclear Medicine. 20 (10): 884–887. doi:10.1097/00003072-199510000-00005. PMID 8616992. S2CID 37316332.{{cite journal}}: CS1 maint: uses authors parameter (link)
  • Laub et al. (1993). "Spleen emptying and venous hematocrit in humans during exercise". Journal of Applied Physiology. 74 (3): 1024–1026. doi:10.1152/jappl.1993.74.3.1024. PMID 8387068.{{cite journal}}: CS1 maint: uses authors parameter (link)
  • Mackenzie, Brian (1999). "Stitch". Sports Coach.

Why do I have a stitch like pain in my right side?

Pain on the right side of the abdomen can be caused by conditions such as appendicitis, hernia, kidney issues, reproductive system issues, irritable bowel syndrome (IBS), indigestion, or even gas.

What else feels like a side stitch?

When appendicitis first hits, it can feel like indigestion or a side stitch. However, the pain will typically shift to your right side over several hours, and it will intensify as the swelling in your appendix grows.

Why do I have a constant stitch in my side?

The most common reason for side stitches is called diaphragmatic ischemia. This pain is more consistent and can present in activities that are not in high respiratory demand. A second cause of side stitch can be a result of a strain or stress on the ligaments that attach the diaphragm to the abdominal lining.

What organ causes a stitch?

A stitch can occur during any kind of mid- to high-intensity exercise, however it is mostly associated with running. A current explanation is that during running, the stitch is caused by the weight of organs such as the stomach, spleen and liver pulling on ligaments that connect them to the diaphragm.