Tiffani Koonce, a 20-year-old student athlete from Illinois, experiences bowel incontinence almost once a week during her daily jogs. She has made calls to her boyfriend, Cayde de Waal, many times over the past year with messages like, “Yo, come get me. There is poo coming down my leg.”
It first happened when she was 17 and doing cross country at high school. “I don’t really remember the moment, just that I told my coach: ‘something’s happened, I gotta go,’” she says. After starting college a year later, bowel incontinence became a regular occurrence. “College ruined me,” she tells Metro from her dorm room.
An ‘inconvenience’ she refuses to be embarrassed about
When she feels it coming, Tiffani holds it as long as she can while looking for nearby toilets, but she reaches a point where she can’t anymore. It’s not diarrhoea, but an inability to control when a movement comes out. Over the past three years, she has had many mid-run hunts for port-a-loos, adopted a squat on a roadside more than once, and has even had to walk a mile back to the house in soiled underwear, trying to avoid other people.
While Tiffani considers this habit an “inconvenience,” she refuses to feel embarrassed. She has posted some of her “accidents” on social media. “I’m kind of an oversharer,” she admits. The first time Cayde picked her up, she decided to record and post it to TikTok. “He turned up with a roll of toilet paper. It was far too late for that and I found it really funny. When I got in the car he was holding his nose and had the windows rolled down,” she says.
That video blew up, and when she posted another to TikTok this summer – this time with Cayde offering a towel – it was the same, with 1.7 million views and nearly 2,000 comments. Among the “another reason not to run” and “are you selling the shorts?” comments, there were people trying to make Tiffani feel embarrassed about it. “But it’s not something I can control,” she explains.
What the experts say
Suggestions that she try going to the loo before (she does) or not eating before she runs (“I need the energy”) have not helped. “I try to explain to the best of my ability that this is just what my body does and they just don’t get it,” she says. According to Tiffani’s doctor, “sometimes this just happens to runners,” and after checking her over, the doctor is not concerned. Neither is Tiffani, especially as she finds this only happens during the summer.
Lucy Allen, Consultant Digestive & Pelvic Health Physiotherapist, says, “Bowel incontinence is a more common problem than people realise – but anyone experiencing it shouldn’t pass it off as something that just happens without being examined.” She explains, “There isn’t one single cause; it’s more typically a combination of physiological, psychological, mechanical and nutritional.”
“From a physiological perspective: during intense exercise, blood flow is directed away from the gut and stress hormones can impact the digestive system, speeding it up. In Tiffani’s case, heat could exacerbate symptoms if it’s a particularly hot environment due to redirection of blood flow and this impact on gut function.”
Following Joanna Wietrzyk’s Hyrox win, where the athlete continued to compete after soiling herself, bowel incontinence during sport has been discussed more openly. Allen says that there are various reasons why this could happen. “Mechanically, if an athlete has an underlying muscle dysfunction within the pelvic floor or anal sphincters – either weakness, or inability to fully relax – it would impact their ability to control stool when exercising. If the stool is looser, this places a greater strain on the mechanics. Nutritionally if an athlete hasn’t eaten the best foods prior to competing then it can cause gastrointestinal upset.”
This latter cause was posited by Paula Radcliffe, who apologised to the nation after relieving herself on the side of the London Marathon in 2005 and later said it was likely due to too much gluten-free pasta and grilled salmon the night before. Another cause is the physical jostling of the organs brought about by running; this movement, combined with the reduced blood flow, can cause food to move through the bowel faster than normal.
Living with the condition
Tiffani is thankful that she has never had a race interrupted by a “movement” but says that, unless she was metres away from the finish line and going to get a personal best, she wouldn’t continue. She knows how common this issue is among athletes. While none of her peers have experienced it, to her knowledge, the comments on her TikTok were flooded with people who had had similar struggles.
According to Allen, bowel incontinence impacts around 5-10% of people in the UK alone, but it is a poorly studied area in athletes. She emphasises that “we can’t directly compare Paula Radcliffe with Joanna Wietrzyk, for example, as they were participating in very different activities, in different environments.” Still, she acknowledges that “bowel incontinence when running is more common in endurance athletes” and for women, factors like childbirth and hormones will play a role.
For Tiffani, the main struggle isn’t actually soiling herself: it’s the clean up and what comes next. “Where I can, I try to salvage my shorts, hosing them down before putting them in the machine. Then I have to wash myself. Then I have to go back out to finish my run.” As a college athlete, she has a strict training schedule, meaning she can’t just be done because her body wants her to be. “I have to run 55 miles every week, poo or no poo.”
The only solution she has found is to run with her phone so she can call for help. The first time it happened, her then-boyfriend’s mum picked her up; nowadays, it’s Cayde.
“No bowel incontinence is normal,” says Allen. She recommends getting checked over if you have any of the following symptoms, so doctors can rule out any underlying bowel or muscular issues: regular incontinence; bleeding either on the stool, in the toilet or on wiping; change in bowel habit for more than 3 weeks; abdominal pain; persistent bloating; feeling of incomplete bowel emptying or pressure in the bottom; unexplained weight loss; any neurological symptoms.
“Everyone’s always been nice when it happens,” Tiffani says. She has learnt to be upfront about it. On a recent trip to South Africa to meet Cayde’s family for the first time, she went out for a training run and had to waddle back after experiencing the familiar sensation. “They knew that this sometimes happens to me and so waited patiently for me to get cleaned up before we headed out for our planned sunset photoshoot.”
While Tiffani doesn’t plan to continue her running career after university, it’s not because of her bowels. In fact, she sees herself becoming a “hobby jogger,” accompanying Cayde on his daily runs. For now, she is welcoming the onset of winter, a period where her accidental poos calm down.
