This article explores the relationship between sports activity and the occurrence of proctological complaints, drawing on the author’s clinical observations of competitive athletes, including triathletes, marathon runners, and cyclists, presenting with various proctological conditions.

It is well-documented that physical activity benefits intestinal peristalsis and helps prevent constipation. However, certain sports may predispose individuals to proctological conditions.

In 2025, a study was published analysing a group of 312 individuals engaged in sports (1). Participants were included based on the criterion of training at least twice a week. Data were collected through a questionnaire, and sports disciplines were categorised into seven groups, including:

• body-building,

• cycling/motorcycling,

• climbing/dancing/athletics,

• running,

• tennis/basketball/rugby,

• football/trekking/alpine skiing/cross-country skiing,

• other sports.

Of the 312 study participants, 34% reported symptoms of haemorrhoidal disease. Among those engaged in cycling or horse riding, 57% reported haemorrhoidal symptoms, while 48% of body-building participants experienced similar issues. These results were statistically significant. Overall, the study findings indicated a significant relationship between cycling, horse riding, and body-building and the occurrence of haemorrhoidal disease. The authors concluded that while certain sports may contribute to the development or exacerbation of haemorrhoidal disease, the numerous health benefits of physical activity outweigh these risks. Therefore, rather than discontinuing sports, patients should receive guidance on safe participation in sports in relation to their specific condition (1). In another article published in “JAMA”, the authors state that any activity or condition that increases pressure on the veins in the lower body may lead to haemorrhoidal disease. The authors mention factors such as exertion and prolonged straining during defecation, extended sitting on the toilet, constipation or diarrhoea, being overweight, and pregnancy – all of which increase intra-abdominal pressure, leading to venous obstruction and swelling of the haemorrhoidal plexus. Additionally, increased intra-abdominal pressure may weaken the pelvic floor structures, secondarily impairing control over stool, gas, and urine (2).

Engaging in sports can increase intra-abdominal pressure through two types of exercise: strenuous strength training (such as weightlifting) and high-impact exercises performed at a higher frequency (such as jumping and running). The former type is characterised by a brief but significant rise in intra-abdominal pressure, while the latter involves repeated impacts from ground reaction forces. This may explain the worsening of haemorrhoidal symptoms in athletes engaged in vastly different sports, such as weightlifters and runners.

Another condition that may affect athletes exposed to high physical strain is gas, faecal, and urinary incontinence. Heavy loads and changes in the sacro-lumbar spine, particularly at the L5-S1 level, where they compress the roots of the pudendal nerve (which innervates both the anal and urethral sphincter muscles), can lead to pelvic floor dysfunction and, consequently, neurogenic incontinence.

Cycling is often regarded as a recreational activity with a low risk of serious or chronic injury. However, competitive cycling leads to overload-related injuries, primarily affecting the ulnar and median nerves, as well as the pudendal nerve, which is particularly relevant in this context. Since the pudendal nerve innervates the entire perineum, including the anal sphincter muscles, repeated injuries can result in reduced gas and stool continence and may contribute to pelvic floor descent (3).

Engaging in moderate exercise, such as walking or Nordic walking, may lower the risk of developing gas, faecal, and urinary incontinence. Trekking, alpine skiing, and cross-country skiing also seem to reduce the risk of incontinence, as they strengthen the pelvic floor muscles without causing excessive strain.

Giagio et al. (4) conducted a review of epidemiological studies on the prevalence of pelvic floor dysfunction (PFD) in both male and female athletes. In a total of 21 studies, the authors specifically examined high-performance athletes, confirming that training-induced overload contributes to the development of pelvic floor dysfunction.