The event has also triggered debate about elite athletes pushing themselves so hard that gastrointestinal accidents happen.
However, it’s far from the first time something like this has occurred. Most famously, the British long-distance runner Paula Radcliffe was overcome by severe stomach cramps during the 2005 London Marathon, and eventually – in full view of spectators and TV cameras – used the roadside as a toilet. She went on to win in 2.17:42.
Paula Radcliffe. Photo / Brett Phibbs
“It’s not really a matter of if it happens to you, but when,” Simon, an ultra-marathon runner, says.
“Managing that is probably the biggest challenge, especially when you start getting into distances from about 80km upwards.”
The need to poo during exercise is common, especially for athletes competing in intense activities like Hyrox or ultra marathons, says Dr Rachel Scrivin, an advanced sports dietitian who completed her PhD in exercise gastroenterology.
There are three main pathophysiological pathways that can cause gastrointestinal (GI) symptoms during exercise, she explains.
The first is the circulatory-GI pathway. During exercise, blood is redirected away from the gut towards working muscles and the skin for cooling.
This can reduce gut blood flow and, particularly during exercise lasting more than three hours, or in intense heat, can compromise the gut lining.
The second cause is the neuroendocrine-GI pathway. Scrivin says exercise can trigger the release of hormones such as adrenaline and cortisol, which can alter gut function and how quickly things move through the intestine and how nutrients and fluids are absorbed.
“A lot of athletes would say they have a nervous poo before they exercise.”
And finally, mechanical disruption – the physical jolting and jarring of exercise can stimulate and potentially damage the gut, impacting the gut lining and/or function.
“So thinking of this athlete in particular, due to the intensity and type of exercise, I would say there’s a lot of change in her gut position, from being upright when running, and then the next minute doing burpees, so they’re up and down, creating a lot of mechanical disruption as well.”
Simon, who runs endurance ultra-marathons, says it’s a topic that is openly discussed and understood in the running community.
It’s why there are so many toilets on marathon routes.
“Generally, it’s manageable. It’s not something that hits you all of a sudden. So for me during the race, if I have to get through the next 5 to 10km, then I can comfortably do that.”
But for long endurance events, particularly in the wilderness, other measures are needed. Simon says it is common for ultra-runners to carry gloves, wet wipes and a sealable bag in case they need to deal with bodily waste.
Is pooing yourself during exercise normal?
There’s an important distinction between the urge to defecate during exercise and uncontrolled faecal incontinence, Scrivin says.
“That feeling of needing to poo, that’s quite common.
“In my research with athletes that have gut symptoms, that was the most commonly reported symptom.”
But that usually comes with a warning, or “an urge” first, allowing the athlete to make it to a toilet.
But more severe symptoms, such as actually pooing your pants, are much less common.
“The question is, did she have that urge to defecate first, and if so, why didn’t she address it? Generally, you can hold your sphincter until you get to the toilet.”
But if she didn’t have that urge, Scrivin says, that would warrant further investigation with a medical professional.
Is it okay to exercise so hard that you poo?
Scrivin says it depends on how often it happens. A one-off incident can just be an unfortunate event, but recurrent, severe symptoms should definitely be investigated.
Pooing isn’t the only gastrointestinal problem athletes can experience during extreme exercise.
Vomiting is also possible, especially during prolonged exercise like ultra-marathons, or extreme workouts like a Hyrox.
Why didn’t she stop?
Elite sport often rewards athletes for pushing through pain, fatigue and adversity. But Iain Saunders, one of the country’s leading high-performance psychologists, says those same qualities can sometimes work against them.
“Athletes who are trying to be great are not always making amazing decisions for their own welfare,” he says.
Saunders says elite performers are often capable of overriding feedback from their bodies – part of what allows them to perform at an exceptional level.
But when an athlete is intensely focused on a competitive goal, Saunders says it may be difficult to know when perseverance has gone too far.
“The question for me would be, is she equipped to make good decisions when she’s in that space between perseverance and persistence, and chasing competitive goals?”
He says he is sympathetic to the athlete, who may simply have been doing what elite sport encourages: pushing herself to the absolute limit.
“The qualities we celebrate in elite athletes … can be liabilities when they’ve not got the right judgment around them.”
Why didn’t someone stop her?
Ultimately, says Saunders, responsibility should have fallen to the event organisers to step in.
“The question for me is, has the environment got the guide rails to keep her and her competitors safe?”
Saunders says international rugby is a good example of a sport with strong health and safety systems, including blood protocols and concussion procedures designed to protect players – regardless of an athlete’s desire to continue.
Hyrox athlete and ultra-marathon runner Jared says the situation is especially unusual as Hyrox events have strict rules around cleanliness and safety, with time penalties added for athletes who spit, litter, or splash water on the floors.
“She didn’t break any rules, technically. But does it make it right? No. But does it make it her fault? It’s pretty grey, isn’t it?”
Hyrox co-founder Moritz Fürste has since apologised on social media, writing: “HYROX made a mistake by not reacting immediately during the race.”
“It is my job to foresee these potential incidents – and I did not … As of this moment, there are new rules and procedures in place to prevent situations like this from happening again.”
How to reduce the risk of needing to go
There are practical things athletes can do to prevent toilet emergencies during events, Scrivin advises.
Eating food that is easy to digest and low in fibre, such as potatoes, kūmara, pasta and rice, is best before an event. For athletes with gastrointestinal issues, Scrivin recommends a low-FODMAP diet in the 24-48 hours before the event.
Fluids can also stimulate the bowel, says Scrivin, so while it’s important to be well hydrated, she recommends just sipping water in the last 30 minutes before an event.
“For endurance events, we definitely have to practise taking on food, taking on fluid … just like you’re doing with your training.”
Jared likens this to a Formula 1 race.
“If you’re going to red-line an F1 car on the track, you want to put the fuel in it that you’ve put in every other time in practice. You don’t want to change a thing.”
Scrivin also works with clients to develop a toileting strategy.
“I have several athletes that have that really down pat, like they get up two hours before, they have their breakfast, they have some fluid, because often fluid in the tummy triggers the gut to have a poo, it makes your tummy think it’s ready to go, and they sit on the toilet, and not force it, but try to empty their bowels.”