Managing Pre-Competition Nausea in Athletes

As athletes, we've all experienced that familiar feeling of anxiety before a big race or competition - the butterflies in our stomach, the nausea that threatens to overwhelm us, and the fear of vomiting in front of our teammates and spectators. Though upset stomachs and GI distress are deeply unsettling, the good news is that there are proactive strategies to manage these symptoms and perform at your best.

Understanding Pre-Competition Nausea

The underlying causes of this pre-competition nausea often involve a combination of physiological and psychological factors. In my experience working with Type A endurance athletes, there’s often a side of perfectionism thrown into the mix, as well. Physiologically, the body's stress response triggers the release of adrenaline and cortisol, which can disrupt the delicate balance of the digestive system, leading to symptoms like nausea, vomiting, and abdominal discomfort. Psychologically, the pressure to perform or the fear of failure can further amplify these physical sensations, creating a vicious cycle of anxiety and gastrointestinal distress.

The Mind-Body Connection

The relationship between the mind and body can make it challenging for athletes to manage these pre-competition jitters effectively. This cycle often results in dozens of trips to the bathroom in an effort to “get it over with,” in addition to wasted energy, decreased focus, and increased anxiety. So what do we do about it?

Stop Fighting Nausea

Most athletes try to fight or ignore these feelings of nausea, but this approach often backfires. (Try to tell yourself NOT to think about your hiccups when you get them. How effective is it?). When we focus on NOT vomiting, we unintentionally give more power to the sensation, increasing our anxiety and making it more likely to occur. If that’s not bad enough, our focus on the anxiety or GI distress pulls our attention away from the task at hand, further hurting our focus and performance.

Embrace the Jitters

Instead of fighting this cycle, a more effective approach is to embrace the pre-competition jitters. (Or, if you can’t embrace them, to at least accept them for what they are). This sounds really counterintuitive, but hear me out: By accepting the discomfort rather than fighting it, we can short-circuit the anxiety feedback loop and free up mental resources needed to concentrate on the task at hand. To do this, we need to acknowledge the presence of nausea and other gastrointestinal symptoms when they show up, and then deliberately choose to shift our attention and energy back to the competition itself.

Create a Game Plan

The first step is to develop a structured routine or "game plan" for managing these physical sensations when they arise. Next, it's important to reframe our relationship with nausea and vomiting. Rather than viewing these symptoms as enemies to be vanquished, we can learn to accept them as natural and temporary responses to the high-stakes situation. By acknowledging the presence of nausea without judgment, and then consciously redirecting our focus to the task at hand, we can reduce the power of these physical sensations and channel our energy towards what we’re doing in the moment–not how we’re feeling in the moment.

Building Pre-Race Routines

So what does this look like? When working with athletes who regularly experience GI distress, I actually have them build the symptoms into their pre-race routine! From there, they can respond with sarcasm when the symptoms appear (e.g., “Welp! Everything’s going according to plan!”, “Oh! This is the part of the day my stomach starts to turn. I know how this goes.”). I also encourage athletes to develop pre-race routines that involve deep breathing exercises, progressive muscle relaxation, or visualization techniques that help to calm the body and mind. These techniques can activate the parasympathetic nervous system and ultimately bring the nervous system back into balance before getting it revved up again at the start of the race. (To really go ham, you can start doing daily mindfulness meditation exercises or breath work. You may be surprised by how effective these strategies are!).

Mindfulness for Athletes

Ultimately, the key is to approach the pre-competition jitters with a sense of curiosity and self-compassion, rather than fear and resistance. While this mindful, acceptance-based approach may feel awkward at first, it can be incredibly effective in helping athletes manage their gastrointestinal distress and unlock their full potential on race day.