Ross Markowitz, a 47-year-old personal trainer from Queens, has run half a dozen marathons, all of them in New York City. Although he typically stops for a handful of bathroom breaks, he paused 15 times during the 2010 race.

The multiple interruptions worked for him rather than against him. He ended up with a personal record, completing it in 3 hours and 44 minutes, and said he was energized by all the 30-second breaks.

But many runners dread bathroom breaks and have to strategize where, when and how they relieve themselves on race day. Going before the race often isn’t enough. Most amateurs wait out the long port-a-potty lines on the course, but some get creative to save time. And some stray off course to avoid disasters.

Many runners use facilities before a marathon to try to hold off until after they cross the finish line. “You have to wait in the starting corrals forever and there aren’t a lot of port-a-potties,” Markowitz said. “People bring bottles with them to pee in, and the start of the race is littered with cups and bottles of urine.”

Manhattan-based physical therapist and six-time marathoner Deanie Barth was running through Staten Island en route to the race’s start one year when nature called. “We had to pee so badly that we literally knocked on the front door of a house and asked if we could use the bathroom,” she said. “We ran in and the whole family was in pajamas, making pancakes, and watching cartoons.”

Now she comes to the start prepared, with an extra-large plastic garbage bag. “I get a lawn and leaf bag, cut a hole for my head at the bottom and wear it like a poncho. You just pop a squat wherever you need to and pee on the ground like you are in a tent,” she said.

Barth also stops at port-a-potties along the course, even though she estimates each stop adds a minute and a half to her time. “I am too vain to wet my pants,” she said.

Nancy O’Flynn, a 48-year-old hedge fund analyst and 10-time marathoner from New York, noted that men have it easier than women, especially when the goal is running as fast a time as possible. “It’s easier being a guy than a girl because guys just run by a wall and can pee against it,” she said. “But for me, if I have to wait on a line it could take five minutes.”

General practitioner and amateur marathoner Dr. Rebecca Press, who practices in Manhattan, said that except for elite runners, stopping for a bathroom break does not necessarily hinder runners. “Even if you slow down for a few seconds to stop and drink or pee it won’t take away from your time because, if you hydrate or urinate, you get a burst and you are able to maintain your speed,” she said.

Plus, the pain of running with a full bladder has slowed her down in the past. “The pressure from it was very uncomfortable,” she said.

Sometimes running through the pain isn’t an option, since running long distances can affect more than just the bladder. “Running helps keep things regular and moving,” Press said.

In 2013, halfway through the New York City marathon, Atlanta-based nutritionist and two-time marathoner, Sarah Shanahan, 37, got a stomachache. “I had to find a bathroom,” she said. Right before getting on the Queensboro Bridge, she ran into a nearby hotel.

The hotel patrons on the bathroom line let her skip to the front. “I had massive diarrhea. I felt like I was in there for hours,” Shanahan said.  She came out and started running again, but a few miles later had to stop again – this time at a port-a-potty behind a construction site.

By the time Shanahan made her final pit stop, hours after that start, the crowd had thinned out – but so had the toilet paper supplies. Luckily she had grabbed some from the construction site.

She finished the race, leftover toilet paper still in hand.   “I don’t know if I’ll ever run another marathon,” she said. “The only upside – other than finishing – was that I never pooped in my pants.”