Severe Menstrual Pain with Rectal Spasms: What to Do Next?

Severe menstrual cramps accompanied by lower abdominal and rectal spasms?

About three years ago, I suddenly experienced severe menstrual cramps during my period.
Initially, I thought it was related to my constitution, diet, and lifestyle, but the pain has progressively worsened.
Eventually, I had to take Ponstan for pain relief, and I found that taking Ponstan during my menstrual periods helped alleviate the pain.
About a year ago, I had an extremely severe episode of menstrual pain accompanied by abdominal spasms that extended to the area near the rectum (the pain felt similar to cramping).
The pain was so intense that my face turned pale, and I felt weak in my limbs; I would collapse as soon as I stood up.
After a brief rest and taking Ibuprofen, I felt some improvement and went to Kaohsiung Medical University for a consultation.
An ultrasound was performed, and the doctor indicated that there were no uterine fibroids, but I had issues with polycystic ovaries.
Blood tests for cancer markers also showed no abnormalities, and there was no evidence of endometriosis.
Therefore, I was prescribed Cataflam and acetaminophen.
However, recently, even outside of my menstrual period, I frequently experience menstrual-like pain and rectal pain.
Sometimes, during sexual intercourse, I feel pain that seems to irritate the rectal area.
The pain near the rectum makes it nearly impossible to sit or move, which is quite a significant disruption to my daily life.
I would like to ask the doctor whether I should continue seeing a gynecologist or if I should consult an internist or a gastroenterologist? Note: My menstrual cycle is regular, the blood flow is normal, and the duration of my period is about 4-6 days.

Joyce, 20~29 year old female. Ask Date: 2016/07/11

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the symptoms of dysmenorrhea can include not only cramping pain in the lower abdomen during menstruation but also nausea, vomiting, headaches, anxiety, fatigue, diarrhea, dizziness, bloating, breast tenderness, mood swings, back pain, and fainting.
The onset of symptoms can occur 1-2 days before menstruation or during the menstrual period, with the most severe symptoms typically occurring in the first 48 hours.
It is estimated that 80-90% of women experience some form of dysmenorrhea, with varying degrees of severity, often impacting work or academic performance.
Therefore, accurate diagnosis and treatment can help improve quality of life and work efficiency.
Dysmenorrhea can generally be classified into primary or secondary dysmenorrhea.
1.
Primary Dysmenorrhea: This is caused by intrinsic mechanisms within the uterus, with no abnormalities in the pelvic structures; pelvic examinations and ultrasounds are normal.
Symptoms often begin 1-2 years after menarche, peaking between ages 23-27.
Women who experience early menarche, have heavier menstrual flow, have never given birth, are obese, have high socioeconomic status, are single, or are under stress may experience more severe symptoms; however, symptoms often improve with age or after childbirth.

a.
Causes:
- Increased secretion of prostaglandins from the uterus leads to abnormal uterine contractions, causing ischemia and pain.
Prostaglandins can also directly stimulate nerve endings, causing discomfort.
- Excessive adrenergic nerve fibers in the uterus (which decrease after childbirth).
- Effects of female hormones, oxytocin, and vasopressin.
- Medical conditions such as anemia, malnutrition, diabetes, and tuberculosis can also have an impact.

b.
Treatment:
- Prostaglandin inhibitors are the best choice (caution is advised for those with peptic ulcers, asthma, allergies, or liver and kidney dysfunction).
- Birth control pills.
- Intrauterine devices containing progestin.
- Surgical treatment (removal of part of the sacral nerve or uterine sacral nerve).
- Psychological support.
- Vitamin B6, caffeine, sweets, calcium, and magnesium may provide relief for some individuals.
- Aerobic exercise, environmental changes, meditation, and subcutaneous nerve stimulation may also have some effects.
2.
Secondary Dysmenorrhea: This arises from pathological changes in pelvic organs, such as adenomyosis, endometriosis, uterine fibroids, endometrial polyps, pelvic inflammatory disease, and intrauterine devices, which may all be contributing factors.
These pathological conditions can also lead to infertility and dyspareunia, with treatment varying based on the underlying cause.
It is recommended to consult a gynecologist for examination and discussion of treatment options.
Wishing you peace and health.
Dr.
Zhang

Reply Date: 2016/07/11

More Info

Severe menstrual pain, also known as dysmenorrhea, can be a debilitating condition that affects many women. In your case, the pain has escalated over the years, and the addition of rectal spasms and discomfort during sexual activity suggests that this issue may be more complex than typical menstrual cramps. Given your history and the symptoms you've described, it’s crucial to approach this situation with a comprehensive understanding of potential underlying causes and treatment options.

Firstly, it’s important to note that dysmenorrhea can be classified into two categories: primary and secondary. Primary dysmenorrhea is usually linked to the menstrual cycle itself and is often due to the release of prostaglandins, which can cause uterine contractions and pain. Secondary dysmenorrhea, on the other hand, is often related to underlying conditions such as endometriosis, fibroids, or pelvic inflammatory disease. Although your ultrasound ruled out fibroids and endometriosis, the presence of polycystic ovary syndrome (PCOS) can also contribute to menstrual pain and irregularities.

Your symptoms of severe pain that radiates to the rectal area, along with the spasms, could indicate several possibilities. One potential cause is the involvement of the pelvic floor muscles, which can become tense and painful due to menstrual cramps, leading to referred pain in the rectal area. Additionally, conditions such as irritable bowel syndrome (IBS) can coexist with menstrual pain, causing discomfort in the gastrointestinal tract during your menstrual cycle.

Given that your pain persists even outside of your menstrual cycle, it is advisable to continue seeking medical attention. You should consider consulting with a gynecologist who specializes in pelvic pain or a pain management specialist. They may recommend further diagnostic tests, such as a laparoscopy, to explore the pelvic cavity for any hidden conditions that may not have been detected through imaging.
In terms of management, while NSAIDs like Ibuprofen and Cataflam can help alleviate pain, they may not address the underlying issue. Hormonal treatments, such as birth control pills, can help regulate your menstrual cycle and reduce the severity of cramps. Additionally, lifestyle modifications, including dietary changes, regular exercise, and stress management techniques, can also play a significant role in managing symptoms.

Physical therapy focused on the pelvic floor may be beneficial as well. A physical therapist can help you learn exercises to relax and strengthen the pelvic muscles, which may alleviate some of the pain and discomfort you are experiencing.

Lastly, if you find that your symptoms are significantly impacting your quality of life, do not hesitate to advocate for yourself in medical settings. It may take time to find the right combination of treatments and specialists who can address your unique situation. Keeping a detailed diary of your symptoms, including their severity, duration, and any associated factors, can also be helpful for your healthcare provider in determining the best course of action.

In summary, while it is essential to continue working with your healthcare providers, exploring both gynecological and gastrointestinal avenues may provide a more comprehensive understanding of your symptoms. With the right approach, it is possible to manage and reduce the impact of severe menstrual pain and associated symptoms on your daily life.

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