Rectal Swelling During Menstruation: When to Seek Help

Swelling of the anus during menstruation?

Hello, Doctor: I usually do not have any abnormalities with my anus, but one to two days before my menstrual period, I experience a slight swelling sensation in the anal area.
During those days, I tend to have bowel movements more frequently, about once or twice a day.
In the first three days of my period, my menstrual flow is heavier, requiring me to use overnight sanitary pads during the day, and I need to change them every two to three hours.
This also leads to a feeling of heat in the anal area.
If I am particularly tired during the first three days or if I have a long car ride, the swelling and pain in my anus become more pronounced.
At that point, I have to sit on a cushion in a warm bath, but I also experience dysmenorrhea, so I need to apply heat to my abdomen.
I often find it difficult to urinate due to the pain, leading to bladder distension, and I have to exert a lot of effort to relieve myself a little.
I frequently run to the bathroom to try to urinate, and when I can't, I attempt to rinse my lower body with warm water.
Taking painkillers only gradually alleviates the pain after three to four hours.
This situation usually lasts for one to two days, after which the swelling in my anus subsides.
However, I dread each month, unsure if I will experience this again.
The frequency is about every two to three months.
Should I consult a gynecologist or a colorectal surgeon for this issue? Thank you.

Tinan, 30~39 year old female. Ask Date: 2018/03/04

Dr. Ke Fangxu reply Surgery

Some women may experience anal pain during their menstrual period.
The most common causes are uterine swelling leading to pressure on the anus or constipation during menstruation causing hemorrhoid swelling.
It is advisable to consult a gynecologist to check for conditions such as uterine fibroids or endometriosis that may be causing discomfort.
Additionally, using rectal suppositories may help alleviate symptoms.
If there is little improvement, a consultation with a colorectal surgeon for further examination and treatment may be necessary.

Reply Date: 2018/03/04

More Info

Understanding rectal swelling during menstruation can be a complex issue, as it may involve various physiological and anatomical factors. Based on your description, it seems that you experience rectal swelling and discomfort primarily during your menstrual cycle, particularly in the first few days when menstrual flow is heaviest. This swelling is accompanied by increased bowel movements, pain, and difficulty urinating, which can be quite distressing.

Possible Causes
1. Hormonal Changes: The menstrual cycle is regulated by hormones such as estrogen and progesterone, which can affect various tissues in the body, including those in the pelvic region. These hormonal fluctuations can lead to increased blood flow and swelling in the pelvic area, which may contribute to the sensation of rectal swelling.

2. Pelvic Congestion: Increased blood flow during menstruation can lead to pelvic congestion, which may cause discomfort and a feeling of fullness or swelling in the rectal area. This is often exacerbated by prolonged sitting or physical strain.

3. Endometriosis: In some cases, endometriosis can cause similar symptoms. This condition occurs when tissue similar to the lining of the uterus grows outside of it, potentially affecting the rectum and causing pain and swelling during menstruation.

4. Hemorrhoids: If you are experiencing increased bowel movements, this could lead to straining, which may exacerbate or lead to hemorrhoids. Hemorrhoids can cause swelling, pain, and discomfort in the rectal area, particularly during menstruation when bowel habits may change.

5. Muscle Tension: The pelvic floor muscles can become tense during menstruation due to pain or discomfort, which may contribute to the sensation of swelling and pressure in the rectal area.

When to Seek Help
Given the symptoms you are experiencing, it is advisable to consult a healthcare professional. Here are some guidelines on when to seek help:
- Persistent Symptoms: If the swelling and discomfort persist or worsen over several menstrual cycles, it is essential to seek medical advice.

- Severe Pain: If you experience severe pain that interferes with your daily activities or is not relieved by over-the-counter pain medications, you should consult a doctor.

- Changes in Bowel Habits: If you notice significant changes in your bowel habits, such as diarrhea or constipation, especially if accompanied by blood in the stool, it is crucial to seek medical attention.

- Urinary Issues: Difficulty urinating or significant changes in urinary habits, such as increased frequency or urgency, should be evaluated by a healthcare provider.

Which Specialist to See
Given the nature of your symptoms, you may consider consulting either a gynecologist or a colorectal surgeon. A gynecologist can evaluate any potential menstrual-related issues, such as hormonal imbalances or endometriosis. On the other hand, a colorectal surgeon can assess any rectal or bowel-related concerns, including hemorrhoids or other structural issues.

Conclusion
In summary, while some degree of discomfort during menstruation can be normal, the symptoms you describe warrant further evaluation. It is essential to address these concerns with a healthcare professional who can provide a thorough assessment and recommend appropriate treatment options. Keeping a symptom diary, noting the timing, severity, and any associated factors, can also be helpful for your healthcare provider in diagnosing and managing your condition effectively.

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