If you've ever experienced a sudden, shooting pain in your rectum during your period, as if someone lit a firecracker in your backside, then you're not alone.
This intense but brief sensation affects up to 18% of the general population and can have various causes, yet many people suffer in silence, unsure whether it's normal or something to worry about during their period.
Dr. Mariam, a family doctor and WHO advocate, is breaking the silence around this common but rarely discussed symptom through her Instagram (@ask.the.dr) reel. "Periods can be a real pain in the ass, literally," she explains.
This sharp rectal pain during menstruation actually has a medical name: Proctalgia Fugax.
Proctalgia fugax, also known as functional recurrent anorectal pain, is defined by the Rome III diagnostic criteria as episodes of sharp, fleeting pain localized to the anus or lower rectum. These episodes last from seconds to several minutes, with no pain between the episodes.
According to medical research, the prevalence of proctalgia fugax ranges from 8% to 18% in the general population, making it surprisingly common, even if it's not commonly talked about.1
There are numerous factors that affect Proctalgia Fugax. These can include sexual activity, stress, constipation, defecation, and menstruation, although the condition can occur without a trigger.
So why does your period cause pain in such an unexpected place? The answer lies in one of your hormones called prostaglandins (PGs).
Dr. Mariam explains the mechanism: "Hormones called prostaglandins are released during periods, this causes the uterine muscles to contract, which is required for the lining of the uterus to shed. This is the main reason for period cramping."
Research shows that many people with painful periods have increased synthesis of prostaglandins in their endometrial tissue, leading to increased prostaglandin release in menstrual fluid. This elevated amount induces incoordinate hyperactivity of the uterine muscle, resulting in uterine ischemia and pain. 2
Dr. Mariam notes, "PGs also cause contractions of the rectum and the pelvic floor muscles around the anal canal, which may lead to intense contractions and can cause anal cramps and muscle spasms around the area."
This explains why that sharp, stabbing sensation happens and your pelvic floor muscles and anal canal are experiencing the same prostaglandin-induced contractions as your uterus.
Period pain is medically termed dysmenorrhea.
It is an extremely common condition. Most girls and women experience pain of varying intensity at some point during their menstrual cycle.
In fact, 1 out of 10 women experience pain so severe that they're unable to carry out usual daily activities for one to three days every month. The pain tends to be worse in women under age 20.
Primary dysmenorrhea refers to period pain that isn't caused by any particular health condition. The pain typically begins when your period starts, though it might begin slightly before.
Hormone-like prostaglandins play an important role here.3
Secondary dysmenorrhea is period pain caused by an underlying health condition. Some women start experiencing more painful periods after years of relatively normal menstrual discomfort.
Benign (non-cancerous) growths in the womb, such as fibroids or polyps, are often responsible for secondary dysmenorrhea. 3
Dr. Mariam recommends several approaches to ease period-related rectal pain:
Heat therapy: Apply heat using a heat pack or hot water bottle to the lower abdomen and pelvic area. Taking a hot bath can also provide significant relief.
Pain management: Over-the-counter pain relievers can help manage discomfort. These medications can also help reduce prostaglandin production.
Avoid prolonged sitting: Sitting for long hours can exacerbate the pain. Try to move around regularly.
Movement and stretching: Gentle stretching and movement can help relax pelvic floor muscles and ease cramping.
While rectal pain during your period can be normal, Dr. Mariam emphasizes important warning signs: "If you have pelvic pain or rectal pain that is not consistent with your periods or that is quite severe in nature, it's time to see your doctor just to make sure it isn't anything else."
Period-related rectal pain, while uncomfortable and sometimes alarming, is a common phenomenon that affects many menstruating women worldwide.
With simple relief strategies like heat therapy, pain relief medication, movement, and avoiding prolonged sitting, most people can manage these symptoms effectively. However, never hesitate to consult your doctor if your pain is severe, unusual, or concerning.
As Dr. Mariam reminds us, periods can indeed be a literal pain in the backside.
1. Jeyarajah S, Purkayastha S. Proctalgia fugax. CMAJ. 2013;185(5):417. doi:10.1503/cmaj.101613
2. Dawood MY. Dysmenorrhoea and prostaglandins: pharmacological and therapeutic considerations. Drugs. 1981 Jul;22(1):42-56. doi: 10.2165/00003495-198122010-00003. PMID: 6790261.
3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Period pain. [Updated 2023 May 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279324/
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.