Dr. Cranquis' Mumbled Gripes
(Disclaimer: Questions related to medical topics will be answered to the best of Dr. Cranquis' (and Google's) knowledge, but the internet-delivered wisdom on this blog CAN NOT AND SHOULD NOT SUBSTITUTE for your Real-Life Doctor's personal attention + examination, and your own common sense too! If you think you're having a medical emergency, hang up and go email 911. The author of this blog takes no responsibility for any medical, relationship, scholastic, financial, or other decisions you may make based on information found in this blog.)
And since people seem to be a bit confused about this: any "real-sounding" patients names are just horrible puns, and not HIPAA violations.
- Cranquis: ... so long story short, I think this intermittent pain in your lower abdomen which gets worse when your periods are heavy is most likely endometriosis.
- 30-something female patient: YES! I KNEW IT!
- Cranquis: Huh?
- Patient: That's what I thought too! And my primary care doctor said so too, and he wanted to send me to an ob-gyn specialist to check it out, but I wanted to get a second opinion from another doctor before going to the specialist.
- Cranquis: But... you realize that you still have to go see the ob-gyn now, right? I mean, I can't order an ultrasound for this non-urgent condition or do anything to fix that myself from an urgent care setting.
- Patient: Oh, I know, I know! I just wanted one more doctor to say "endometriosis" before I went to a specialist. Thank you so much! Bye! *waltzes out of the clinic*
- Cranquis *grumbling*: I'll just go back to the less important patients with 104-degree fevers or broken ankles now, if that's ok with you.
This week’s theme is pain. Not just any pain, but pelvic pain. That’s right, I’m talking about vagninismus, vulvodynia, endometriosis, IBS, internal cystitis, etc. I started having pain with sex my senior year of high school and finally received a secondary diagnosis of vulvodynia in April of…
Excellent collection of links re: Pelvic Pain!
Tough to say, Cramp Counselor — but the recent change of pain, including mood swings and headaches, sure doesn’t sound right to me either!
It could be that you’ve just become over-sensitive to the hormones in the birth control — but what about endometriosis? If your body is growing additional areas of hormone-sensitive tissue, this could make your menstrual pain worse. A doctor could evaluate you for this with blood tests, a pelvic exam, and an ultrasound or CT scan of your pelvis/abdomen.
Or what about ovarian cysts? A pelvic exam and ultrasound would show this.
These diagnoses might not fit all of your symptoms, but I think you should ask your doctor about them and discuss what else to try for your problem. At the very least, you may need to try changing or discontinuing your hormonal birth control for a while. Perhaps using a hormonal birth control to completely skip 3-6 periods could help? Good luck!
***Pending Cranquis-Mails: 7; Ask Box: Still closed — that lazy Cranquis is still on vacation until the last week of July.***
Anonymous Asks:
I have a question to do with menstruation. (thank goodness for the anonymous option).I started my period when I was 10 (too early, I know, I didn't even know what it was at the time). Starting early doesn't run in my family, it's just me. Would you happen to know the cause for this?
Also, for the many years that I've been having my period (I'm 20 now), they've always been regular, but extremely painful, I can't even begin to describe the pain. I tend to stay home on those days (missing out on school every month isn't a great thing-I'm a med student and always have so much catching up to do later). It pains to such an extent that I vomit most of the times, and sometimes I even end up with fever(just on the first day), I also can't sleep -these are times when I wish I could wrench out my uterus. I know this could be due to increased prostaglandin production, and aspirin would work. But I prefer not having to use it since I bleed even more and then I can't manage the whole period thing. My mum says the pains are probably genetic (she had the tendancy to faint, but not any more). Could such a thing possibly be genetic? Paracetamol doesn't help me, neither does olfen, neither does exercise, or diet, I really don't know the cause.
Thank you so much for your help :)
cranquis Said:
Hello, Chocolate Sister — I wonder if you have endometriosis?? Read that linked article — I think your symptoms fit this pretty well, even the “being so young when your periods first began”! The article has a lot of info about treatment options too. I think you should see an ob-gyn specialist about this. (And yes, endometriosis can be genetically-linked.) Good luck!
Bonus: A good blog article about the declining age of first menstruation (menarche) worldwide, along with some discussion about societal influences on menstruation behaviors.
***Pending Cranquis-Mails: 26; Ask Box: Closed, but opening soon***
Anonymous Asks:
I know you’re only an urgent care physician, but I’d still like to get your take on my little problem.
It may be a little TMI, so bear with me. I’m a relatively healthy 24 year old woman; a little overweight, but generally healthy. I’ve had pretty normal periods all my life. I was on birth control up until about a year ago, give or take. And after I got off the birth control my periods continued to be normal except my cramps were a little more intense and hurt a little more, no biggie.
About three months ago when I got my period, my cramps were really bad and I started getting spasms in my rectum. They would come intermittently. I never knew when they’d come, but they would only last a few seconds, maybe 10 seconds at most. If I was sitting they would make me lift my butt off whatever I was sitting on. After they pass, I’m fine. I noticed too that it would be a little “spasm-y” when I would try to have a bowl movement. I tend to get diarrhea first then constipation during my period. When I would get constipated it would be hard for me to make my bowls move not only because I was constipated but because the spasms and pain would get so bad.
I got my period this last Monday and while my cramps aren’t real bad, the anal/rectal spasms are still there and still uncomfortable.
Now I did I a little research with these symptoms and the only thing that would come up is endometriosis. My mother had endometriosis so bad that she miscarried 3 times. And I know one of the risk factors I saw was having a close relative with it. Another risk factor is never having a child.
Again, I know you’re only an urgent care physician, but do you think this could be what I have? Could there be something else entirely? Could it be because I’m a little heavy?
My yearly exam is usually in March so I will see my doc pretty soon as it is. I just don’t want to go in sooner than I should because I’m paranoid.
Thanks in advance!
cranquis Said:
Well now, Sphincter Panther, as it happens, even though I am an urgent care/family medicine physician, and as such would normally have little idea how to address your issue, it turns out that Mrs. Cranquis went through a very similar situation a few years ago, and so I may actually have some light to shed on your problem “where the sun don’t shine”!
It turned out, in Mrs. Cranquis’ case, that a large portion of her perineal/anogenital pain was being caused by her tendency to clench her pelvic floor muscles when she was under stress or in pain. She actually underwent a couple months of biofeedback training with an occupational therapist, learning how to consciously relax her Kegel (and other related pelvic/lower abdomen muscles) — and it helped wonderfully!
So, when you see your doctor in March for your yearly physical, be sure to inquire about having an evaluation by a Woman’s Health or Gynecology specialist (if your doctor isn’t one already). Endometriosis would be another consideration, true, but if they do an ultrasound/CT and don’t find any endometriosis, don’t just let them stop hunting there — ask to be evaluated by an occupational therapist with experience in treating pelvic pain.
I hope that advice can point you in the direction of eventual relief. Mrs. Cranquis suffered with similar symptoms for years, but is now spasm-free! And she has often said, “If my experience can help at least one of your patients solve their pelvic pain problem quicker, it will have been worth it.”
Best of luck!
