Hi, Dr. Cranquis!
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!
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!