Cracking the Case on Period Butt Cramps

If you've ever experienced sharp, shooting pain in your butt during your menses, you are not alone. Recently, TikTok content creators have been sharing relatable videos on this common but less talked about symptom.

Some people have equated it to feeling like a "stab in your booty" while others have narrated that the pain feels like "sharp cramps in your butt."

So what causes period butt cramps, and is there any way to stop the stab? We talked to experts to find out. "It's known as proctalgia fugax [PF] and can be described as a severe, fleeting anal or rectal pain that can occur around your menses," explained Kiarra King, M.D., a board-certified OB-GYN in Chicago. "It can also occur at other times and has different triggers. PF is more common in women than men and the episodes are self-limited but can be very uncomfortable."

The causes of butt pain during your period

There are a variety of reasons you may feel pain in your bottom during menstruation.

Prostaglandins

One of the most common culprits is prostaglandins, which are lipids and hormone-like substances that can be released by multiple organs or tissues.

"During menstruation, prostaglandins are released to cause uterine contractions in order for the uterine lining to shed, the process we call a period," King explained. "These prostaglandins aren't just specific to the uterus; they can cause changes at any site that has receptors. This includes the intestinal muscles, so if you throw some prostaglandins in the mix, you can imagine that it might result in muscle spasms for some people."

Period poop

Many women also experience constipation and change in bowel habits before and during menstruation, which can exacerbate rectal pain, said Alyssa Dweck, M.D., an OB-GYN in New York and spokesperson for feminine care brand Intimina.

Endometriosis

While transient and/or cyclical rectal pain during menses may simply be related to the cycle, Dweck noted that persistent or worsening pain could signify other conditions, such as endometriosis. This disease occurs when tissue similar to the lining of your uterus (the endometrium) grows outside of the uterus in places such as the fallopian tubes, ovaries and intestines.

"These implants release inflammatory mediators, such as interleukins and cytokines, which then trigger a cascade of symptoms by impacting structures they are located on, as well as ones adjacent or distant from them," explained Laurence Orbuch, M.D., a board-certified OB-GYN in California and medical director of GYN Laparoscopic/Robotic Surgery Associates LA.

Orbuch said if the tissue is growing in your bowels or rectum, it can trigger myriad gastrointestinal symptoms, including rectal pain.

Fibroids

Butt pain could also point toward fibroids, which are benign growths in the lining of the uterus.

"When fibroids grow and enlarge the uterus, they can apply pressure to surrounding structures and organs," Orbuch explained. "In the case of fibroids located in the posterior aspect of the uterus, which lies on top of the rectum, they can cause rectal pressure and pain.

"In addition, the presence of fibroids can make menstrual bleeding heavier, last longer and contribute to the pain and discomfort," he said.

Retroverted uterus

Having a retroverted uterus—a uterus that's tilted toward the back rather than the front of the pelvis—is fairly common. Around 25 percent of women have this anatomic variation. Women with a retroverted uterus may generally experience more rectal pain during menstruation, Orbuch said.

"A retroverted uterus can contribute to rectal pain purely by its pressure on the rectum, which lies immediately behind the vagina and uterus," he explained.

In addition to rectal pain during menstruation, some common symptoms of a tipped uterus are painful intercourse—especially in certain positions—trouble using tampons during menstruation and urinary problems such as urinary tract infections (UTIs). However, not everybody with a retroverted uterus experiences these symptoms.

Other causes

Other possibilities for butt pain during your periods include:

• Anal fissures/tears
• Irritable bowel syndrome (IBS)
• Hemorrhoids
• Crohn's disease
• Infection in the pelvis
• Coccydynia (tailbone pain)

When to see a doctor about your period butt cramps

If you have any pain that is long-standing and concerning, King said it's worth a mention to your doctor.

"They may be able to provide reassurance or may recommend follow-up visits or testing to rule out other causes," King said.

The treatment of butt pain is mainly dependent on the cause, and it may be best to first check with your healthcare provider to ensure there is no underlying disorder that warrants your attention.

"Constipation, for example, may be remedied by increasing water and fiber intake," King said.

If there is no underlying disorder and your rectal pain is just general muscle tension, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help alleviate the discomfort, Dweck advised.

"A heating pad or hot bath can also be soothing since they relax the muscles," she added. "Dietary modification and plenty of water can also help, and anticipating discomfort with a menstrual app or calendar is the best way to prepare."