Confession: When I'm on my period, I don't just get regular cramps. Sometimes, it feels like my butthole is repetitively making a fist. The feeling doesn't usually last long, but when it happens, it's like my butt got struck by a paralyzing lightning bolt.
Whenever I tell someone about these uncommon cramps, I'm met with some combo of "OMG, what?!?" and "Sounds awful, can't relate." But, when this TikTok about butthole cramps got over 1 million likes and thousands of "same, girl!" comments, I knew I wasn't alone. So, I reached out to a few doctors to better understand the phenomenon.
"It's the charley horse of your ass," says Evan Goldstein, DO, anal surgeon and founder of Future Method. "The terminology is proctalgia fugax." That translates to "anal pain of unknown cause." It occurs when the muscles that control your butthole (in the pelvic floor and anal canal) spasm and contract. Doctors don't know exactly why butthole spasms happen, but they can be triggered by a few things, including, you guessed it, menstruation.
Why do I get cramps in my buttocks and anus during my period?
Lucky Sekhon, MD, a reproductive endocrinologist and infertility specialist at RMA of New York, says that butthole cramps tied to your period are the result of signals sent to your uterus that went a bit rogue. "Rectal cramps, also known as proctalgia fugax, are cramps felt in the rectum due to the release of prostaglandins during your period which are responsible for the breakdown of the uterine lining," she says. These compounds cause the blood vessels in your uterus to constrict and expel blood right before your period. Some lucky people (like me!) thus may also experience anal cramps as a side-effect of overactive prostaglandins.
You might also experience butthole cramps during ovulation, explains Dr. Sekhon. But those happen for a different reason.
"It is possible to feel cramps or irritation from ovulation in the rectal area," she says. "This is because the pelvis, containing the vagina, cervix, uterus, bladder, rectum, and colon are all in close proximity in the lower pelvis. If ovulation leads to bleeding and fluid accumulation in the pelvis, this can irritate the lining of the pelvic cavity and lead to pain in different regions. This could likely lead to pain when lying flat as the fluid could pool posteriorly and be irritating to the rectal area."
These cramps aren't related to any twitching sensation. Instead, "it is more like a painful cramp or a lightning-like sensation which can even feel like a gas pain," says Dr. Sekhon. Generally, these cramps aren't a cause for concern. "but if there are accompanying side effects such as blood in the stool I would see a GI specialist," she says.
Are these cramps related to period poops?
Dr. Goldstein explains that those anus cramps may also be tied to dreaded period poops. Your estrogen and progesterone levels drop dramatically right before your period. Since progesterone also controls how things move through your digestive tract, losing a lot of it all at once changes your motility, which depending on the person can cause constipation, diarrhea, and anything in between. These hormonal changes (or just the act of pooping more frequently/having a harder time pooping) might trigger a bout of anal cramps.
If you notice pain while pooping frequently and unrelated to your period, Dr. Sekhon suggests getting checked out. Especially if you notice anal bleeding.
"Pain and bleeding during defecation should always be investigated with a colonoscopy at the very least," says Dr. Sekhon. "Sometimes this can mean that there is endometriosis involving the colon."
Butthole cramps aside, you can actually use food to help make your period symptoms less gnarly. Here's how:
Can butthole cramps happen that are unrelated to your menstrual cycle?
In a word, yes, says Dr. Goldstein. He theorizes that it could potentially be caused by too much sitting, which he says puts a lot of physical pressure on the pelvic floor. "We spend all of our days so contracted [from sitting] that now all of a sudden there potentially could become some spasming that happens."
Butthole cramps can also be triggered by a heavy leg day. "People are going to the gym and they're concentrating on doing a lot of leg lifting, squats, and kettlebell swings, and they really are contracting their pelvic floor way, way, way too much," says Dr. Goldstein. He recommends making sure that when you squeeze your glutes that you're not also squeezing your butthole (easier than it sounds, believe me).
If your butthole cramps don't feel situational, Dr. Sekhon says seeing a doctor is key, as they could be the result of inflammation that should be treated.
If you're afraid that butthole cramps couple be a sign of hemorrhoids but you don't have any other symptoms (like swelling and itching) Dr. Sekhon says not to worry. "Butthole cramps are usually due to prostaglandin release which has nothing to do with hemorrhoids. Hemorrhoids can occur in response to chronic constipation," she says.
Okay, so what can I do about these anal cramps?
As I can personally attest, anal cramps are annoying AF. But they're thankfully pretty easy to deal with. Dr. Goldstein says taking a walk or a warm bath can help relax the muscles and ease the cramping. Over-the-counter pain killers and supplements like evening primrose oil ($36) or magnesium ($11) can also help, he says—just be sure to consult your doctor before starting any new supplements.
Stretching is also super helpful for butthole cramps, explains Vanessa Chu co-founder of Stretch*d. "Stretching can help relax the muscles, particularly the areas that get tight and tense from cramping," she says. A great one is the Double Knee Hugg*r, which targets your hamstrings, glutes, and lower back. "Lying on your back, bend both knees and plant the soles of the feet on the ground, slightly wider than hips distance apart," says Chu. "Gently draw the knees in wide towards the armpits, using your hands behind the thighs for assistance." Hold this position for two to three seconds, then release and set the feet back down on the ground. Do 10 to 12 reps.
Dr. Goldstein also recommends finding other ways to relax the pelvic floor in order to manage anal cramping. "I tell a lot of my clients that the best way [to manage anus cramps] is to actually have sex and to play with yourself with toys," says Dr. Goldstein. Not just because it's fun, but because stretching out your muscles with things like butt plugs and dilators can help counteract the contraction and stress that can build in the pelvic floor, he says. Even if you have no desire to engage in anal intercourse, he says vaginal sex can also help to relax the pelvic floor. There are even stretches you can do post-sex to help relax your muscles further.
If you're frequently dealing with anal cramps, Dr. Goldstein recommends talking to your doctor in order to rule out something more serious like anal fissures or hemorrhoids. But for the most part, this type of cramping is annoying, but pretty benign. If you too get butthole cramps, remember that they're more common than you think and that you're not alone. "It's super, super common and normal," says Dr. Goldstein. "Don't feel as if you're singled out."
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