We’ve talked a lot in the past on how pelvic floor dysfunction can cause pain with sex or changes in bowel and bladder function. *Or* changes in sex and pain with bowel and bladder function. A lot of people see a pelvic floor physical therapist (PFPT) because of acute or chronic problems that end up affecting their daily lives. But there’s another possible cause of pelvic pain that we, as women, may often be told it’s *just another part of life we are expected to deal with.*
Dysmenorrhea
Dysmenorrhea is the medical term for painful menstrual period or menstrual cramping. Cramping occurs when the hormone prostaglandin causes your uterus to contract. These contractions help the uterine lining shed, which is the blood and tissue that comprises your period. Other symptoms may include nausea, fatigue and diarrhea. Mild to moderate cramping is normal, but approximately 5 - 15% of those who get periods report such severe symptoms, that it interferes with their daily life.
There are two types of dysmenorrhea:
Primary dysmenorrhea is the pain that comes with your menstrual cycle. Symptoms may begin 1-2 days before onset, but usually subside within 2-3 days. Pain is often felt in the lower back, abdomen and thighs / groin. Up to 60% of people experience primary dysmenorrhea.
Secondary dysmenorrhea is pain caused by an infection in your organs or a pelvic condition such as endometriosis, fibroids, and pelvic inflammatory disease. Pain usually begins more than a few days before your cycle and lasts longer after bleeding starts.
So how can you tell the difference between primary and secondary dysmenorrhea? Coco (1999) included five criteria for distinguishing between the two:
Dysmenorrhea that occurs within one to two cycles after getting your first period.
Secondary is severe pain that begins after 25 years of age.
Late onset dysmenorrhea that begins after a history of [relatively] painless periods. Although a history of pregnancy and childbirth must also be considered a factor here.
A physical examination by a healthcare provider that demonstrates a pelvic abnormality, heavy flow, infertility or a heavy menstrual cycle.
Little to no response to NSAIDs (like Motrin or Aleve) or oral birth control.
So how do we deal with dysmenorrhea? Depending on your severity level, you may just plan on taking some Motrin, using a heating pad and calling it a day. Even if you consider your periods relatively mild or “doable,” there is evidence that exercise could significantly help reduce your period symptoms. Armour et al. (2019) found that exercising for 45-60 minutes at least three times during your menstrual cycle could significantly reduce cramping pain – regardless of intensity.
It is also important to address your pelvic floor directly. Pazare et al. (2019) formed a protocol of isometric exercises that, when combined with diaphragmatic breathing, may help reduce menstrual pain. This includes:
In supine position with knees straight, press your feet together for 5 seconds then relax.
Next, cross you feet and press then together, holding for 5 seconds. Relax.
With a pillow between your bent knees, squeeze the pillow for 5 seconds then relax.
In the same position, place your hands on your waist and press it into the bed, holding for 5 seconds.
Still in the same position, take a deep breath to tense your core muscles and lift your head and neck off the bed, holding for 5 seconds before relaxing.
Still in the hook lying position, lift your head and neck and side bend towards your right thigh for 5 seconds. Repeat to the left.
This is a good place to start! But it is always important to assess your body and where it is at.
If your cycle interferes with your daily life in any way, it may be good to get checked out. And a pelvic floor PT can always help with dysmenorrhea or anything else going on *down there!*
<3 The Recharged Performance Therapy Team
321-802-1630
paige@rechargedperformancetherapy.com
https://www.rechargedperformancetherapy.com
References
https://pelvicrehab.com/pelvic-rehab-can-help-dysmenorrhea/
Armour M, Ee CC, Naidoo D, Ayati Z, Chalmers KJ, Steel KA, de Manincor MJ, Delshad E. Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews. 2019(9).
Coco AS. Primary Dysmenorrhea. American Family Physician. 1999,60(2):489-96
Efficacy of Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis
Remedios López-Liria,1,* Lucía Torres-Álamo,2 Francisco A. Vega-Ramírez,2,3 Amelia V. García-Luengo,4,* José M. Aguilar-Parra,5 Rubén Trigueros-Ramos,5 and Patricia Rocamora-Pérez1,*
Agnieszka Drosdzol-Cop, Academic Editor and Anna Fuchs, Academic Editor
Pazare S, Sawant L, Ingale S. The Effects of Kinesio Taping and Isometric Exercises on Pain in Primary Dysmenorrhea–A Comparative Study. Indian Journal of Physiotherapy & Occupational Therapy. 2019 Nov 21;13(4):117-21.
https://www.aafp.org/pubs/afp/issues/2021/0201/p186.html
https://www.physio-pedia.com/Primary_Dysmenorrhea
https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea