Painful Bowel Movements and Rectal Pain
Bowel movements that hurt, with deep rectal pain or pressure that flares around your period, can be a sign of endometriosis behind the uterus or on the bowel. Adenomyosis, which often comes with it, is linked with more bowel symptoms too. Pain that follows your cycle is a key clue.
- How common
- Common
- When
- Around your period
- Where
- Rectum, deep in the pelvis
Medically reviewed by Dr. Steven Vasilev, MD
Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute · Updated Oct 2026
Where you feel it
Front view of the pelvis. The rectum and the sigmoid colon are highlighted.
- Rectumdeep pain, pressure
- Sigmoid coloncan be involved too
- Uterusadenomyosis grows here
When it flares
It can start a day or two before bleeding and eases once your period ends. Pain that doesn't follow your cycle still deserves a check.
Does this sound like you?
Tap any that fit. We'll turn them into a note you can bring to your visit.
None of these? If going to the bathroom hurts, it's still worth a conversation. Speak with us
When to get help
Pain with bowel movements that comes back with your period can be a sign of endometriosis near the bowel, and is reason enough to see an endometriosis specialist.
Keep track
For two or three cycles, note the cycle day, how bad it is, your stools and any bleeding. It's the most useful thing to bring to your first visit.
Speak with Us
Book a visit if it:
- Comes back with your period
- Comes with rectal bleeding around your period
- Comes with painful periods or painful sex
- Keeps getting worse or disrupts your life
Your first visit
We go through your history and your notes, then map out next steps together, whether that's tests, imaging or treatment.
When it needs a specialist: Bowel endometriosis surgery
What it feels like
How patients often describe it
- It feels like passing glass.
- A stabbing pain deep in my rectum.
- Heavy pressure, like it can't pass.
- It aches for hours afterward.
Doctors call it dyschezia. The pain can peak as stool passes or linger for hours, and passing gas can hurt too. It's often worst during your period, though some people hurt all month with a monthly flare. Bowel habits can look normal, or swing between constipation and diarrhea.
Why it happens
Endometriosis behind the uterus
Endometriosis often grows behind the uterus, on the ligaments that hold it or between the vagina and rectum. These patches swell and become inflamed around your period, and passing stool presses on them. Painful bowel movements during periods are especially linked to deep endometriosis at the back of the vagina.
It can also grow into the bowel wall, often where the rectum meets the sigmoid colon, or leave scar tissue (adhesions) that tethers the bowel, bringing constipation, diarrhea or narrower stools. Rectal bleeding with your period is worth checking promptly.
Adenomyosis
Adenomyosis is tissue like the uterine lining growing into the uterus's muscle wall. It doesn't grow on the bowel, but the uterus sits right in front of the rectum, so when it's swollen and tender around your period, its cramping and pressure may be felt as rectal pain.
It often comes with endometriosis, which can leave adhesions between the uterus and bowel, and people with both report more cycle-linked bowel changes.
Tight pelvic floor muscles
Pain makes the pelvic floor muscles tighten, and they may not relax fully when you go. That means more straining and more pain, a cycle that can continue even without disease on the bowel.
Learn moreEndometriosisAdenomyosis
“Tell your doctor when it hurts to go, not just that it does. Pain that follows your cycle points us behind the uterus, and a normal colonoscopy doesn't rule that out.”
Why it's often missed
Painful bowel movements are easily put down to IBS, constipation, hemorrhoids or a small tear (fissure). These can sit alongside endometriosis or adenomyosis, so finding one doesn't rule out the others. The clue is timing: pain that comes back with your period.
Tests often miss it too. A colonoscopy checks the bowel's inner lining, while endometriosis usually sits outside or in the wall. A standard ultrasound can miss deep disease; a scan aimed at endometriosis looks for it on purpose.
How it's diagnosed
Track two or three cycles
Note the cycle day, how bad it is, your stools and any bleeding. Pain that lines up with your period is a key clue.
Rule out other bowel causes
Hemorrhoids, fissures, IBS and inflammatory bowel disease can look alike. Bleeding or other warning signs may call for a colonoscopy.
An exam and focused imaging
A pelvic exam and an ultrasound or MRI aimed at deep endometriosis can map disease near the bowel.
See an endometriosis specialist
An endometriosis-focused evaluation can confirm and remove disease near the bowel, with a bowel surgeon when needed. It starts with a detailed conversation, so bring your notes.
Treatment options
Treatment depends on what's driving your pain, and often combines several approaches.
- Medical
Hormonal therapy
Quiets the cycle so period flares ease, which can make bowel movements less painful.
Hormonal Therapy - Medical
Pain relief
Anti-inflammatory, nerve-calming or antispasmodic medicines, as part of a wider plan.
Pain Management - Surgical
Excision surgery
Removes endometriosis at the root, including on or near the bowel. Bowel surgery takes specific experience, and sometimes a colorectal surgeon.
Surgery overview - Support
Pelvic floor therapy
Helps tight muscles relax and work together, which can make going less of a strain.
Pelvic Floor Therapy - Support
Everyday bowel care
Soft stools with fluids and fiber, a footstool, heat and gentle movement.
Integrative Medicine
Painful bowel movements around your period?
We look for endometriosis and adenomyosis where they're often missed, including behind the uterus.
Schedule a ConsultationPrefer to talk it through? Call or text us.
Questions people ask
Can adenomyosis cause bowel symptoms?
Yes, adenomyosis can be associated with bowel symptoms, especially around your period, even though it does not grow on the bowel. An enlarged, inflamed uterus can contribute to bowel discomfort, but symptoms can also come from overlapping endometriosis or IBS-like bowel sensitivity.
Can adenomyosis cause pain with bowel movements?
Yes, adenomyosis can cause pain with bowel movements. Because the rectum sits directly behind the uterus, uterine cramping and pressure can be felt as rectal pain even when the bowel itself is not affected. Painful bowel movements can also have overlapping causes.
Can endometriosis cause pain during bowel movements?
Yes, endometriosis can cause pain during bowel movements, including deep rectal pain, cramping or pressure, especially around your period. This can happen when it involves the bowel or when inflammatory lesions and scar tissue irritate nearby pelvic structures.
Is rectal bleeding during your period a sign of endometriosis?
Yes, rectal bleeding that predictably happens during your period can be a sign of bowel endometriosis. But it is not specific to endometriosis: hemorrhoids, fissures, inflammatory bowel disease, polyps and other GI conditions are other possible explanations.
Can endometriosis cause a painful bump near the anus?
Endometriosis can contribute to pain and pressure near the anus, but a painful bump on the anus itself is more often something else, such as a hemorrhoid, fissure, or skin infection/abscess. In some cases, pelvic endometriosis and these conditions can coexist.
How do we evaluate painful bowel movements in endometriosis?
We evaluate painful bowel movements by mapping your symptoms, with a pelvic exam when appropriate, and may recommend ultrasound or MRI. Normal imaging does not rule out endometriosis, and we may coordinate a GI evaluation if symptoms suggest overlapping conditions.
Often happens with
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Sources & medical review
Reviewed by Dr. Steven Vasilev, MD, Board-Certified Gynecologic Oncologist & Integrative Medicine Diplomate, Advanced Robotic Endometriosis Excision Surgeon, Director of Lotus Endometriosis Institute. Last reviewed Oct 2026; next review Oct 2027.
- Fauconnier A, Chapron C, Dubuisson JB, et al. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719–726.
- Habib N, Centini G, Lazzeri L, et al. Bowel endometriosis: current perspectives on diagnosis and treatment. Int J Womens Health. 2020;12:35–47.
- Brunoro MM, Servidoni ACP, Wakabayashi SDN, et al. Coexisting adenomyosis in endometriosis: similar pain and quality of life, with longer bleeding and bowel symptoms—a comparative cross-sectional study. Int J Gynaecol Obstet. 2026;175(1):164–173.
- Fraga MV, Oliveira Brito LG, Yela DA, et al. Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: an underestimated association. Int J Clin Pract. 2021;75(8):e14350.