Sudden pain attack in public: How to effectively help someone with endometriosis?

A sudden and violent attack of painful contractions in endometriosis , referred to in clinical practice as a symptom flare , can be extremely traumatic and paralyzing in a public place—on the street, in a shopping mall, at work, or on public transport. The intensity of these symptoms is compared in medical literature to the pain of labor, acute renal colic, or the symptoms associated with a heart attack. Such a sudden burst of pain can lead to a shock response, a sudden drop in blood pressure, severe nausea, or even complete loss of consciousness. As a companion or witness to such an event, you act as a crucial support system. Your role is not to make a diagnosis, but to efficiently organize the surroundings, protect privacy, and provide thoughtful first aid that will allow you to safely survive the most difficult moments of the attack.

Physical First Aid: Stabilization and Protection of Intimacy

When a person with endometriosis suddenly turns pale, breaks out in cold sweats, experiences a strong reflexive bending of the torso, or is forced to sit down immediately, the first and most important step is to secure a safe position. If possible, help them sit with support or lie on their side. The fetal position provides noticeable relief because it allows for the natural relaxation of tense abdominal muscles and pelvic floor muscles. The greatest psychological burden and anxiety-intensifying factor at such a moment can be the presence of random onlookers. It's a good idea to immediately shield the patient with your own body or ask those around them to create a discreet screen. The feeling of being the object of unwanted attention dramatically increases cortisol and adrenaline levels in the blood, which, through the sympathetic nervous system, further intensifies vascular and smooth muscle contractions in the pelvic floor.

If an attack is accompanied by shortness of breath, fainting, or nausea, immediate assistance should be provided to unbutton any clothing that is constricting the abdominal cavity, such as a belt, tight pants, or a skirt button. Severe pressure on a bloated and inflamed abdomen is a significant physical torment. If possible, it's best to calmly move to a quiet, secluded, and shaded area. However, it's important to remember not to force the patient to walk under any circumstances if the pain radiates to the lower limbs or sacrum, which indicates irritation of the pelvic nerves. In such a situation, it's much safer to wait out the strongest wave in the area where the patient is currently located, taking care only to insulate themselves from the cold ground.

Emergency Bag Equipment: Support Here and Now

Those accompanying women with endometriosis should have a well-thought-out emergency kit that allows for rapid symptom relief in the field. Self-adhesive heating patches are an extremely effective tool, applied directly to underwear around the lower abdomen or lumbar spine. Deep heat blocks the transmission of pain signals at the spinal cord level and has a much faster antispasmodic effect than oral medications, which, in a state of shock, are absorbed from the gastrointestinal tract with significant delay.

Still water should also be included in the kit, useful both for washing down medications and for washing the face or temples in the event of fainting. Regular painkillers and antispasmodics, prescribed by a doctor and tested by the patient, are essential. Administering new, previously unfamiliar medications during an attack is absolutely unacceptable. It's also worth having a small snack with simple sugar or dark chocolate, as severe stress can cause a rapid drop in glucose levels, leading to hand tremors and weakness. Wet wipes and spare underwear complete the kit, allowing for quick refreshment and restoring a sense of control.

Emotional support: Calmness, composure and decision-making

The emotional reaction of those around you directly influences the dynamics of the attack. Panic, loud cries for help, or chaotic questions intensify anxiety and the pain. It's important to speak to the patient in a calm, low tone, using simple, clear messages that assure them of safety, shared slow breathing, and an unlimited amount of time to wait out the difficult moment. It's crucial to avoid trivializing the suffering with statements suggesting exaggeration or forced reassurance, as this is a moment of extreme exhaustion for the patient.

Once the most severe wave of pain subsides, assistance should be provided in making a rational decision regarding further action. Objectively assess whether the patient is able to safely return home by taxi or whether an ambulance or transport to a hospital emergency room will be necessary, for example, in the event of loss of consciousness, unresponsiveness to medications, or a suspected ruptured endometrial cyst. Taking on the role of decision-maker relieves the patient of the burden of analytical thinking at a time when her nervous system is under strain. Assistance provided in a public setting primarily restores dignity, a sense of security, and respect in a situation where her own body has failed.

Źródła:

Armor M, Lawson K, Wood A. Emergency Care, What to do during an endometriosis flare-up. Endometriosis UK, London, January 2021.

Guideline Development Group. Patient Advocacy, Education for Supporters and First Responders. World Endometriosis Society, San Francisco, May 2020.

Nazar K, Wieczorek A. Emergency first aid, procedures for severe abdominal pain and fainting. PZWL Medical Publishing House, Warsaw, September 2022.

Young K, Fisher J, Kirkman M. Recognizing and Managing Gynecological Pain Crises in Public Spaces. Journal of Emergency Nursing, volume 45, number 5, pages 512, September 2019.