Stress and the Pelvic Floor

Your palms start to sweat…your stomach feels uneasy…you are tired, but you cannot sleep…there is a pounding in your head…you have chest pain…sex drive is gone…you have pain and tightness in your muscles. These are common effects of stress on the BODY.

You cannot sit still…you are overwhelmed and irritable…you feel anxious but have a lack of motivation and focus…you feel alone even in a room full of people…you are sad and possibly depressed. These are common effects of stress on MOOD.

You are socially withdrawn…you are no longer exercising…you cannot eat, or you are overeating…you become angry and short-tempered and may have outbursts…you choose crutches like smoking, drinking or drugs to help you cope. These are common effects of stress on BEHAVIOUR.

The human body is designed to both experience stress and to react to it. Stress can be a very important protective mechanism whereby the body becomes alert and positioned to avoid danger. This positive stress is referred to as “eustress”. The opposite occurs when stress becomes negative and an individual faces continuous challenge without relief. This type of stress is called “distress” and it is this stress that impacts the body in the ways outlined above.

The pelvis is the “bony container” that surrounds the bowel, the bladder, and the reproductive organs. The pelvic floor muscles present like a “hammock” and span the bottom of the pelvis, holding the pelvic organs in place and playing a vital role in bowel, bladder and sexual function.

What you may not know is stress can directly affect the pelvic floor. Remember, we talked about the body’s response to stress? When we experience stress, particularly that of a prolonged nature, we will hold our muscles very tightly, even our pelvic floor muscles. With stress, our body triggers the fight-or-flight response, releasing stress hormones like cortisol and adrenaline. These hormones increase muscle tension to prepare us for perceived danger. While this is helpful in short-term emergencies, persistent stress can lead to prolonged muscle tension, including in the pelvic floor. For people under chronic stress, the pelvic floor muscles may remain partially contracted for extended periods, leading to tightness, fatigue, and even pain. This tension can also increase the risk of muscle spasms.

By all accounts, stress plays a major role in pelvic floor disorders and many of my patients experienced their first pelvic floor symptom during or following a particularly stressful time in their lives. There’s compelling research linking stress with the activation and potential dysfunction of pelvic floor muscles, which can contribute to a range of pelvic health issues.

We have all experienced cyclical situations, and a persistent state of stress is no different. Stress and the tightening of the pelvic floor muscles (consciously or sub-consciously) can lead to conditions including but not limited to the following:

• Urinary or fecal incontinence (leakage)
• Urinary urgency
• Urinary frequency
• Sexual pain
• Difficulty with sexual arousal and orgasm
• Constipation
• Pelvic pain including vulvodynia and vaginismus
• Bladder pain including IC/BPS

These conditions then lead to stress and anxiety, possibly because people are afraid to discuss them. We experience symptoms, our fear or embarrassment prevents us from discussing them, which then creates stress. The symptoms worsen, and as a result, so does the stress. We now have a stress-dysfunction cycle that will continue perpetuating itself until something stops it. The only way to initiate the healing process is to break this vicious cycle.

The most important message that I can convey is the importance of talking! Let’s stop the whispering! How will people ever understand the relationship between stress and pelvic pain if we don’t talk about it?  I often recommend that patients choose one person that they may feel comfortable discussing their pelvic health with. This might be their partner, their best friend, or potentially a trained professional. People do NOT have to suffer in silence, and they do not have to carry the stress that goes along with pelvic dysfunction.

The loneliness and isolation associated with pelvic floor dysfunction can be the root cause of the exacerbation of symptoms, all of which contribute to the stress that can become all encompassing.

There is help and there are people who want to help!  There are times when it does take a village and as Pelvic Health Physiotherapists, we have the ability to not only be an invaluable resource, but we also have the ability to introduce patients to other resources that may assist them with their healing journey. Many of those struggling with stress-related pelvic floor issues find relief when they manage their stress effectively.

Keri Martin is a Pelvic Floor Physiotherapist and owner of A Body in Motion Rehabilitation.  She discovered her passion for Pelvic Physiotherapy in 2013 and has continued to further her education in the areas of sexual pain, incontinence, special topics in women’s health including endometriosis, infertility and post hysterectomy treatment, gastrointestinal disorders, and oncology. Keri enjoys her work with children with paediatric incontinence, her pre-natal and post-natal clientele as well as men and women suffering with pelvic pain as a result of bladder or bowel difficulties, interstitial cystitis and prostatitis. She boasts a strong commitment to educating and empowering people to find their ultimate pelvic health.