Stress and its Relation to Pelvic Pain

-By Sami Ashenbrener, DPT, PCES; Partner at CPR

One fact of life is that stress is a universal aspect of living. Although many of us learn successful coping skills over the course of a lifetime, stress may lead to processes within our body which are unseen but may have physical effects and addition to emotional symptoms. From a physical therapy standpoint, mental stress, anxiety, and depression can be a major piece of the puzzle when addressing pain, thus we need to look holistically at each patient, taking in the combination of physical, social, and emotional factors.

For muscle tension, we know there is a mind/body correlation. Mental stress, depression, and anxiety often manifest in physical form in our body, resulting in muscle tension. This tension may be felt and noticed, but it can also result in underlying, subconscious “gripping” which changes baseline levels of resting tone/tension in our body. This may result in chronic muscle tension and/or discomfort. The regions which tend to be most affected by stress and muscle tension in the body include the upper trapezius (neck), jaw, gluteals (buttox/hips), and the muscles of the pelvic floor. In this blog we will focus on the latter mentioned, the pelvic floor muscles.

The pelvic floor muscles are a group of muscles and connective tissue located in the bowl of the pelvis which function to support the internal organs in both males and female sexes. This muscle group has various other roles in our body including controlling urination, defecation, sexual function, stabilizing the spine and pelvis as part of the core, assisting with posture, and controlling and absorbing pressure from internal and external forces (i.e. coughing, sneezing, jumping, lifting, exercise) in order to protect spine and internal organs. The muscles in the pelvic floor are just like any other muscle in the body, meaning that the muscles can become weak, too tense, or lack effective motor control function, which can contribute to pelvic floor dysfunction. Unlike other muscles in the body, these muscles are often considered “hidden” pieces to the puzzle, because they may be more challenging to assess in the body. It is easy for most people to notice tension in regions such as the neck or low back, but the pelvic floor may not be as obvious due to its location and/or lack of awareness of the region. Some symptoms of pelvic floor tension include bowel and bladder or sexual dysfunction symptoms, including urinary incontinence (leakage), pelvic organ prolapse, constipation, tailbone pain, pain with intercourse, or pain with bowel movements.

When stressed, our body responds via the HPA (hypothalamic-pituitary-adrenal) axis. This is a feedback loop in our body that triggers the response of stress hormones such as cortisol, epinephrine, and norepinephrine. Epinephrine (also more commonly known as adrenaline) and norepinephrine work together in stressful situations to increase blood flow and cause our body’s nervous system to go into “fight or flight” mode. These stress hormones tend to leave our body quickly, but when a person is under constant, prolonged stress, these hormones can result in muscle tension in our body. Cortisol is another stress hormone which conversely stays present in the body for hours after the stressor has occurred. Chronic stress and this stress hormone can cause muscle tension, exhaustion, pain, poor sleep, and lower immunity.

As evident, stress and tension play a role in both physical and mental stress. This leads to the next question: what can we do to help decrease the impact that stress as on our health? Research shows that there are several activities and daily practices that are proven to reduce the effects of stress in our mind and body. According to a Harvard Health Research study, mindfulness practice/movements that have proven to be effective include deep abdominal breathing, focusing on a soothing word (such a peace or calm), visualization of tranquil scenes, repetitive prayer, tai chi, and yoga. Each person should work to incorporate whatever practice is most appropriate in their life, and then find a consistent time of day or week to incorporate into their routine. Deep diaphragmatic breathing is often a wonderful place to begin, and this is easy to perform in any location, such as in bed, at home, at work, driving in the car, or in the outdoors. Deep breathing should focus on rib expansion, envisioning a 360-degree expansion around the entire ribcage as though the ribcage is opening like an umbrella. The belly should also expand, but the shoulders should stay down away from the ears and relaxed to avoid use of the accessory muscles of the neck. Performing a set of 5-10 breaths is often enough to reduce muscle guarding and tension throughout the body and mental stress.

If self-treatment does not seem to be working at home, pelvic health physical therapy is a proven treatment technique to assist with pelvic floor muscle dysfunction. Treatment in physical therapy may include a verbal subjective interview, objective assessment including strength and range of motion assessment, internal examination to assess pelvic floor function, strength, and muscle tone, guided pelvic floor muscle training which may include use of biofeedback, ultrasound, verbal and tactile feedback, guided exercise and breath work with pelvic floor incorporation, discussion and education in ways to improve ideal bowel, bladder, and functional habits, and the creation of a home exercise program in order to improve muscle function, strength, and posture. Research has shown time and time again that pelvic floor therapy is effective in reducing or eliminating pelvic floor dysfunction, and in most studies there are NO reports of adverse effects with treatment. Patients are also encouraged to find a team of trusted providers to provide support in varying areas of health, including but not limited to a primary care provider, gynecologist/urologist, physical therapist, and counselor/psychologist.

If you would like to learn more about your pelvic health, visit your local pelvic floor physical therapist, such as our team at CPR Physical Therapy + Performance in Twin Falls and Buhl, Idaho. Our Pelvic Health Therapists are highly trained and specialized to help you attain your desired results. We provide personalized therapy and highly-effective, individualized treatment for physical dysfunction in the pelvic, abdominal, hip and low back regions. Prioritizing your health is the best way to improve your overall well-being and quality of life.

Resources:

Dumoulin, Chantale et al. “Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women.” National Library of Medicine. 2 Oct. 2018, Hermann and Wallace https://pubmed.ncbi.nlm.nih.gov/18310371/

McCormick, Rachel and Vasilaki, Aphrodite. “Age-related changes in skeletal muscle: changes to life-style as a therapy.” Biogerontology. 2018; 19(6): 519–536, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223729/

“Pelvic Floor Level 1” Hermann and Wallace. Omaha, Nebraska. 2015

Reardon, Sara. “Stress and Pelvic Floor Tension.” The Vagina Whisperer. https://thevagwhisperer.com/2023/04/25/stress-and-pelvic-floor-tension/

Jeffcoat, Heather. “The Jaw Bone’s Connected to the… Pelvic Bone! TMJ and Pelvic Pain.” Femina Physical Therapy. https://feminapt.com/blog/the-jaw-bone-s-connected-to-the-pelvic-bone-tmj-and-pelvic-pain

Sawettikamporn, Wilai. “Attitudes and barriers to pelvic floor muscle exercises of women with stress urinary incontinence.” BMC Women’s Health. 26 Nov 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9701389/

“The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary.” National Library of Medicine. 2010, https://www.ncbi.nlm.nih.gov/books/NBK53914/

“Understanding the Stress Response.” Harvard Health Publishing. 6 July 202, https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

Vaz, Camilia Teixeira et al. “Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial.” Brazilian Journal of Medicine. 19 Jan 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428909/#bib0165