Anxiety & Pelvic Pain: A Mind-Body Cycle

Anxiety is a powerful emotion. It’s one that can be both beneficial and detrimental. While it helps keep you more vigilant in emergencies, more often than not, anxiety presents as intense emotional destress that can feel like physical pain — a tension that grips your entire body.

This is particularly true for those experiencing pelvic floor dysfunction (PFD), where anxiety can exacerbate pelvic pain, leading to common symptoms like pain with sex. But how exactly does anxiety contribute to pelvic pain, and what can be done about it?

Anxiety, physical pain, and muscle tension are all natural parts of your body’s built-in stress response — the sympathetic nervous system’s “fight or flight” process. When anxiety and pain stick around too long, it can contribute to a frustrating cycle of heightened pain and anxiety that can be self-perpetuating.

Keep reading to learn about the connection between anxiety and pelvic pain and how pelvic physical therapy can be an important part of breaking this cycle of pain, muscle tension, and anxiety.

The Anxiety & Pelvic Pain Cycle

When you have anxiety, it can set off a cycle of responses throughout your body and mind that can create or flare symptoms of pelvic pain:

1. High anxiety sets off alarms: Anxiety can trigger a stress response, including increased muscle tension throughout your body.
2. Your body responds with muscle guarding: Pelvic floor muscles (see a diagram of your pelvic floor here) tense as part of the general stress response.
3. Muscle guarding leads to pain: Tight muscles can quickly worsen existing pelvic pain. Overtime, it can lead to new muscle tightness and pelvic pain.
4. Pain intensifies due to anxiety: Anxiety can lower your pain threshold and your pain tolerance, making pain worse.
5. Pain imprints on your system: Pain is marked on your nervous system, and this can shift your vagus nerve into survival mode.
6. Anxiety is reinforced: The experience of pain can increase anxiety when you worry that pain will happen again, feeding the cycle of anxiety and pelvic pain.

The Science of Anxiety & Pelvic Health

Anxiety — and any type of emotional stress — can impact your pelvic floor health and vice versa. Research shows that nearly 30% of women who have chronic pelvic pain (CPP) also have anxiety. And nearly 50% of women with urinary incontinence (UI) and 20% who have pelvic organ prolapse report anxiety.

Both mental health and physical pain are quite complex and the relationship between anxiety and pelvic pain is not fully understood. But research has uncovered the following strong links between the two:

Anxiety causes your pelvic floor muscles to involuntarily contract

Colloquially known as the “fight, flight, or freeze” response, this is how your sympathetic nervous system (SNS) mounts a defensive strategy when your health or safety is threatened. Anxiety can trigger the stress response alarm.

Part of this stress response includes tensing your muscles. While balling your fists and clenching your jaw are a couple of more obvious ways muscle tension shows up during anxiety, your pelvic floor muscles also tense as part of the normal stress response.

One fascinating research study was able to demonstrate this. While monitoring pelvic floor muscle activity with an internal sensor, participants were found to have increased pelvic floor muscle activity when they experience a feeling of “threat.”

All pain, including pelvic pain, is biopsychosocial in nature

One widely accepted theory is that pain is a complex product of your biology, psychology, and your social interactions — aka biopsychosocial.

Biologically, factors such as inflammation, muscle dysfunction, and central nervous system responses, can contribute to pain. Socially, how your pelvic pain impacts your relationships, work, and social activities can further exacerbate symptoms. Psychologically, your beliefs, thoughts, and emotions — like anxiety — can affect the perception and intensity of pain.

A recent finding that's too amazing to go unmentioned: Research suggests that physical pain and social pain, like the kind caused by social rejection, are controlled by some of the same biological systems. One study looked at how acetaminophen (Tylenol), commonly used for physical pain and fever, might also reduce social pain through neurochemical pathways, while forgiveness reduces social pain through psychological pathways. The study found that over time acetaminophen eased social pain levels, but only for those who had high levels of forgiveness.

Anxiety makes pain feel more intense

To figuratively add salt to the wound, anxiety has been shown to reduce your pain threshold and your pain tolerance. This means that for most people, pain will feel worse when you have anxiety.

Pain makes you feel more anxious

It's a double-edged sword. When you have experiences of pain, your brain may start to experience anxiety over the worry that you could feel that pain (or more pain) again.

This tension can cause or worsen pelvic pain, creating a self-perpetuating cycle of pain and anxiety.

Your mind (and body) can get stuck

The vagus nerve plays an important role in managing stress and anxiety by helping to regulate the body's parasympathetic nervous system (PNS), which promotes relaxation and recovery after stress. When the vagus nerve functions optimally, it helps transition the body from a "fight or flight" state to a "rest and digest" state, thereby reducing stress and anxiety levels.

Chronic anxiety can impair your vagus nerve's ability to manage the stress response, leading to a vicious cycle of heightened anxiety and pain.

Chronic Pelvic Pain & Pelvic Floor Dysfunction

Individuals suffering from pelvic pain tend to have more than one form of pelvic floor dysfunction (PFD). PFD can cause frustrating symptoms impacting your bowel, bladder, and sexual function due to muscle inflexibility and pain signals that can disrupt normal muscle functioning.

When the pelvic floor muscles are tight and unable to lengthen, contract, and coordinate properly, it’s known as overactive PFD and it can cause pelvic pain.

Because these muscles help support your bowel, bladder, and sexual function, other symptoms of PFD-related pain include:

• Sexual pain and dysfunction, including vaginismus
• Urinary symptoms like frequency, urgency, and incontinence
• Bowel issues like constipation, painful bowel movements, and even fecal incontinence

While physical factors like injury often contribute to PFD, psychological factors such as stress and anxiety can play a complex and significant role.

Managing Pelvic Pain & Anxiety

For anxiety-related pelvic pain, a holistic approach to care that combines pelvic physical therapy and mental health care is essential. Addressing both the physical and emotional aspects of pelvic pain through comprehensive treatment and interdisciplinary care can significantly improve symptoms and overall well-being.

Here are a few things that may help:

• Talk to your doctor. For any new or changed symptoms of pelvic pain, it’s always best to connect with your healthcare team. They will be able to you find the cause of your symptoms, and connect you with a pelvic physical therapist if needed.
• Pelvic floor physical therapy, which will often include techniques like myofascial and trigger point release, mindfulness and relaxation exercises can help reduce anxiety and alleviate pelvic pain.
• Read more about chronic pelvic pain and why it's different than pain in other areas of the body.
• Consider psychological support. There are many effective mental health treatment options and if anxiety is a part of your pain, then seeing a mental healthcare professional is one of the most important parts of your treatment.

If you don’t know where to start, it can help to schedule an appointment with a pelvic physical therapist at Origin Physical Therapy. They specialize in pelvic pain, and understand how pain and anxiety can work together to worsen your symptoms. Most importantly, they know how to use a holistic approach to care to break your cycle of pain. Schedule today and either be seen virtually in your own home, or in person at one of our many locations across the country.