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Mental Health

The Effects of Stress on Pelvic Pain

by Allyson Augusta Shrikhande, MD, CMO

April is Stress Awareness Month, although I’m going to go out on a limb and say stress is something that we’ve all been pretty keenly aware of for most of the past year. Stress and anxiety are fully understandable responses to the way that 2020 and the start of 2021 have unfolded, but that doesn’t change how unpleasant they can be, or the negative impact that these feelings can have on your health.

It’s important to have strategies in place for coping with stress not only for the sake of your mood and emotional state, but also because of the very real relationship that that stress has with your physical health. This is particularly true of people with chronic pain issues. Emotional duress and physical pain very frequently go hand in hand, and it’s critical to treat both sides of this equation.


What effect does stress and anxiety have on chronic pelvic pain?

Stress and anxiety can cause involuntary tensing of the pelvic floor muscles. This contributes to spasms of the pelvic floor muscles and compression of the pelvic nerves which causes them to fire inappropriately and cause pain. Stress and anxiety can also contribute to winding up your central nervous system, which can make pain signals from the body seem “louder” or more intense. Stress and anxiety can also contribute to poor sleep. Sleep is restorative and vital for healing, wellness and hormone regulation, and sleep deprivation can have a barrage of negative effects on your physical and mental wellbeing.


What makes pelvic pain so emotionally taxing?

The pelvic region is located at the literal center of our physical bodies and also represents a core part of who we are personally. For many, this is a highly private area which is not easy to talk about, so pelvic pain is very often accompanied by unwelcome feelings of shame and embarrassment. The stigma surrounding the pelvic region can fuel the fire of the stress and anxiety which people with chronic pelvic pain might be feeling. In turn, stress can cause the pelvic muscles to tense and go into holding patterns that may remain in place even once the stressor is gone or the stressful event is over.


Can chronic pelvic pain sometimes be psychological?

Subconscious tensing and holding patterns in the pelvis can make it more challenging to rehabilitate and retrain the neuromuscular system, which is a very important thing to address in order to heal pelvic pain. However, unless a patient has undergone significant trauma, the majority of chronic pelvic pain is the result of a variety of factors. Though stress and anxiety are large contributors, there is also an underlying organic or physical factor in the majority of cases.


What can be done to alleviate the effect stress and anxiety has on chronic pelvic pain?

There are a number of strategies that may be effective in reducing stress and anxiety. One-on-one cognitive behavioral therapy (CBT) is an evidence-based method that can help calm down the central nervous system and relax the muscles of the pelvic floor. Mindfulness meditation, guided imagery, and muscle relaxation techniques may also be helpful. Massage and acupuncture may also help to reduce your emotional burden. Beyond that, anything that you find relaxing may be beneficial, whether it’s a warm bath, essential oils, listening to music, or even pursuing a meditative hobby like painting or drawing.


Mental healthcare is healthcare too!

While chronic pelvic pain is very real and typically stems from some physical cause, the impact that your state of mind can have on your illness is not to be discounted. It’s important to be honest with yourself about how you are feeling and what you can and can’t handle. If you find yourself overwhelmed with stress, fear, or anxiety, you shouldn’t write off or minimize these feelings. Addressing the mental and emotional side of chronic pain can be just as important as the physical.


Dr. Allyson Shrikhande, a board certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment.