Why are my symptoms worse when I am stressed?

We all know about the negative effects that stress has on our body and on our mental health, however can it actually make your pelvic floor symptoms worse?
Absolutely.

As it relates to the pelvic floor, when we are stressed a few things happen:

•  Our breath shallows resulting in decreased diaphragmatic excursion
• We can hold tension and therefore clench our pelvic floor muscles
• Our system has increased cortisol levels, resulting in increased inflammation and decreased tissue healing

These things put our system and therefore result in a “fight or flight” nervous system response. So how do we address this in pelvic PT?

The diaphragm is controlled by the Vagus nerve which when stimulated activates our rest and digest nervous system and therefore has a calming effect. Thus, diaphragmatic breathing is often one the of the first things that we try with patients to get their nervous system to calm down. Although breathing sounds like an easy exercise, it often is very challenging. Many times, if a patient has been dealing with long-standing  stress, their body has adapted to it. This could result in tightness in certain muscles and joints, making proper diaphragmatic breathing a challenge.

There is a close relationship between diaphragm use and pelvic floor muscle use. So, when you inhale, your diaphragm goes down and your pelvic floor relaxes. One exhale, your diaphragm goes up and contracts (slightly). Without using the diaphragm to breathe, the pelvic floor doesn't move with each breath. This can create and contribute to a rigid, tight pelvic floor. 

If you are struggling with pelvic pain or pelvic floor dysfunction, that is worse when you are stressed, there is good reason for it.