Can emotional stress cause pelvic pain?

Can emotional stress cause pelvic pain - Sad and stressed woman

The short answer to the question “Can emotional stress cause pelvic pain?” is yes. It can contribute to it. But in no way does that mean you can get rid of your pelvic pain solely by limiting your emotional stressors. It’s not as simple as just relaxing or getting over it and it’s definitely not in your head. If it were really that easy, 1 out of 7 women in the U.S. and 20% of women worldwide would not be dealing with chronic pelvic pain.

What is pelvic pain and what usually causes it? Is it normal?

Woman at doctor with pelvic pain

Pelvic pain is an umbrella term that encompasses many potential disorders and symptoms. All involve pain in and around the pelvis. In some cases, pelvic pain can be caused from a structural pathology. For example, you might have endometriosis, pelvic inflammatory disease with adhesions, or hip pain from a labral tear. But so often it is idiopathic in nature, meaning it has no structural cause that can be determined. Some examples include dyspareunia (pain with intercourse), bladder pain syndromes, and some lower abdominal and hip pains. 

In all cases, the body develops a low threshold of pain as the pain becomes chronic (lasting 3 to 6 or more months). The pain itself can come and go or persist consistently and may be anything from a dull ache, burning, and/or sharp pain to severe and stabbing. 

When living with any type of pelvic pain, it is really important to talk about. You especially want to voice and speak about the emotional and energy-reducing toll it takes because emotional stress can cause pelvic pain to become worse. With pelvic pain, there is not a single part of someone’s life that isn’t affected. It impacts days missed from work. (Think painful periods as an example). It also often affects relationships and stunts typical social activities. It even creates difficulty with prolonged sitting and standing, and creates reduced and strained intimacy. And, of course, don’t forget about bladder and bowel-emptying difficulties (just to name a few). 

Can anyone have pelvic pain?

Can emotional health cause pelvic pain- who gets it/ woman and men at office

Yes. Women underreport pelvic pain. However, pelvic pain happens to others, too. Some of the most underreported cases involve other groups. Males, transgender individuals, larger-bodied, and other marginalized individuals may be even less likely to seek help. This can be because of stigma, mistreatment, and disregard by partners, friends, healthcare, and society in general. 

How exactly can emotional stress cause pelvic pain?

Can emotional stress cause pelvic pain- how are they connected- teacher in classroom stressed

Pelvic pain and emotional health are intimately connected. When pelvic pain becomes chronic, it can be challenging to determine which came first. Did ongoing emotional stress cause pelvic pain? Or did the pelvic pain cause emotional stress or distress? Truth be told, depending on an individual’s unique experience, it can also be both.

How can what’s going in your life manifest as pelvic pain? Think of your pelvis as a neurological hotspot. It houses past, present, and future stressors and traumatic occurrences. Ever found yourself eating your emotions over a bowl of ice cream and a Netflix fest? Not only do we stuff emotions into our abdomens, but these parts of our body are physiologically linked. The brain is well-designed to push stress all the way down deep–right into the pelvis. 

How stress and stress hormones impact your body and pelvic floor muscles

When someone is under constant or intermittent but persistent stress that seems to come like waves in the ocean, your cortisol level raises. This cortisol release and muscular stress contraction protect us from harm. The issue is, our nervous systems cannot tell the difference between threat levels. A bear chasing us in the woods gets perceived as dangerous. And so does the job we feel stuck in, the news, or social media binges. Constant stressors, like trying to do it all, feeling silently unfulfilled or lonely, mom guilt, or juggling schedules send our cortisol levels up too.

Too frequently, our hormones are pumping to attempt to reduce constant stressors. As a result, pelvic muscles get tighter and tighter in an attempt to protect your body. This becomes a vicious cycle of emotions leading to pelvic floor constriction and pain, and pelvic floor pain resulting in worsening anxiety and stress.

HPA axis dysfunction can also have an effect on pelvic pain

Over time, constant stressors lead to your hypothalamic-pituitary-adrenal (HPA) axis being unable to keep up. Your cortisol lowers. Lower cortisol means less energy and a higher pain level. It also equals poor sleep, emotional disturbances, and compromised immune function. In addition, stress and specifically anxious thoughts from low cortisol then create a muscular response. This directly contracts specific pelvic floor sphincters and musculature.  

I feel like a different person after pelvic pain and that it has completely changed my life and mental health

Can emotional stress cause pelvic pain and affect mental health- woman lonely and leaning against window

That is completely understandable and so common. Researchers over the last several years have started to look more seriously at the emotional implications of pelvic pain. Embarrassment, shame, confusion, dissociation from the body, anxiety, and depression have all been associated with the experience of pelvic pain. You’re not alone if you’ve ever thought: What is wrong with me? Why does my pelvis hate me? No one gets it. In fact, it can feel lonely before you find help. But you do not have to be a part of the 50% of cases go completely undiagnosed and untreated. There is help out there. Let me repeat: you are not alone.

Over the last several years, I have had women from 5 different continents share with me: 

“I really have been wondering if this stress/stressful event contributed to my pelvic pain. But no healthcare professional never asked me about it, so I figured it was all in my head.” 

A good pelvic floor therapist can help with both the pain and emotional distress of pelvic dysfunction. Having a licensed mental health counselor who specializes in chronic pain is important as well.

Is it common to feel embarrassed and alone about pelvic pain?

Can emotional stress cause pelvic pain and embarrassment- woman covering face in street

I was working with a client in her 70s. We reviewed her history of vaginal dryness and pelvic pain. As I kept asking questions, she shared a sentiment that I hear a lot. She was embarrassed to tell anyone what she was dealing with. For her, around 35 years ago, intercourse with her partner became mildly uncomfortable. But she didn’t share that with him because she felt embarrassment and inadequacy. So she kept going, silently.

As she transitioned through menopause, the pain changed. Despite lubrication, it became stinging and burning during intercourse. Then, discomfort wearing underwear. At that point, she assumed this came with menopause. She attempted to seek help from her physician. But the options were few and so she kept silently suffering. By the time we started working together, in her 70s, she could no longer have intercourse. Each time resulted in severe muscle tension and pelvic pain. She could no longer walk for exercise due to the pain. Stress was at an all time high. She had gone 35 years without proper treatment. The pain left her feeling alone, inadequate, and embarrassed. She felt it couldn’t possibly be normal to be in so much pain but wasn’t sure.

It is all too common that individuals experience this. You may feel embarrassed and avoid discussing pelvic pain. After all, many people feel this area of our bodies is just supposed to work. When it doesn’t, distress or avoidance often ensue. Some people describe feeling not just embarrassed but also shameful: that something’s wrong with them.

The stigma of pelvic pain

There’s a common stigma that pelvic pain just is part of being a women. Menstrual cramps carry this stigma. Women say they hear: Oh, period pain is normal. It was that way for me, too. Periods are supposed to be painful and miserable. No, no, no. Your body communicates through pain. Pelvic pain or any other pain is a signal that a structure, lifestyle habit, or emotional stressor needs attending to. 

Is there something that can be done to help me feel better?

Woman on exercise ball as part of pelvic floor physical therapy

Learning to release tension and reduce tone in musculature is vitally important. When emotional stress causes pelvic pain or is linked to it, your nervous system has perpetually been in fight or flight due to chronic pain and/or a string of stressful events. How we activate our ability to retrain a heightened nervous system is the real and often under-attended question when it comes to treating and healing chronic pelvic pain.

Building a healing team can help with the emotional stress that causes pelvic pain

Can emotional stress cause pelvic pain? Woman building a healthcare team to treat pelvic pain

Because emotional stress and pelvic pain are connected, it is important to consider a provider with a well-rounded approach to care. Or, build a team of providers to support you. You want a diverse group who understands how emotional stress causes pelvic pain and vice versa. Some key options to help you start healing:

Staying focused on more than just the physical part of therapy

Pelvic pain and the implications of emotional distress are just more recently being properly discussed. I find all too often that those with pelvic pain do not get the types of assistance they greatly need. If you have pelvic pain, support to manage the stress that causes muscular contraction is important. It is far too common for the mental and emotional root causes of pelvic pain go under-diagnosed and unaddressed. We long to be seen, heard, and valued. We all deserve to have these basic needs met and they’re important. 

For example, I recently spoke with a woman dealing with prolapse and associated pelvic pain. She shared that her pain specifically started after a very upsetting event, where she felt extremely unsupported by her husband. She tried to bring this up with her physician and physical therapist. Both dismissed it. However, she experienced significant success when we began working together. One of the things we did? We gave space to the mental and emotional stress in her marriage, and we addressed it as a root cause.

Understanding why your physician might not understand your pelvic pain and what to do

I really feel some doctors dismiss pain because their professional tool boxes are not well stocked with solutions. I know firsthand how difficult it can be for someone to come to you hoping for pain relief and there not being an easy solution. While I do not condone any doctor dismissing you, I do think it helps to understand their training. For most, it just doesn’t include much on the pelvic floor. Sometimes, I think that can put them at a loss for what to offer a patient.

It’s vitally important to feel supported, heard, and attended to in order to reduce pelvic pain in an effective and efficient manner. (Check out my article on how to find the right provider for you.) Pelvic floor physical therapists can be difficult to find in some areas. But it is definitely becoming a more popular field. Stay vigilant because there is help to be found. Pelvic floor physical therapists are highly trained to help with all aspects of pelvic floor dysfunction and pain.

What is treatment like with a pelvic floor therapist? Can you help with the emotional stress of pelvic pain too?

Physical therapist working on woman in PT

Treatment often can involve internal assessment and treatment. Many women feel uncomfortable with this, especially at first. For this very reason, it is important to ask questions first. Always know that it is your body and your rules! You decide who you feel safe with and when certain treatments will occur. Handling your care this way is empowering. It also lends itself to a reduction in pain (recall, less anxiety equals less pain). 

What if I’m not comfortable with treatment? Or, if I can’t find someone close by?

Telemedicine visit in kitchen for emotional stress that has caused pelvic pain

Because of the often under-addressed mental and emotional stressors and the intimacy and vulnerability of pelvic floor treatment, I now work with women in a few ways. We do over the phone, secure video, or in-person as needed. Many professionals scoff at remote approaches and say results just aren’t possible. But I have found I get the best results for my clients with the least invasive measures. There is a time and place for everything. Seeking providers who are willing to think outside the box and advocate for you is vital. They are out there, and you deserve to be free to move joyfully in your body and in every area of your life. 

Lean on your team and a community of women to heal and find hope

Emotional stress and pelvic pain- there is hope- woman feeling hopeful, smiling

The number one thing I have witnessed in speaking intimately with individuals about pelvic pain is the feeling of being utterly alone in their experience. This causes a lot of emotional stress, which can make pelvic pain feel worse. Also, loneliness is largely associated with depression, and depression and anxiety are huge side effects of pelvic pain. For this reason, one of the biggest things I am committed to is gathering women together in safe spaces. We discuss, learn, and heal with one another. And, so importantly, we are able to find big beautiful wells of hope and relief from pelvic pain. 

Sara Smith, DPT, RYT-200, CHC
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