How Anxiety is Affecting Your Pelvic Floor

We are living in a unique time where our stressors seem to have stressors. Most of us notice how these stressful situations affect our bodies: changes in appetite, sleep, and mood changes, but subtle changes or anxiety are also occurring in our pelvic floor.

You may have noticed an increase in pain, changing/worsening symptoms of incontinence, pain with sex, or constipation. Don’t worry, you are not alone. 

How Our Bodies Handle Stress:

When we experience stress, which can be as small as missing your turn while driving or as large as a pandemic without a known cure, our bodies secrete the hormones epinephrine, norepinephrine, and cortisol to help us cope. These hormones are designed to keep us alive during stressful moments by making energy more available for our muscles and vital organs to use, sharpening our senses like sight and hearing, and managing inflammation. They are also known to help in our mental coping by pulling information from previous memories that might be helpful to keep us safe and focused. This “fight or flight” system is vitally important to our survival when used short-term. Unfortunately, most of the stressors we are experiencing right now are not short-term. 

Effects of Long-Term Anxiety: 

Essentially, when we are unable to manage our stressors effectively, our bodies enter a long-term stress state. We run out of coping resources like cortisol, which is only meant to be used for 1-2 hours at a time. This cortisol depletion leads to several negative effects such as increased inflammation throughout your body, muscle breakdown, fatigue, pain, and difficulty recalling memories. The state of chronic stress also affects our diet, sleep, and emotion centers as our body is not designed to digest or rest during experiences where safety and wellbeing are jeopardized. These symptoms perpetuate the stress system due to fear of injury, fear of recovery, or feelings of hopelessness, etc. It is a positive feedback system that continues to build on itself. This is one of the physiological reasons contributing to the experience of chronic pain, and why it is challenging to treat. But please, do not lose hope. It IS treatable!

What Does Anxiety Have To Do With My Pelvic Floor?

One of our helpful coping strategies for mental or physical stress is a subtle contraction of our pelvic floor muscles. This contraction helps prevent urinary or fecal leakage and co-contracts with our abdominal muscles to protect our spine. If we experience long-term stress, our pelvic floor stays contracted and eventually can have difficulty relaxing. You may have heard terms like hyper-active pelvic floor, non-relaxing pelvic floor, or tight pelvic floor muscles which are often used to describe this phenomenon. When our pelvic floor learns to stay in a semi-contracted state, we lose the functional strength needed to hold in urine and feces, the mobility needed for pain-free intercourse, and the stability needed to prevent pelvic organ prolapse. We also lose the ability to positively cope with pain, even if our body is no longer in danger.

So Now What?

Let’s start with a simple exercise to become more acquainted with your pelvic floor. Start by closing your eyes and feeling what your pelvic floor is doing. It is easiest to think about the groin, rectum, or the area surrounding your vagina/penis. If you’re having trouble locating your pelvic floor you can do a Kegel (pretend to stop the flow of urine) and the muscles that contract are your pelvic floor muscles. To start, don’t change anything. Just observe. 

Are you holding tension or contracting your pelvic floor? Or is it relaxed?

Now, put one hand on your belly and the other on your chest. Take a deep belly breath. The hand on your belly should move outwards and the hand on your chest should not move. Once you get the hang of that, close your eyes again and feel what your pelvic floor is doing. It takes a lot of focus, but you should be able to feel a subtle relaxation of the pelvic floor when you breathe into your belly. It’s possible that if you have been experiencing chronic stress without positive coping mechanisms, your pelvic floor is unable to relax with this exercise. That is a good indication that you should seek assistance with a pelvic floor physical therapist who can help you learn how to voluntarily relax your pelvic floor.

This voluntary relaxation of the pelvic floor through diaphragmatic breathing (belly breathing) is an excellent coping strategy that breaks the cycle of stress. This form of breathing stimulates the vagus nerve, which is responsible for the “rest and digest” system in our body. It turns down the stress hormones to give our bodies a break (even if only temporarily) from those stress symptoms we talked about earlier. 

A challenge for you: can you maintain awareness of your pelvic floor today? Try to recognize if your pelvic floor is relaxed or contracted during various life situations like sitting in traffic, having a hard conversation with a family member, eating, and watching TV. If you notice your pelvic floor is contracted, can you relax it with diaphragmatic breathing?

Healthy Coping Strategies

There are many ways to manage stress and pelvic floor dysfunction. A pelvic floor physical therapist can help you determine if your pelvic floor is hyper-active and not relaxing, if your muscles are tight, or if you are having difficulty coordinating relaxing from a contracted state which can contribute to symptoms such as incontinence, pain, and constipation. Research is suggesting that treatment for these conditions are more successful with mental health treatment as well through cognitive behavioral therapy (CBT). CBT is helpful in many ways, but in this situation, it is helpful to learn how to mentally cope with stressors to prevent chronic stress from occurring in the first place. 

Other ways to combat stress is by practicing mindfulness. This just means staying aware of your emotions so that you can recognize when you are relaxed versus stressed. Knowing when you are experiencing stress is a powerful tool. If you know you are stressed, you can utilize helpful coping skills like deep breathing, taking a break from the stressful situation, or taking a walk to reset. Meditation and yoga practices promote this inner awareness and are tools frequently used to manage the physical and emotional effects of stress. There are many apps that are designed to help you get started on this journey including but not limited to: Insight Timer, Headspace, and Calm. You can also find guided meditations on YouTube. 

In Conclusion

No matter where you and your pelvic floor are at, no matter what state of stress or anxiety you are in – know that there are tools here for you to help manage and heal. So try to stay positive and keep those cortisol levels low for when you really need it! 

About Grace Waters, PT, DPT

Grace earned her Doctorate in Physical Therapy from Tennessee State University after earning a Bachelors of Engineering in Biomedical Engineering from the University of Memphis. She originally attended physical therapy school with the intention of working with amputees, but she discovered her passion for pelvic floor therapy upon learning the prevalence of pelvic floor dysfunction and the infrequency of pursued treatment. She is committed to being an advocate for people of all identities who experience pelvic pain, incontinence, sexual dysfunction, and constipation.

If you would like to schedule an appointment with Grace, please visit her Provider Profile at for her availability and scheduling information. You may also email N2 Physical Therapy’s Patient Care Coordinator at for more information. 


Fries E, Hesse J, Hellhammer J, Hellhammer DH. A new view on hypocortisolism. Psychoneuroendocrinology. 2005 Nov; 30(10): 1010-1016. Accessed online:

Hannibal K, Bishop M. Chronic Stress, Corisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Phys Ther. 2014 Dec; 94(12): 1816-1825. doi: 10.2522/ptj.20130597

Knight S, Luft J, Nakagawa S, Katzman W. Comparisons of pelvic floor muscle performance, anxiety, quality of life and life stress in women with dry overactive bladder compared with asymptomatic women. BJU Int. 2012; 109(11): 1685-1689. doi:10.1111/j.1464-410x.2011.10590.x

Levac K. Research on Diaphragmatic Breathing. National Qigong Association Available at:

Physiopedia. Impact of Stress and Coritsol Levels on Pelvic Pain and Pelvic Stress Reflex Response Available at: [Accessed 8 June 2020].

Taple B, Griffith J, Weaver C, Kenton K. Enhancing behavioral treatment for women with pelvic floor disorders: Study protocol for a pilot randomized controlled trial. Contemporary Clinical Trials Communications. 2020 Mar. 17. doi: