A tiger is chasing you through the forest and you’re running as fast as you possibly can. Your body has undergone a series of neurological and hormonal sequences to mobilize your body by increasing blood flow and nutrient availability so that you can run, run, run. Our bodies are designed to react to stress in ways that protect us and mobilize us to act. Fortunately in our modern world, running from tigers is not on our regular list of stressors, but the body’s reaction to life’s demands – such as opening a stressful email or navigating hellish traffic to make it to an appointment on time – can elicit the same response from within our body. From a hormonal and neurological perspective, we do not decipher if we are running from a tiger or simply trying to finish a work project by a deadline.
Stress is any type of change that causes physical, emotional, or psychological strain or threat. We all undergo some levels of stress regularly, and some stress can be a positive way to mobilize ourselves into action. It is our body’s response to anything that requires attention, and therefore causes physical changes in our body as we prepare ourselves to respond to the perceived stressor.
Stress and pelvic pain go hand in hand. Oftentimes stressful periods of life are related to the onset of pelvic pain, or correlate with flare-ups of familiar symptoms. While significant life changes, such as the death of a loved one, a divorce, or a surgery obviously increase stress, unmanaged daily life stressors add up and take a toll too. How we understand, manage, and respond to stress may make the difference between nasty flare-ups of pelvic symptoms or a healthy, happy pelvic floor.
Adrenaline & Cortisol: The Hormones of Stress
Hormones are molecules secreted by our endocrine system that travel to other cells to send signals and messages. When we experience stress, our nervous system and our endocrine system work together to release hormones known as epinephrine and norepinephrine, often referred to as “adrenaline”. The rush of adrenaline is also known as our “fight or flight” response, designed to help us react more quickly to situations we perceive as stressful, exciting, or dangerous. These hormones are released very quickly and break down quickly as well.
By contrast, cortisol is the other major stress hormone, it is released 10 minutes after the stressor is detected, and stays in circulation for 1-2 hours after. The hormone is secreted by a sequence of communication from the hypothalamus (located in the brainstem), to the pituitary gland (located just below the hypothalamus), and to the adrenal glands (located just above the kidneys). This communication pathway, known as the HPA axis can be overactivated for people continuously under stress. Cortisol levels naturally fluctuate throughout the day and help us to some degree with waking up in the morning, cell repair, suppressing inflammation, regulating blood pressure, regulating metabolism, modulating our sleep-wake cycle, and immune function. However, high levels of cortisol can make us feel anxious, agitated, increase our pulse, and result in poor sleep.
If you are under stress for longer periods of time, the HPA axis is constantly activated, and cortisol accumulates in the body. Over time, the nutrients needed to produce cortisol may become depleted and cortisol levels actually decrease over time. Low levels of cortisol can be associated with increased pain, poor sleep patterns, depressed immune function, decreased healing, and lower capacity to handle additional stress.
Increased Stress & Chronic Pelvic Pain
Though we often associate high levels of stress with high levels of cortisol, research shows low levels of cortisol to be associated with many female chronic pelvic pain conditions because the body has exhausted the nutrients and capacity to produce sufficient levels of cortisol.
In particular, one study found that lower levels of cortisol, higher levels of perceived stress, and lower scores on quality of life questionnaires were associated with multiple pelvic pain conditions. Read on below to see what the research says about how different pelvic pain conditions are affected by stress and cortisol levels:
Chronic Pelvic Pain: Women with chronic pelvic pain experienced lower levels of cortisol, higher levels of perceived stress, and overall lower scores on quality of life questionnaires.
Endometriosis: Women with endometriosis had lower levels of cortisol overall and lower levels upon waking compared to people without pelvic pain or endometriosis.
Recurring Yeast Infections (Vulvovaginal Candidiasis): Women who experienced recurrent yeast infections also had lower levels of cortisol in the morning and throughout the day
Vulvodynia: Pain that lasts for 3 months or longer at the vulva (external female genitalia) that cannot be explained by an infection, skin condition or other medical diagnosis is known as vulvodynia. According to research, women with vulvodynia experienced higher levels of stress and lower levels of cortisol in the morning compared to control groups.
Painful Bladder Syndrome (PBS)/Interstitial Cystitis(IC): Similarly, research on PBS/IC found lower cortisol levels in the morning for those affected by PBS and IC compared to control groups.
*Chronic Prostatitis and Chronic Male Pelvic Pain: Men with chronic pelvic pain or prostatits had reported higher levels of stress and anxiety. Similar to the findings on female pelvic pain, researchers also found dysfunction of the HPA axis but overall lower levels of cortisol in the mornings.
Stress & You
Do you have pelvic pain and increased stress? The good news is that follow-up studies have shown that after weekly pelvic health physical therapy sessions, cortisol levels increased, perceived stress decreased, and there were positive correlations between vitality, emotional and social function, and mental health for women with chronic pelvic pain. In other words, pelvic health physical therapy can help lower stress, normalize cortisol, and improve pain. Your physician and mental health provider can also help you learn ways to manage stress that can positively impact pelvic pain. Contact us at N2 or your local pelvic health physical therapist for more information.
Sources
https://www.who.int/news-room/questions-and-answers/item/stress
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037
https://pubmed.ncbi.nlm.nih.gov/18800310/
https://www.tandfonline.com/doi/abs/10.3109/0167482X.2012.729625?journalCode=ipob20
https://pubmed.ncbi.nlm.nih.gov/26768711/
https://www.acog.org/womens-health/faqs/vulvodynia
https://pubmed.ncbi.nlm.nih.gov/18158367/
https://pubmed.ncbi.nlm.nih.gov/18207189/
https://link.springer.com/article/10.1007/s43032-019-00053-0
https://my.clevelandclinic.org/health/articles/22187-cortisol