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Anxiety & Pelvic Pain - How They Are Connected & Treatment Options

There’s no doubt that the pandemic has added lots of stress to everyone’s life. And sadly, there’s also no doubt that many women experience pelvic pain, since the condition affects between 15-20% of women in the United States.1 But are the two linked?

Anxiety affects the body in different ways, and there does seem to be a connection between anxiety in women and pelvic floor health. We’re still learning a lot about pelvic dysfunction, but one thing seems clear: stress and anxiety have a role to play.

The Link Between Anxiety and Pelvic Pain

Pelvic pain can be acute or chronic, being labelled chronic when it’s persisted for at least 3 months. It can occur for gynecological or non-gynecological reasons, and distinguishing between these two is important for diagnosis and treatment.

It’s now common knowledge that stress and anxiety in women can impact the body in many negative ways. One common response to stress is to clench our pelvic floor muscles. And in fact, clenching the pelvic floor muscles specifically is a common reaction to stress.

Many pelvic floor disorders, like pelvic organ prolapse, are caused by loose pelvic floor muscles – it’s why doctors so often recommend Kegel exercises.

Pelvic Floor Dysfunction

But when we are constantly tightening these muscles (often involuntarily due to chronic stress), this can lead to a state of tight muscles sometimes referred to as hyper-active pelvic floor or non-relaxing pelvic floor dysfunction. This condition can lead to voiding dysfunction, anorectal dysfunction, sexual dysfunction and pain.2

Non-relaxing pelvic floor dysfunction can be caused by many factors, such as abuse, trauma, or skeletal asymmetry. Sometimes the cause is never identified. But we do know that sleep disturbance, mental health concerns like depression and anxiety in women can perpetuate chronic pain, and that these conditions can adversely affect a woman’s quality of life.3

Moreover, we also know that chronic stress and mental health exposure early in life can contribute to pelvic pain in adulthood, and that acute stress can induce or increase symptom severity.4 And studies have also shown that people with pelvic pain also suffer from psychological conditions like stress and anxiety in women at a higher rate than the general public. Namely, one study found that the rates of anxiety in women with chronic pelvic pain range from 39-73%, while the anxiety in women rate is only 12% of the general population.5

Pelvic Pain Syndrome

Pelvic pain syndrome, a complex condition, encompasses various disorders, including chronic pelvic pain, vulvodynia, and irritable bowel syndrome (IBS). These conditions can coexist and often share similar symptoms, making diagnosis and treatment challenging. Chronic pelvic pain syndrome typically involves persistent discomfort in the lower abdomen and pelvic region, often lasting for at least three to six months. Pelvic pain syndrome may be characterized by sharp, dull, or burning sensations and may worsen during menstruation or sexual activity reducing a woman’s quality of life.

Interstitial Cystitis

Interstitial cystitis (IC), often referred to as painful bladder syndrome, is a chronic condition characterized by bladder pain and urinary urgency and frequency. While IC primarily affects the bladder, its symptoms can overlap with those of pelvic pain syndrome. Many individuals with IC experience pelvic pain as a prominent symptom, further highlighting the intricate relationship between pelvic pain and other urological conditions.

Endometriosis and Pelvic Pain

Endometriosis is a common cause of pelvic pain in women. The tissue growths (endometrial implants) can become inflamed, bleed, and cause irritation and scarring in the pelvic area. This can result in varying degrees of chronic pelvic pain, which may be severe in some cases. The impact of endometriosis includes pain during menstruation, sexual intercourse, and even during daily activities.

Women with endometriosis can have a profound psychological impact on their lives. Living with ongoing pain can lead to increased stress, anxiety, and depression. The uncertainty and frustration of managing a chronic condition can contribute to emotional distress, which, in turn, may exacerbate the perception of pain.

Addressing both the physical and emotional aspects of endometriosis is essential for comprehensive care. Treatment options for endometriosis often include medications to manage pain and inflammation, hormonal therapies, and surgical interventions. In addition to these medical approaches, managing anxiety and addressing its impact on daily life is crucial. This may involve counseling, relaxation techniques, and mindfulness practices to help individuals cope with both the physical and emotional challenges posed by endometriosis.

Psychological Factors and Anxiety

Psychological factors play a significant role in the experience of pelvic pain, and anxiety is among the most common emotional responses to chronic pain. Living with persistent discomfort can lead to anxiety, depression, and stress, creating a cycle where mental health issues exacerbate physical symptoms. It’s crucial to address these psychological factors alongside physical treatment to achieve holistic pain relief. Therapies such as cognitive-behavioral therapy (CBT) can be particularly effective in managing anxiety and improving overall well-being in individuals dealing with pelvic pain.

Recognizing Pelvic Pain Symptoms

Recognizing the wide range of symptoms of pelvic pain is crucial for timely intervention. Symptoms may include pelvic pressure, discomfort during sexual intercourse, urinary urgency and frequency, constipation, and bowel irregularities. Pain can vary in intensity and may radiate to the lower back or thighs. If you experience any of these symptoms for an extended period, it’s essential to seek medical attention to rule out underlying conditions and receive appropriate treatment.

Treating Anxiety and Pelvic Pain

Far too many women suffer from pelvic floor dysfunction and chronic pain in silence. And those that do seek help often meet with doctors who are unable or unwilling to diagnose them properly. That’s why we highly recommend patients seek out doctors who specialize in the pelvic floor (use our Physician Finder to start physical therapy and find one near you).

Treatment Options for Pelvic Pain

Treatment for pelvic pain often involves a multidisciplinary approach. Depending on the specific diagnosis, treatment options may include physical therapy, medications for pain management, lifestyle modifications, and dietary changes. Pelvic floor physical therapy is particularly beneficial for many patients as it aims to relax and strengthen the pelvic muscles, providing relief from muscle tension and pain.

Thankfully, for women who do seek out proper help, there are many treatments for pelvic floor disorders. Given the connection between mental health and pelvic pain, this can often look like therapy, medication and exercise. Pelvic physical therapy is also often used for pelvic pain.

Finally, it is important to note that many pelvic floor disorders like incontinence can also lead to anxiety. Pelvic pain can feel scary, especially when there is trauma associated with it. In fact, according to one study, there is “increasing evidence that pain may be a stronger risk factor for developing depression or anxiety than the inverse.”6

When to Seek a Physical Exam

If you’re experiencing persistent pelvic pain or any of the associated symptoms mentioned earlier, it’s advisable to schedule a physical pelvic exam with a health care provider. This exam can help identify any physical abnormalities, such as muscle tension or structural issues, that may contribute to your pain. Additionally, your medical care provider can recommend further tests or refer you to a specialist for a more comprehensive evaluation.

So it’s important to find your way towards the root cause of your suffering to avoid continued physical pain affecting your daily life, but also to avoid or heal from the emotional pain that often accompanies pelvic pain. And let’s always remember that mental health and your quality of life is just as important as physical health.

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