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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 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 can impact the body in many negative ways. One common response to stress is to clench our 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.

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, depression and anxiety 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 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 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 rate is only 12% of the general population.5

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 find one near you).

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

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

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