Stress and Trauma in Pelvic Pain

“I was so scared, I peed my pants!” This saying hints at the intimate relationship between the functions of the pelvic floor and the emotional state of your body. Your pelvic floor (a bowl-shaped group of muscles that nestles like a hammock at the bottom of your pelvis) and your pelvic organs (vagina, bladder, etc.) are designed to respond to emotional stimuli. For example, the complex physiological changes of sexual arousal rely heavily on emotions and the relaxation response.

Your Nervous System Under Stress

The nervous system is a network of nerves that controls communication between your brain, spinal cord, and the rest of your body. The nervous system functions like an alarm system. It alerts the brain to information from the environment and sends signals from the brain to the rest of the body.

Under stress, your nervous system becomes extra sensitive and creates protective responses to certain situations. Think about your house alarm system on high alert: Imagine if it went off every time a leaf fell on your porch? That same logic applies to your pelvic floor under stress.

Stress and Your Pelvic Floor

Stress increases muscle tightness in your pelvic floor. This can cause pain and dysfunction by decreasing blood flow and circulation. You may not even be aware of holding tension in this area. Ever caught yourself holding your breath or clenching your teeth when you were nervous, sad, or angry? Your pelvic floor is no different. In fact, it can be more sensitive to stress due to the rich network of nerves that control bladder, bowel, and reproductive and sexual function.

Trauma and Your Pelvic Floor

Research has found that almost half of women being treated for chronic pelvic pain have a history of sexual, physical, or emotional trauma. If you have suffered physical or emotional trauma (especially sexual trauma) you may be more prone to pelvic pain or dysfunction. This can occur due to association or “muscle memory.” If you have experienced unwanted sexual activity or sexual trauma in your past, your nervous system may associate this activity as threatening. So even during a comfortable, safe sexual experience, your pelvic floor muscles may tense up and cause pain.

We encourage you to see a mental health professional if trauma is a factor in your pelvic floor symptoms.

How to De-Stress and Soothe Your Pelvic Floor

  • Do your Hinge Health exercises. Exercise is a proven way to lower levels of stress hormones. Your Hinge Health exercises are tailored to ease tension in your pelvic floor.

  • Lace up your sneakers and get moving. Aerobic exercise, like brisk walking, jogging, or cycling, can help decrease anxiety, improve mood, and decrease pain.

  • Make sleep a priority. Establish a good sleep schedule (go to bed and wake up at the same time every day) and sleep hygiene routine (avoid screens before bed, sleep in a dark, cool room). Talk with your provider if you have difficulty falling asleep or staying asleep.

  • Do diaphragmatic (belly) breathing, which can help relax a tight pelvic floor and calm your nervous system. Ask for our resource on this if you need a refresher.

  • Take a hot bath to relax your muscles, encourage relaxation, and ease pain.

  • Devote some time each day to explore your five senses and discover positive sensations in your body. If you enjoy a cup of coffee each morning, pause to feel the warmth of the mug against your hands, savor the rich aroma of the coffee, or make note of the familiar soothing sound of your coffee pot while it brews.

  • Be mindful of stressful physical sensations. Sometimes physical sensations in the body can recreate feelings of stress or trauma. For example, having an elevated heart rate during aerobic exercise may feel similar to the heart pounding you experience when you are nervous, angry, or scared. If you notice exercise increases your levels of stress or reminds you of a previous trauma, consider working with a behavioral health specialist.

Key Takeaways

  1. Stress and trauma can make your nervous system more sensitive and increase pelvic pain.

  2. Pelvic floor physical therapy (and exercise in general) can help relieve stress and improve symptoms like incontinence and pelvic pain.

  3. Regularly engaging in other stress-relieving activities can help calm your nervous system and improve the health of your pelvic floor muscles.


  1. Exercising to relax. (2020, July 7). Harvard Health Publishing.

  2. Bair, M. K., Robinson, R. L., Katon, W., et al. (2003). Depression and Pain Comorbidity: A Literature Review. Archives of Internal Medicine, 163(20), 2433-2445. doi:10.1001/archinte.163.20.2433

  3. Urits, I., Callan, J., Moore, W. C., Fuller, M. C., Renschler, J. S., Fisher, P., Jung, J. W., Hasoon, J., Eskander, J., Kaye, A. D., & Viswanath, O. (2020). Cognitive behavioral therapy for the treatment of chronic pelvic pain. Best Practice & Research Clinical Anaesthesiology, 34(3). doi:10.1016/j.bpa.2020.08.001

  4. Impact of stress and cortisol levels on pelvic pain and pelvic stress reflex response. (n.d.). Physiopedia.