Stress and Pelvic Floor Tension: Causes, Treatments, and Exercises for Relief

You’re not sleeping well. Your stomach feels off, your shoulders are tight, and you’re next-level irritable. You’ve been here before — this is you under stress. What you may not realize: The stress that makes your shoulders tense and achy is doing the same thing to the muscles in your pelvic floor. 

Read on to learn how stress and trauma affects your pelvic floor, the benefits of physical therapy, and best PT-recommended exercises and tips to help relieve tension and manage pelvic floor symptoms.

What’s Your Pelvic Floor?

Your pelvic floor is a group of muscles and connective tissues that stretches like a hammock from your pubic bone in the front to your tailbone in the back. It helps hold pelvic organs in place, such as your bladder and rectum and plays a role in bladder control, bowel control, and sexual response.  

Just like other muscles in your body, your pelvic muscles can get too tight, or hypertonic. They may stay contracted, spasm, or have difficulty relaxing. When pelvic floor muscles are too tight, they can’t function properly. An overactive pelvic floor can lead to pelvic pain, urinary and bowel symptoms, and sexual dysfunction. Pelvic floor tightness may be due to many different factors — one of which is stress, anxiety, or trauma.

How Stress Can Cause Pelvic Floor Tension

Your body is designed to experience stress and react to it. When you’re faced with a challenge or threat, your nervous system alerts your brain to release a burst of chemicals that raises your heart and breathing rates and activates your muscles so you’re ready to respond. 

One of your body’s automatic responses to stress is to tense your pelvic floor — without you even being aware of it. Ever caught yourself holding your breath or clenching your teeth when you were nervous 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 your bladder, bowel, and reproductive and sexual functions. Once the threat is gone or stress is relieved, your body is meant to return to a normal, relaxed state. 

Chronic Stress and Pelvic Floor Muscle Problems

When stress is chronic or long term, however, your body essentially stays on high alert. The continued activation of the stress response can contribute to or worsen a range of health issues — including pelvic floor problems. If you’re under constant stress, your pelvic floor can become tight and fatigued, leading to pain, spasms, and urinary problems. For example, pelvic floor muscles need to relax to allow urine to flow out of the bladder. If the muscles are too tense, you may feel like you can’t empty your bladder completely or have another urge to go right after you finish urinating. Also, pelvic pain can be heightened by stress, leading to a vicious cycle of symptoms.

Trauma and Pelvic Floor Tension

Stress doesn’t come only from physical factors. Many people with pelvic health issues deal with the stress of anxiety and depression. Emotional stressors, such as sexual trauma or abuse, can also affect your stress response and pelvic symptoms. If you have experienced sexual trauma in your past, your nervous system may associate sex with threat. So even during a comfortable, safe sexual experience, your pelvic floor muscles may tense up and cause pain.

Whatever the source of your stress, the pain and symptoms that result are real and hard to ignore. But it’s possible to retrain your pain system and address all the factors that contribute to your pelvic floor symptoms — including your stress levels and emotional health.

Symptoms of Pelvic Floor Tension

One common symptom is persistent pelvic pain. You may feel pain or pressure in your lower back or hips, as well. It may also occur in a specific spot, like your bladder, or with specific activities, such as during urination or bowel movements. Other signs of tense or hypertonic pelvic floor muscles include: 

• Urinary urgency and frequency (feeling like you need to pee urgently, often, or right after you go)

• Urinary incontinence (having a sudden urge to urinate, followed by leaking pee)

• Difficulty starting to urinate

• Slow urine flow

• Difficulty starting a bowel movement

• Feeling like you’re straining when pooping, or are unable to empty completely

• Constipation

• Painful intercourse, or dyspareunia

Physical Therapy for Pelvic Floor Tension

Healthy pelvic floor muscles need to be able to tighten (contract) and fully release (relax) so they function properly. When pelvic floor muscles stay tense and contracted, it can lead to pain and other symptoms. Pelvic floor physical therapists (PTs) can recommend relaxation exercises to help stretch and relax tense muscles to relieve symptoms. Pelvic floor exercises can help you:

• Reduce levels of stress hormones

• Reduce pelvic pain, low back pain and bladder pain  

• Reduce pain while urinating or during bowel movements

• Enjoy more comfortable sex

• Improve bladder control and reduce urgency and frequency 

• Improve bowel control and reduce constipation

Often, pelvic floor muscles are both tight and weak. Some signs of a weak pelvic floor might include urinary incontinence, an inability to hold back stool or gas, a noticeable bulge in the vaginal opening, or the inability to feel the movement when performing a Kegel exercise. When pelvic muscles are both tight and weak, PTs will focus on exercises to release tension in the muscles first before strengthening them. 

Pelvic floor physical therapy is a comprehensive treatment that may include education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. You can see a physical therapist in person or use a program like Hinge Health to access a PT who specializes in pelvic health via telehealth video visit.

Diaphragmatic Breathing for Stress and Pelvic Floor Tension

Diaphragmatic breathing may be a key part of your pelvic floor physical therapy treatment for pelvic floor tension. Here’s why: With each breath you take, your diaphragm (the muscle that sits at the bottom of your ribcage) moves. When your diaphragm moves, your pelvic floor moves. Think of these two as dance partners.

When you inhale, your diaphragm moves down. This causes your pelvic floor to lower slightly, giving it a nice stretch. When you exhale, your diaphragm rises up, which allows your pelvic floor to move upward with a gentle contraction.

Slow, deep breathing (aka diaphragmatic breathing) allows your pelvic floor to rest periodically so your muscles release tension, relax, and remain strong and flexible.

To help relax and stretch your pelvic floor muscles, your pelvic floor physical therapist may recommend exercises including: