Hi friends! April is Stress Awareness Month, and to observe we are going to talk about how mental health disorders like anxiety and depression can impact our pelvic floor health.
Pelvic floor muscle dysfunction can include a variety of things including urinary incontinence, fecal incontinence, constipation, pelvic pain, pain with sex, and more. Studies have shown that pelvic floor dysfunction can seriously lower quality of life and may cause anxiety, depression, and sleep disorders (Kalata, 2022).
Research has shown that depression and chronic pelvic pain are closely associated (Keller, 2012; Ramao, 2009). Depression has been linked to decreased sexual desire and arousal (Basson, 2007).
Some common pelvic floor conditions associated with higher rates of anxiety/depression include:
Interstitial cystitis (Vasudevan, 2017)
Vestibulodynia (Weijmar Schultz, 2005)
Persistent genital arousal disorder (Leiblum, 2007)
But what can we do? It is hard to say whether pelvic floor dysfunction causes anxiety or depression or whether anxiety and depression cause pelvic floor dysfunction. When treating pelvic floor conditions when anxiety and depression are present it is often best to see multiple providers. Seeking help for mental health and seeing a pelvic floor therapist are great resources.
Most insurance plans cover mental health treatments by providers in your area. You can also learn more from the National Alliance on Mental Illness. Remember, it is okay to ask for help!
A pelvic floor therapist can help address the pelvic floor dysfunction and symptoms. Most states in the US have direct access, which means you can see a PT without needing a referral from a physician. And the great news—pelvic PT is covered by most insurances!
A pelvic PT can help in so many ways! One of the biggest ways a PT can help is through education. The PT can explain to you the anatomy of your body and the way it functions. Understanding this, can be a big step towards managing your symptoms. They also help you to recognize habits you may have and help you to create new, healthy ones.
They can provide relaxation training and biofeedback (down training) to help relax tight pelvic floor muscles. They can also use manual therapy techniques, such as massage and trigger point release, to help relax the pelvic floor and surrounding muscles.
A pelvic PT may give you exercises to perform as part of a home exercise program to help maintain progress made in physical therapy. These exercises may be to stretch and/or strength your pelvic floor while also addressing any movement dysfunctions you may have. Below are examples of some of the stretches they may ask you to do.
PTs are often equipped with modalities that can help to address pain such as moist heat packs, ice, and electrical stimulation (sometimes called TENS).
A PT may suggest the use of bracing and orthotics depending on your symptoms. These may include a SIJ/pelvic belt, or even foot orthotics. Faulty foot position can influence your entire body and put a greater strain on the pelvis and pelvic floor.
A PT can provide pain neuroscience education, which means they will explain to you how pain works. In understanding your pain, you are better equipped to manage it.
If you are having pain with penetration of any kind, including inserting a tampon or having a vaginal exam, your PT may suggest the use of vaginal dilators. Vaginal dilators come in many different sizes and are used to gradually increase tolerance to objects entering the vagina. Often times with chronic pelvic pain, the pelvic floor muscles tighten in response to an object being inserted—which makes it painful. The dilators start smaller than the size of an index finger and get progressively bigger to help the pelvic floor muscles relax and allow penetration.
Ask your provider for a referral to a pelvic floor therapist near you, or find one at www.mypfm.com/find-a-pt.
Ready to learn more about your pelvic health? Here are some helpful resources:
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Watch our YouTube playlist on Pelvic Floor PT
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
For providers, join our Ambassador Program to gain access to our many online courses, including:
Anxiety, Depression, and the Overactive Pelvic Floor with Dr. Jill Krapf, MD, Med, FACOG
Pelvic Pain Strategies to Empower Patients at Home with Dr. Amanda Olson, PT, DPT, PRPC
Pelvic Floor Therapy Management & Treatment for PGAD/GPD (Persistent genital arousal disorder/genito-pelvic dysesthesia) with April Patterson, PT, MSPT
Written by Emily Reul, PT, DPT
References
Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet.2007;369(9559);409-424.
Kalata U, Jarkiewicz MM, Barcz EM. Depression and anxiety in patients with pelvic floor disorders. Ginekol Pol. 2022. doi: 10.5603/GP.a2022.0130
Keller JJ, Chen YK, Lin HC. Comorbidities of bladder pain syndrome/interstitial cystitis: a population-based study. BJU International. 2012;110(11):E903-9.
Leiblum ST, Chivers ML. Normal and persistent genital arousal in women: new perspectives. Journal of Sex and Marital Therapy. 2007;33(4):357-373.
Ramao AP et al. High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain. International Journal of Clinical Practice. 2009;63(5):707-711.
Vasudevan V, Moldwin R. Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome.
Weijmar Schultz et al. Women’s sexual pain and its management. Journal of Sexual Medicine. 2005;2(3):301-316.