Is Stress the Missing Link in your Pelvic Floor Dysfunction?

It’s so exciting to see more people discussing the pelvic floor these days. From personal stories of those experiencing pelvic floor dysfunction to healthcare providers sharing educational resources, there’s a growing wave of awareness. This shift is empowering, as it gives many the confidence that pelvic floor issues can be addressed and resolved.

However, even with the right guidance, setbacks can arise along the path to healing. An important role for me as a pelvic floor physical therapist is helping people navigate these setbacks.

It can be incredibly frustrating when you’re following a plan but not seeing the progress you expect. Healing isn’t always linear, and sometimes, a shift in perspective or approach can make all the difference in your journey to recovery. 

Pelvic floor physical therapy uses a variety of techniques to address pelvic floor dysfunction. These methods include manual therapy techniques, strengthening and mobility exercises, neuromuscular re-education, and lifestyle modifications, just to name a few. 

But there’s one important factor I want to highlight that can be a missing link to recovery: stress. Stress can have a significant impact on pelvic floor health, and understanding its role is key to push healing forward.

The Connection Between Stress and Your Pelvic Floor

There’s a multitude of evidence that shows that stress takes a physical toll on the body. When you’re under stress, your sympathetic nervous system—the “fight or flight” response—becomes activated. This system steps in when the body perceives a threat, initiating a range of physiological changes.

One of the most common responses is increased muscle tension. Increased pelvic floor muscle tension can be a significant cause of dysfunction. When pelvic floor muscles stay in a state of tension, they can’t contract or relax as they should, which inhibits their function and can lead to a number of pelvic floor issues.

Stress also affects how we experience pain. Chronic stress can elevate certain hormones that increase how the body experiences pain, worsening symptoms for those dealing with pelvic pain.

How Stress Manifests in the Body

Stress often manifests in ways we may not even recognize. Here are two common ways it affects your pelvic floor:

1. Breathing

When the sympathetic nervous system takes over, your breathing rate tends to increase and become shallow. Since the diaphragm and pelvic floor muscles work closely together, any disruption in your breathing mechanics can also affect how they work together.

Tip: Practice deep breathing by inhaling through your nose, expanding your ribcage on all sides. Hold the breath for 3 seconds, then gently exhale through your nose. This simple technique can help reset your breathing pattern and help you feel more calm.

2. Glute Clenching

When stressed, many people unknowingly clench their glutes, which can exacerbate pelvic floor dysfunction. When you’re clenching your glutes you’re more than likely clenching your pelvic floor muscles too. Additionally, glute clenching can be associated with jaw clenching or shoulder tension, which are other ways stress can manifest in your muscles.  

Tip: If you’re noticing your glutes feel tense try wiggling in your seat to relax the muscles around your hips and pelvis. You can even take it a step further and do “glute check-ins” every hour to make sure you’re not clenching throughout your day. 

Breaking the Stress Cycle

Managing stress is not as easy as waving a magic wand. But understanding how stress plays a role in pelvic floor dysfunction is an important first step in addressing it. Without identifying the source of the issue, it’s much harder to make meaningful progress.

If you recognize that stress is a factor in your pelvic floor dysfunction—or if you notice that your symptoms worsen under stress—it might be time to focus on stress management. Stress-reducing activities like proper rest, exercise, engaging in enjoyable hobbies, and seeking support from mental health professionals can all play a vital role in improving both your overall quality of life and pelvic floor health. You can also work with a pelvic floor physical therapist to provide additional relaxation techniques.

Conclusion

As a pelvic floor physical therapist, my goal is to help patients uncover the many areas that might be contributing to pelvic floor dysfunction and provide the framework to address it. Stress is often an overlooked yet important link in the healing process, and addressing it can be the missing piece in your recovery journey.

References

1. Chu B, Marwaha K, Sanvictores T, et al. Physiology, Stress Reaction. [Updated 2024 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541120
2. Pierce AN, Christianson JA. Stress and chronic pelvic pain. Prog Mol Biol Transl Sci. 2015;131:509-35. doi: 10.1016/bs.pmbts.2014.11.009. Epub 2015 Feb 2. PMID: 25744684.
3. Mínguez-Esteban I, De-la-Cueva-Reguera M, Romero-Morales C, Martínez-Pascual B, Navia JA, Bravo-Aguilar M, Abuín-Porras V. Physical manifestations of stress in women. Correlations between temporomandibular and pelvic floor disorders. PLoS One. 2024 Apr 16;19(4):e0296652. doi: 10.1371/journal.pone.0296652. PMID: 38626037; PMCID: PMC11020383.
4. Porrón-Irigaray A, Rodríguez-López ES, Acevedo-Gómez MB, Ojedo-Martín C, Benito-de-Pedro M. Coactivation of the Pelvic Floor and Gluteus Medius Muscles While Walking and Running in Female Runners. Sensors (Basel). 2024 Feb 20;24(5):1356. doi: 10.3390/s24051356. PMID: 38474893; PMCID: PMC10934361.