Pelvic Floor and Stress Connection

For this blog, I wanted to write about the connection between stress and your pelvic floor. I've talked about each issue separately in the past but I specifically wanted to link these two things together because I see these issues show up a ton with patients and I thought it deserved some of its own time.

The different things that affect how we react in our body to stress can tie directly into how we hold our pelvic floor. So just jumping right into it, if you think of how you get when you are stressed or have too much on your plate, those kinds of things, we tend to tuck our tailbone under and hold it in our pelvis, like clenching our glutes. When an animal gets scared, it will sometimes tuck its literal tail under. I know when my dog gets scared it tucks its tail under. I know that he is feeling stressed or unsafe, and humans do the same thing. It's just that we lack tail but that tailbone acts the same way and you can totally tuck it under. We end up clenching our glutes, and it creates a snowball effect of how it affects our posture, our biomechanics, and our pelvic floor.

What Happens To The Pelvic Floor When We Are Stressed

I wrote a blog before on mom butts and how when we are stressed and we're clenching our glutes, it does not make them stronger, unfortunately. It starves them of blood, keeps them tight and locked down too much, then they get atrophied, and then we're not able to get full and good contraction on them. We get this stressed, unsafe feeling, we tuck the tailbone under or we clench the glutes, we have atrophy of the glutes, then we get this mom butt thing happening.

The other thing that happens that is talking to the pelvic floor is that when we tuck our tailbone under, we scoop the sacrum or coccyx or tailbone – whatever you want to call it – under. We bring the bones that we sit on, our sit bones are our ischial tuberosities, together, we tuck under, we squeeze those together, we scoop the tailbone under, and it shortens those points of the pelvic floor.

So our pelvis is a circle, it's a ring, and we have an inlet and the top where a baby comes into and an outlet where the baby comes out of. The pelvic floor is the floor to the outlet. So when the inlet at the top widens, the outlet closes, so they have to reciprocate back and forth. So when we get that closing in the pelvic floor by drawing the four points together, your tail bone and your pubic bone, when those get squished together, you get the shortened pelvic floor.

The other component with that over clenching of the glutes, shortening of the pelvic floor, and atrophy of the glutes, is the disengagement of the lower abdomen. A lot of times after or during pregnancy, we lose that connection to the lower abdominals or if you have a C-section that cuts through that lower area, we're very turned off, very disconnected with our lower abdominals. And because of that, our body loves to compensate. It's going to try to find a way to right that, to make you be able to move through space and do the things that you need to do. So we start with the bootcut clenching process, which then in turn, leads us down that slippery pathway of shortening up our pelvic floor.

So it's all kind of woven together and why it seems probably so common with women postpartum because of that chain of events.

When The Pelvic Floor Shortens, It Doesn’t Always Show Up As Incontinence

The other thing with shortening the pelvic floor and the glute clenching and everything being tight and shortens, not necessarily strong, but shortened, is it doesn't have to show up as incontinence. So we always think leakage, incontinence, and while that's true as that can often be the main symptom, that's not true for everyone and it can show up in other ways.

With myself, that was really never my issue but I definitely had that pelvic floor issues for me. It showed up as a very severe hip issue and it doesn't have to be hips, it doesn't just have to be incontinence, it can be pain with sex, pain with inserting tampons, it can be constipation, it can be hemorrhoids, it can be those things. So, it doesn't just have to be the pelvic floor near the vaginal opening, it can be the pelvic floor near the anal opening. It's all interwoven together and learning how to fully relax the pelvic floor is going to make things like hemorrhoids, and constipation much easier to deal with. And it seems like it should be so easy, you can easily relax your bicep, you can easily relax your quads, but the pelvic floor is tricky because it is tied into things like stress and trauma.

Even if you just have tearing that is minor, that is a form of trauma. Think of the first time you had to go to the bathroom after having a baby. If you had tearing, it’s probably super frightening. You would have thought, “Oh my gosh. I don't want the burning sensation,” or, “I cannot imagine pooping after this. This is never going to be the same.” It could even be just the fear associated with just going to the bathroom

Long-Term Effects If You Have Incontinence Or Leakage

There are also long-term effects if you've got incontinence or leakage and you can't pinpoint it to what is causing it, or when you never know exactly what is going to cause a leak.

Let's say one day it is running for you, one day it's sneezing, another day it is just opening up the doorknob because there's different types of incontinence. You could have stress incontinence and that is more the muscular issues. And then you have urge incontinence or you can just have a mixture of both. So if you never know exactly what's going to be your trigger to a leak, then you are constantly going to be on edge as to when is this going to happen. You might ask yourself, “Am I going to be in a really embarrassing situation? Am I going to be at work? Am I going to be in a public setting for my kids?” That is very stressful.

Even if you don't realize you're doing it, you're going to be clenching and holding as tight as possible all the time to prevent that from happening and that is not how your pelvic floor is meant to work. You trying to hold it and gripping your glutes and gripping your adductors and clenching, clenching, clenching all the time, with that fear that you're going to have a leak of some sort is going to leave you with your pelvic floor shortened and irritated and it's actually going to make it worse. And it's probably unfathomable to you to totally and utterly relax the pelvic floor because you just feel so fearful over having a leak happen. And that is completely understandable. That's what makes it so difficult to get that full relaxation and full elongation of your pelvic floor.

Starting With Breathing To Get Elongated Musculature Of Your Pelvic Floor

So that's why we always start with breathing because the easiest way to get really elongated musculature of your pelvic floor is to use your breath. The diaphragm is that dome-shaped muscle that is attached to the board of your ribs and your spine and it should mirror your pelvic floor. So, as you inhale, ideally, the diaphragm pushes down, widens out the ribcage and a 360-degree pattern pushes your abdominal contents down to the little bowl of your pelvic floor muscles. And then if you relax, it accepts the pressure and you can open that up and get that full length and full stretch on the pelvic floor, which you are in desperate need of if you're worried, fearful, and clenching all the time, every time you think that you're in a scenario that you really don't want to have a leak.

So it's so very important to not just practice your breathing and the elongation and relaxation of that pelvic floor once a day, or twice a day, but doing it in the morning, doing it in the car, sprinkled in throughout the day, because your pelvic floor muscles are just like muscles elsewhere in your body - they need new fresh patterns to embed that muscle memory into your brain. So just like when I tell people what their rehab exercises are in any other form, it is so much better to do a teeny tiny bit sprinkled throughout your day or daily to create a good muscle memory pattern rather than doing it once a week for two hours and thinking, “I get the same time all bundled up together this one day.” It is not the same because you need consistency and little reminders for your brain to create that new pattern and allow yourself to relax that area and let it elongate. Because you cannot have a full contraction of any muscle unless you get the whole life happening.I did a YouTube video a few weeks ago on a way to do hip thrusts where you get a nice elongation of your glute max, your butt muscle, we wanted to stretch it as far as we could to get that full nice engagement of the glutes. Same thing with your pelvic floor, you have to be able to lengthen it before you can have a nice good contraction.

A lot of people have a stressed environment and too much on their plate, too much screen time from their jobs, or hobbies, or being seated all the time, there are just so many reasons that we often tend to get this paradoxical breathing pattern. And the first line of defense is learning how to breathe in that 360-degree expansion of your ribcage again and bring that normalized pattern of breathing back to your body to help be able to even begin to lengthen your pelvic floor.

Proper breathing has other sorts of benefits. It helps with your stress too, because we learn to get that whole 360 expansion and it helps stimulate our vagus nerves. And then that helps with our stress level - a physiologic level that helps our stress level.

I am not anti-medicine or anything like that but I like to find as many alternatives as I can. I think that proper breathing is a great addition if you're struggling with anxiety, depression, or any of those things, even if you choose to go a medicated route, which is sometimes so very necessary. I think it's imperative that you add in these kinds of things as well, and those issues I often see hand-in-hand with pelvic floor issues because it can be a very isolating experience, a very stressful experience, and they often come in tandem, and if you don't address the whole picture, I feel like it's not going trying to resolve as quickly as it could.

The other thing with breath, with learning how to breathe well again, is learning how to not cinch all the pressure down towards your pelvic floor on the exhale. Think of knitting the abs and core musculature together up, like you're zipping a jacket up towards your throat, rather than sending the pressure down towards the pelvic floor. Because if you think about just how pressure works and where you want it to go, we want it to come away from the pelvic floor.

Conclusion

Those are my correlations – a little bit between the stress connection and the pelvic floor. I see it time and time again, it’s connected. I just had a brand new patient recently who reinforced it for me that they are often tied together and it can be decades and decades in the making. It doesn't even have to have anything to do with postpartum because it can happen without ever having a kid, and it is something that we need to really validate and treat and honor the fact that our bodies respond physically to our stressors and present in a very tangible, physical, real way.

So if you have any questions for me, let me know. And I know that for myself, I've really been trying to get back into Vedic meditation practice that my good friend Dr. Lisa introduced me to. I think it's beneficial for everybody and the more I work with people hands-on in my office, the more I realized the need that one of the biggest stumbling blocks not just with the pelvic floor, but with any physical issue, is that we have to get someone in the state, the non-stressed state, that they're able to heal themselves in the best way possible as they are so intimately tied together.

If you have any questions, you can drop it in the comment section or you can send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

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