The nervous system & pelvic floor dysfunction

If you have chronic conditions like IBS, vaginismus, or pelvic pain, you might have felt previously dismissed by practitioners insisting that it’s “just anxiety,” or that you just “need to relax more.” This may feel alienating and condescending, considering that most people would “just relax more” if they know how or could.

You may have a vague sense that stress impacts your health.

You may have a vague sense that stress impacts your health. Perhaps you’ve gotten diarrhea before an important presentation. Or maybe you threw out your back after the loss of a loved one. If you’re in tune with your body, maybe you have noticed the way your jaw clenches, chest tightens, and stomach turns when you’re upset, nervous, or restless. Why is this, and how is it connected to bowel and pelvic floor dysfunction?

First we have to understand the autonomic nervous system. The autonomic nervous system, or ANS, is broken up into two parts: the parasympathetic and sympathetic nervous system. The parasympathetic nervous system is responsible for your “rest and digest'' mode. With the help of the vagus nerve, it helps innerve aspects of heart rate, respiration, and digestion. The sympathetic nervous system is associated with “fight or flight.” The sympathetic nervous system helps conserve energy, increase heart rate, and get the body into preparation to respond to overall threat. Both parts of the nervous system act reflexively, and are based on evolutionarily biological needs of mammals to escape threat, connect with others, and find pleasure.

It’s been well documented that agitation to the nervous system can trigger diarrhea, constipation, and other IBS like symptoms.¹ Additionally, adverse childhood experiences are associated with IBS symptoms.² Research supports a correlation between sexual abuse and pelvic floor dysfunction³, and as well as trauma and pelvic floor overactivity⁴.

When we’re in states of acute or long term stress and trauma, this nervous system continues to send threat signals to the brain, leading to “fight or flight” activation, or “freeze/collapse” activation.

This "fight, flight, freeze" can show up in many different ways in our body. It might mean our body continues to conserve energy by slowing down digestion, or by sending out chemical and hormonal signals that disrupt the gut and lead to loose stool. This might look like the body “bracing for impact” by holding muscle tension, or a long-term dissociation from pain signals as a coping mechanism.

A treatment program for pelvic pain or GI dysfunction that doesn’t address the nervous system will most likely be incomplete. What can this look like?

We come into parasympathetic nervous system activation in a variety of ways. A major one is through social connection, which is why it’s so important to have an emotionally attuned therapist who makes you feel safe and at ease. We can use many other mind-body tools such as mindfulness training, breathwork, movement, orienting to your environment, and pleasant imagery to help create a sense of embodied safety.

Accessing feelings of safety, connection, and ease will continue to support your pelvic floor recovery and overall well being.

If you are looking for help with your pelvic floor dysfunction related to your nervous system, pelvic floor therapy can help you on your journey to re-regulate your nervous system and start healing.

This article was written by Mirah Sand OTR/L. They are a pelvic floor occupational therapist who is certified Pregnancy and Postpartum Corrective Exercise Specialist, and has received advanced pelvic health training through Herman and Wallace Pelvic Rehabilitation Institute.

Citations

1. Raskov H, Burcharth J, Pommergaard HC, Rosenberg J. Irritable bowel syndrome, the microbiota and the gut-brain axis. Gut Microbes. 2016;7(5):365-383. doi:10.1080/19490976.2016.1218585

2. Park SH, Videlock EJ, Shih W, Presson AP, Mayer EA, Chang L. Adverse childhood experiences are associated with irritable bowel syndrome and gastrointestinal symptom severity. Neurogastroenterol Motil. 2016;28(8):1252-1260. doi:10.1111/nmo.12826

3. Cichowski SB, Dunivan GC, Komesu YM, Rogers RG. Sexual abuse history and pelvic floor disorders in women. South Med J. 2013;106(12):675-678. doi:10.1097/SMJ.0000000000000029

4. Karsten MDA, Wekker V, Bakker A, et al. Sexual function and pelvic floor activity in women: the role of traumatic events and PTSD symptoms. Eur J Psychotraumatol. 2020;11(1):1764246. Published 2020 Jun 16. doi:10.1080/20008198.2020.1764246