If these last few years of the pandemic have shown us anything, it is that our society lived in constant stress. A stress that, when it stops being a punctual reaction and becomes a chronic situation, has multiple consequences. According to the American Psychological Association, chronic stress, if left untreated, can lead to anxiety, insomnia, muscle pain, and a weakened immune system. It can even contribute to the development of serious ailments such as heart disease, depression and obesity.” Although what many people are unaware of is that stress can even affect our pelvic floor. And it is that, according to various investigations, this is because the pelvic floor muscles actively contract in response to physical or mental stress.

Why emotional stress moves to the genital area

“It is common that when we feel tense or nervous we tend to tighten the gluteal muscles. Although it is a normal response, when it is caused by chronic stress, it can cause all kinds of pelvic floor disorders”, explains Rachel Gelman, physiotherapist specialized in pelvic floor and collaborator of INTIMINA. In this way, various consequences can appear that range “from pain during sexual intercourse, pelvic organ prolapse or low back pain to bladder dysfunction and constipation.” Something we might never have related.

Caroline Correia, director of Fisiofit Mujer, provides more information. “When we are stressed, we alter our postural and respiratory pattern, which leads to an alteration in the musculature of the diaphragm.” Specifically, this usually remains more tense, favoring the increase in intra-abdominal pressure and the downward thrust of the abdominal viscera. In this way, the pelvic floor muscles are forced to contract to counteract the increased pressure and ensure urinary continence. All this process of pelvic floor contraction over time will lead to the formation of trigger points, which are basically pain points. “Most of the time they are the cause of pain during sexual intercourse, back problems, pain that radiates to the leg or discomfort during the period. In addition to these problems, a constant contraction of the pelvic muscles can lead to muscle fatigue, favoring the appearance of the dreaded urinary incontinence”, explains the expert physiotherapist in pelvic floor.

In the case of pain during sexual intercourse, this can also become a vicious circle. According to a study by the University of Örebro (Sweden), only among women under 30 years of age, around 20% report recurrent sexual pain. This pain, in addition, causes fear of sexual relations and, therefore, the avoidance of them. In this way, according to this work, “women with pain reported higher levels of fear avoidance and pain catastrophizing, as well as depression and anxiety.” A situation that does nothing but maintain the stress and the underlying cause of the pain itself.

Identify the relationship between stress and pelvic floor

The first step is to identify that the symptoms may be due to a stressful situation and not to any other problem. Something that is not easy at first. The key is precisely to rule out other possible causes. As Correira exemplifies, “a very similar case is that of chronic constipation. There are many women who have a correct diet, adequate water intake and exercise regularly, but still suffer from constipation. The answer would be the level of stress.”

In the case of the pelvic floor, it would be necessary to rule out that the pain is due to a physical cause. For example, having gone through childbirth or having suffered some type of injury or infection in the area, as Gelman recalls. If we do not find another apparent cause and we know that we are going through a long stage of stress, perhaps we should first try to work on it. Obvious things like “going outdoors, doing gentle exercises like yoga and dancing, writing, spending time with friends, masturbating or of course going to therapy,” insists the physical therapist.

On the other hand, there are also specific exercises to relieve stress on a more physical level. Caroline Correia recommends breathing mindfully for at least a minute. “Something so simple helps stimulate the parasympathetic nervous system, which is responsible for lowering stress levels.” It should be remembered that there is a relationship between respiratory and postural function with the pelvic floor. According to some studies, functional improvements in breathing patterns and pelvic stability could indirectly affect the changes produced in the pelvic floor, even in the case of symptoms such as urinary incontinence. In addition, some stretching could also be useful to favor the relationship of the diaphragmatic muscles. “Such as stretching that favors hip opening, psoas stretching and quadratus lumborum”, Correira adds.

Pelvic floor exercises when stress overwhelms us

Although working on stress, which is the underlying cause, is key, if we already suffer from pain in the pelvic floor area, there are also certain exercises that can help relieve it.

In this regard, Rachel Gelman proposes these three ideas:

  • Happy baby: “Lie on your back and gently pull your knees up toward your chest, but keep them pointing out to the sides. Place your hands behind your thighs or knees. She holds on and breathes deeply for about thirty to sixty seconds. If this puts too much pressure on your knees or hips, you can prop your ankles and feet up on a chair and let your knees gently drop to the sides while lying on your back.”
  • Child’s Pose: “Start on all fours and slowly lower your hips over your feet. You can put a pillow or something similar between the heels and the pelvis. Afterward, he extends his arms or keep them folded under his head. Hold this pose for thirty to sixty seconds, and breathe gently.”
  • Supported deep squat: “Lean against a wall and slowly slide down into a squat position. The lower back should remain against the wall. If your hip or knee hurts or you have difficulty squatting, you can use a pillow or stool under your hips. Hold the squat for 30 to 60 seconds and take a deep breath.”

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