The Pelvic Floor and Mental Health

We often talk about mental health in terms of mood, sleep, energy levels, and even digestion—but rarely do we consider its connection to the pelvic floor. Yet, growing research and clinical experience suggest that stress and emotional health play a crucial role in pelvic floor function, particularly when it comes to urinary symptoms. If you’ve ever noticed that your bladder feels “off” during stressful times—more urgency, more frequency, maybe even leaking—you’re not imagining things. Let’s unpack this powerful, often-overlooked mind-body link and how pelvic floor therapy and mental health are connected in daily life.

Understanding the Pelvic Floor

The pelvic floor is a group of muscles and connective tissues at the base of your pelvis that

support your bladder, bowel, and (in females) the uterus. These muscles assist with bladder and

bowel function, sexual function and internal pressure management. They naturally contract and

relax with your breath and movement, functioning best when they’re both strong and well-

coordinated.

The Role of the Nervous System

Here’s where mental health comes in. The pelvic floor is closely connected your autonomic

nervous system which is made up of the sympathetic (“fight or flight”) and parasympathetic

(“rest and digest”) branches. When we experience chronic stress, anxiety, or trauma, our nervous

system often leans heavily on the sympathetic side. This can create a constant state of internal

tension, including in the pelvic floor muscles.

Imagine clenching your jaw for hours every day without realizing it. Over time, your jaw would

become tight, painful, and dysfunctional. The same thing can happen in the pelvic floor. In times

of emotional stress, these muscles can become overactive or "guarded," leading to symptoms like urinary urgency (the need to go right now), frequency, or incontinence—even if you’re otherwise healthy.

Stress and Bladder Behavior

Bladder activity can be directly influenced by emotional states. People under stress often notice changes in their urinary habits—either urinating more frequently or, conversely, finding it difficult to fully empty the bladder. That’s because stress increases overall muscle tension, including in the pelvic floor. For some, this leads to urgency and frequent urination, even when the bladder isn’t full. For others, the added tension makes it harder to relax the pelvic floor enough to urinate, resulting in infrequent or incomplete voiding.

This isn’t just “in your head”—stress can create real, physical changes in muscle tone and coordination that disrupt normal bladder or bowels function. For those with existing pelvic floor dysfunctions, stress can make symptoms worse and create a cycle that diminishes pelvic health. Even primary care providers are increasingly recognizing the role of emotional well-being in treating pelvic floor disorders.

Addressing the Root Cause: A Mind-Body Approach

The good news is that breaking this cycle is possible. Addressing pelvic floor dysfunction in the context of mental health means treating the whole person—not just the muscles of the bladder. Some helpful strategies include:

• Pelvic Floor Physical Therapy: A trained physical therapist specializing in pelvic floor therapy can assess whether your muscles are overactive, underactive, or uncoordinated and help you regain control through breathing techniques, manual therapy, and specific pelvic floor exercises.

• Mindfulness and Breathwork: Deep breathing, meditation, and grounding practices activate the parasympathetic nervous system, helping calm both the mind and the pelvic floor. When combined with cognitive behavioral therapy, this mind-body approach can improve resilience and long-term outcomes.

• Lifestyle Adjustments: Practicing good sleep hygiene, eating a well-rounded diet, and engaging in regular exercise and strength training all support pelvic and mental health. A treatment approach that considers diet, stress management, and exercise can help address both pelvic organ prolapse and bladder control issues.

By integrating pelvic floor therapy and mental health strategies, patients can experience more effective outcomes and a wide range of improvements, including reduced urinary symptoms, better bowel movements, and enhanced quality of life.

Final Thoughts

Your body is not disconnected from your emotions. The pelvic floor is a dynamic, responsive part of your core that mirrors what’s happening in your nervous system. If you’re experiencing unexplained bladder symptoms—especially during times of stress—it might be time to look beyond just the physical and consider what your body might be telling you emotionally.

Taking care of your pelvic floor isn’t just about kegel exercises—it’s about caring for your mental well-being, too. Because when your mind is calm, your pelvic floor can be, too. If you’re struggling with chronic pelvic pain or other pelvic floor disorders, working with a physical therapist who understands both pelvic health and mental health can provide the best treatment approach.

Want to learn more or see if pelvic floor physical therapy is right for you? Book an appointment with us at The Health Lab—our pelvic floor specialist can help you address tension, improve bladder control, and restore healthy muscle coordination so you can feel more confident and in control.