By Lorraine Faehndrich
Persistent pelvic pain can, and often does, have an emotional component. The pelvis is a part of the body that for many reasons tends to hold emotion, and when that emotional component is addressed alongside the physical components of pelvic pain it can be an effective combination.
If you’re suffering with pelvic pain, or you work with patients who are, you are very likely already aware of the connection between mental and emotional stress and physical tension and pain. Most of us have experienced that connection in one way or another in our lives. Whether through an occasional tension headache or backache, or just increased tension in the places we tend to carry it (neck, shoulders, low back, etc).
When I say that pelvic pain can have an emotional component, I’m not referring to some abstract connection between the mind and the body, and I don’t mean that the pain isn’t real physical pain, or that pelvic pain sufferers are to blame for their pain. There is actually a very real physiological connection between emotional energy and the muscles, nerves and fascia in the body.
How Emotions Can Contribute to Chronic Pain
Emotions are energy that is meant to move through our body in response to events in our lives. In this way, they help us process, learn from, integrate, and let go of our experiences.
When emotions are flowing in this way, they not only help us move through stressful experiences more easily, they contribute to our health and wellbeing, and they don’t create physical tension or chronic pain.
Problems arise when our emotions are suppressed. This can happen when the brain learns (usually through negative or traumatic early experiences) that certain emotions are a threat to our wellbeing. When that happens, our brain and body will protect us from those emotions by unconsciously suppressing them, and they do that by stopping emotional flow.
There are two primary ways the body can stop the flow of emotional energy.
- Tensed and contracted muscles: Muscles can tense in response to certain emotions to stop their flow. In this way they protect us from feeling the emotions that our brain has learned are threatening to us in some way. For example, it’s common for men to learn that it’s inappropriate to cry, or women to learn that they shouldn’t express anger. Those emotions then get “buried” or suppressed in the body. Chronically contracted muscles can hold back that emotional energy, over time impacting circulation, nerves, fascia, and surrounding tissue. The neck, shoulders, jaw, back and pelvis are common places to hold emotion in the body, and the muscles there can be contracted for years before we end up with chronic pain. (Our bodies are actually pretty resilient that way.)
- Restricted breathing: Similar to contracted muscles, shallow breathing or holding the breath between the in-breath and out-breath, inhibits the flow of emotional energy. If you have a hard time taking a full deep breath, this can be why.
Both of these mechanisms are unconscious. We’re not aware of the emotions themselves, nor that we are suppressing them, until we bring our conscious attention to our body and begin to observe what’s going on.
To give you an idea of the impact that these patterns can have over time, you can do a little experiment. Contract your bicep – nothing too intense, just gently engage the muscle. Now imagine keeping it contracted like that for a full 24 hours. Now imagine multiplying that by weeks, months, or years. At some point, this is going to get uncomfortable, and eventually it will be painful. And the pain is not going to stop until you relax your muscle. Now, if you’re consciously engaging your muscle it’s not so hard to stop. Or if it’s engaged because of a physical issue, a physical therapist can help you retrain and relax your muscle.
But, if your bicep were contracted in order to hold back emotional energy that your brain is protecting you from feeling, the only way to permanently relax it would be to learn how to allow that emotional energy to flow. Otherwise, no matter what you do physically to relax and strengthen the muscle, that protective pattern is going to keep kicking in.
In other words, in order to relieve the pain, you need to re-learn how to be with your emotions – and more than that, how to show your brain that that is actually a safe thing to do.
Chronic tension in the pelvis can be part of a long-term habitual and unconscious pattern of blocking emotional flow in the body, and the first step of unraveling it is awareness.
How pelvic floor physical therapy and mind body healing can work together to relieve pelvic pain
As a mind body coach my goal is to help my clients become aware of their unconscious protective patterns (mental and physical), so they can learn how to consciously choose to feel their emotions and allow them to flow. When the brain no longer perceives emotions as a threat, because it has been retrained to recognize that they are actually safe to feel, the muscles can relax.
(Remember, flowing emotions don’t cause chronic pain, suppressed emotions do.)
Depending on the level of negative early experiences or trauma a person has been through this can take varying degrees of time and support. But it all begins with awareness, re-connecting to the body, and a willingness to be present with sensations – a little at a time, in a way that feels safe and supported.
And what I have seen is that physical therapy can help tremendously with this process! Especially if the physical therapist is aware of the potential emotional component of the physical pain, and actively creates an environment where it is safe to allow emotions.
Creating a Safe Space for Emotions
If emotions start to move, or release, as a result of physical therapy, it is a great opportunity to learn how to be present with the sensations of those emotions and process them in new and healthy ways.
When the patient and practitioner work together to create a safe environment, emotional energy can flow and contribute to the healing process. On the other hand if the environment feels unsafe, emotions can be suppressed and can hinder the healing process.
How to Allow Emotions to Flow
If you are already working with a pelvic floor physical therapist, and you suspect there may be a mind body component to your pain, here are some tips for working with that during your sessions and during any home practice that you’re doing – like stretching, using dilators, massage, etc.
- Intend: Set your intention to allow and be present with the sensations of your emotions in your body as they arise. Simply being aware that emotions may come up and at the same time willing to feel them is a huge step in the right direction. When you have that intention, you’ll naturally be more aware and welcoming of any emotional sensations that do arise.
- Breathe: During your sessions (and during any home practice) maintain a gentle continuous breath into your low belly. You don’t have to do this perfectly at all! The idea is to stay present in your body and allow any emotions that may come up to flow. If you notice you’re holding your breath or your breathing has gotten shallow again, simply bring your breath gently down into your low belly.
- Track Sensations: Keep your conscious attention on the sensations in your body paying particular attention to sensations that seem connected to emotions. If you notice any emotional sensations like heaviness, dense or sinking feelings, tightening in your chest or belly, tingling or swirling, hot or cold; or you feel tears or anger swelling up, be curious about the sensations, allow them, and keep breathing. You don’t need to understand why you’re having the emotions. For now, just being willing to be present with the sensations of them is more than enough.
- Maintain Good Communication: Don’t push through anything that feels uncomfortable. Stay in communication with your PT. If anything hurts, feels uncomfortable or overwhelming – physically or emotionally, let your therapist know. Learning how to honor your body and go at it’s pace can go a long way to creating the safety you need to be able to feel on an emotional level.
- Get Support: Consider getting support from a mind body coach or therapist who can teach you how to start feeling emotions in your body as they surface. A mind body practitioner can help you process emotions in new healthy ways that won’t contribute to physical tension and pain.
Because of the nature of pelvic floor physical therapy most therapists will already be creating a welcoming and safe environment for their clients. But if there’s anything else you need to support your staying present with the sensations in your body don’t hesitate to ask. Most of my clients find that their physical therapists are more than happy to support their mind body work when they do.
If you’re a physical therapist or other bodywork practitioner, simply being aware of and creating space for this mind-body-emotion connection, and the potential for emotions to surface can be a great benefit for your patients or clients that do have an emotional component to their pain.
It’s All Connected
We tend to think of the mind, body, and emotions as separate things, but they are not actually separate. They are all part of one being that is us. The mind, body, and emotions are inextricably linked, and supporting any one of them inevitably supports the others, creating the optimum conditions for healing and relief.
If you’d like to learn more about a mind body approach to relieving pelvic pain – sign up to receive a free Mind Body Alchemy Kit at www.radiantlifedesign.com or register for Lorraine’s upcoming free class, Say Goodbye to Pelvic Pain, accessible by phone or online from anywhere in the world.
Regards,
Lorraine Faehndrich
Lorraine Faehndrich is a Women’s Mind Body Mentor and Pelvic Pain Relief Coach specializing in the relief of female pelvic and sexual pain. Through her company Radiant Life Design, she empowers women with the skills and information they need to understand the connection between their mind and body, allow their emotions, access their inner wisdom, and go on to live radiantly healthy joy-filled lives!
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Thanks for providing such a thoughtful, clear, and positive explanation of the mind body spirit connection. As someone with endometriosis and IC, I have seen first hand how we have the ability to ease, manage, and heal our own physical bodies with a holistic approach.
You’re welcome Beth! I’m happy you’ve seen this connection first hand with your symptoms. Thanks for reading and commenting!
Thank you for this, I will pass this info on as I believe it will be helpful to so many people, men too!
Michelle, Lily Peace Massage & Spa
Thank you Michelle!
Warmly,
Lorraine
Love the article, well executed. Do you work with people long distance?
Hello,
Yes we do work with people long distance! We offer virtual telehealth sessions which can be booked through this link https://pelvicpainrehab.com/telehealth/
Hi. Yes, I do work with women long distance both one on one and in groups, on addressing the underlying mind body and emotional components of pelvic and sexual pain. There is lots more information on my website here: https://radiantlifedesign.com
Warmly,
Lorraine