Tips for Managing the Stress of COVID-19 and Your Pelvic Floor

In Pelvic Floor Physical Therapy by pelv_admin2 Comments

By Morgan Conner, DPT, PHRC Los Gatos

A lot has changed in the past few weeks and days. Since, the WHO has declared a pandemic for the novel coronavirus (the virus itself is called “SARS-CoV-2” and what it causes is the “Covid-19” disease),1,2 many of us have probably seen our daily routines put in a blender or chucked out the window entirely. Even since I started writing this post on Sunday, I have updated it as my own situation has dramatically changed. I live in the San Francisco Bay Area and as you have probably heard, we are now under a “shelter in place” order. Here at PHRC we are following all government directives and therefore have closed in San Francisco, Walnut Creek, Berkeley, and Los Gatos. (Please note: we are still open in West LA, Los Angeles, Westlake Village, and Lexington, MA and Bedford, NH). So now, as I write this on Tuesday, I am at home in the Bay Area and social distancing. And if you are like me, this rapidly changing situation and the general uncertainty of the whole affair has left you feeling more stressed than usual. 

Maybe you are seeing that your stress level is higher or lower than those around you and it may be hard to reconcile their level with yours. If you are more stressed than those around you, that in turn may be increasing your stress. Or, if you are less stressed than others, maybe you feel frustrated because it seems everyone is freaking out and you don’t feel like that’s called for. It’s okay to be in either camp but remember that it’s important to take care of yourself right now.

Personally, I have been reading a lot about coronavirus and find myself trying to walk the fine line of balance between overreaction and underreaction. Generally, I have been trying to shift my focus from frustration with the uncertainty to trying to appreciate the magnitude of the situation and positive steps that people are taking to try to stop the spread. (Granted, I wrote that before the “shelter in place” order was put in place when there were still many companies not doing this, so like many other things that are rapidly changing, my own writing is already outdated at two days old!) I feel grateful for the efforts by so many people to both socially distance themselves and encourage others to do so to protect the most vulnerable among us.

Even with these focus shifts, I will admit that my stress level is still higher than normal. In the clinic last week, as I talked with patients, I noticed that many were also finding their stress levels elevated and their symptoms a little more flared than they were the week prior. This got me thinking about a few things: What exactly is stress? How does it affect the body and the pelvic floor? What are the effects of relieving or reducing it? And how can we do that? So, that’s what better to do than wrist a blog post about it! 

What is Stress and how does it affect the body?

According to the Cleveland Clinic3 “Stress is the body’s reaction to any change that requires an adjustment or response.” It could be in response to a good or happy change or to a negative change that can come from your environment, your body, or your thoughts. Your reaction to it could be physical, emotional, mental or a combination. Physiologically, the body has a system to react to stress and you’ve probably heard of it, the “fight or flight” response. This response is good if you are fighting off a lion or need to get out the door in the morning on time but can be problematic when it persists without relief. During a stress response the hypothalamus in the brain tells your adrenal glands to release a bunch of hormones including adrenaline and cortisol. Adrenaline gets your heart pumping and boosts your energy while cortisol releases glucose (sugar) into the bloodstream so that you can have better brain function and energy… off that tiger right!?! It also prepares the immediate immune response in the bloodstream in case of injury to prevent infection. However, cortisol also turns the volume down on other non-tiger-fighting functions like normal regulation of the other parts of your immune system, digesting your food, growing, or your reproductive system. All things that are essential for everyday function. And it also alters the part of your brain that regulates your mood and emotion. But, if all goes well, after the situation calms down, your body can then keep going about its usual business, you can go back to digesting that lunch and or getting a good night’s rest.

However, if the stress is prolonged, (say there’s a global pandemic and your typical daily routine is anything but and the situation seems to be changing on an almost hourly basis??) the body doesn’t have a chance to recover and return to those essential functions (rest, digestion, growing, normal immune function) and bad things can start happening. Although there might be a short term increase in immunity, chronic stress (whether for days or longer) can lead to decreased immunity. After that initial bump in immunity wears off, the cells responsible for fighting invaders decrease in number leaving you more susceptible to getting sick.4 For example, during my first semester of physical therapy school, I didn’t get sick. Even through a grueling and stressful set of exams! But over the semester break I went to Hawaii with my family and promptly got a nasty cold. When I came back for the spring semester, I found out that the same thing had happened to about half my class! Chronic stress can also lead to problems with digestion, sleep, anxiety, depression, headaches, heart problems and muscle pain.5 That last one is what I want to talk about next. 

Effect of Stress on Muscles (including the pelvic floor!):

Stress can make us tighten our muscles or as we PTs sometimes refer to it, “guarding.” You’ve probably noticed it before: you’ve made earrings out of your shoulders, turned your jaw into a vice grip, or turned your bottom into a solid rock. If this tightening and over activation of muscles persists you might start getting headaches, jaw pain, hip, or back pain. The pelvic floor is no exception. It is a muscle and if you are stressed you could be tightening it without even realizing it. Even if you have been working hard on relaxing and letting go of your pelvic floor with your PT for weeks or months, that tendency to guard and clench may be creeping back in. We know that a tight pelvic floor can contribute to pelvic floor dysfunction and even if your symptoms have been quiet for a while or have been slowly getting better, you might see a flare up right now. Remember, you are going to be okay. This will pass. For the time being you may have to ramp up your self-care activities and dig out that old home exercise program that your PT gave you way back when. Most of all, don’t panic and stress yourself out more!

What can you do to relieve your pelvic floor tension:

So what can you do to decrease your pelvic floor tension? Below are some of my favorite exercises for decreased pelvic floor muscle tension and guarding! They are in ascending order to intensity with the first being the most basic and the last being the most advanced.

Diaphragmatic breathing: 

  • Lie in a comfortable position (suggest pillow under the knees or feet on a low chair/sofa/table)
  • Inhale through the nose into the low belly
    • Helpful to put one hand on belly and think about sending air into hand
    • Keep chest and ribcage relaxed and “soft”
  • Exhale allow belly to fall back down 
    •  Exhale through mouth or nose whichever is more comfortable for you
    • Check out our YouTube Video here

Pelvic floor drops:

  •  Start in a comfortable position (suggest with feet up as this puts pelvic floor in a more lengthened position)
  • Inhale into low belly AND pelvic floor to lengthen and “drop” the pelvic floor down towards the feet
  • Visualizations:
    • Opening up or widening vagina or anus 
    • Filling a balloon in the lower trunk
    • “Blooming a flower” out of vagina or anus
  • Exhale and let everything go (you may feel the pelvic floor tighten again, that’s fine!)
    • Check out our YouTube Video here


  • Start in quadruped position (hands and knees) with hands under your shoulders and knees under your hips 
  • Slowly alternate between arching and curling the spine
  • Trying breathing in with arching and breathing out with curling and vice versa
    • Both are nice and you can feel different stretches with each
    • I usually do about 5 of each. 
    • Check out our YouTube video here

Deep squat with pelvic floor drops:

  • If your body is able (don’t hurt your knees, hips or back doing this!) start with the feet apart in a stance that is slightly wider that your hips with your feet turned out comfortably
  • Squat down into a deep but comfortable squat.
  • Do your pelvic floor drops (see above) with your inhale
    • Check out our YouTube Video here

Ideas to decrease general stress:

I have been polling my co-workers here at PHRC, my family, and the people of Instagram for ideas on what they are doing to decrease their stress levels. Below you can find a list of some of the ideas that I’ve been hearing and loving. 

I have been polling my co-workers here at PHRC, my family, and the people of Instagram for ideas on what they are doing to decrease their stress levels. Below you can find a list of some of the ideas that I’ve been hearing and loving. 

  • Go for a walk outside (just remember to maintain social distancing).
    • One of our PTs has been trying to wake up every morning to watch the sunrise: 

Photo Credit to Courtney Edgecomb
  • Download and sign up for the Headspace app. They are offering free access to a collection they are calling “Weathering the Storm.” You can find information on it here. Shannon Pacella of PHRC Lexington told us that the meditation app Ten Percent is giving healthcare providers a 6 month subscription for free. Use the code HEALTHCARE on
  • Watch Youtube or Tiktok videos that make you happy! Examples include
    • Baby animals doing cute things. Personally I am a sucker for munchkin kittens!
    • ASMR videos: Apparently, because the internet can always deliver, there are already ASMR Coronavirus videos out there!
    • TED Talks: learn something new while you are at home! I love Roman Mars and have been listening to his podcasts for years and I loved his TEDTalk on flags
  • Try to keep doing some part of your normal daily routine: for example I always listen to the same daily podcast in the morning, when I get ready for work. I’m still doing that even though I’m not going to work.
  • Exercise: run, walk, do yoga, do home strength or HIIT workouts. I would not advise going to classes or gyms right now though!
  • Keep a Coronavirus Quarantine Diary. I try not to take myself too seriously (and apparently can’t spell) so here’s the first page of mine:


  • Look for good books to read or catch up on your reading list.
  • Take a bubble bath, epsom salt bath (a great choice for relieving muscle tension), candlelit bath or some other decadent fancy-pants bath.
  • Buy a gift certificate to a local or small business restaurant or store that you love so you can stop worrying about whether they will be able to survive this situation.
  • Cuddle with your pets. (Dogs seem to be at low risk of infection) Here is a compilation of #PHRCpets for you:


  • Go to bed early and try to get enough sleep. Sleep and stress both affect each other. The American Institute of Stress has an article here on how stress can affect your sleep. 
  • And finally BREATHE.

I hope somewhere in this blog there was something that spoke to you and will help you get through this. If you feel so inspired, please comment on what you are doing to help relieve your stress during this time or other times. 



Did you know….

PHRC is offering telehealth options? Check out our homepage for more info!



  1. So glad to read this article today! While I’m “cured” thanks to Morgan, I’ve definitely noticed some increased tension in the last week! I hope all of our wonderful PTs at PHRC are taking good care of themselves during this time too.

    The Calm app is also offering many free meditations at this time ☺️

  2. I got the CALM app. They have a daily calm, that I am doing, and have several things targeting anxiety, which have helped me. I got a walk in today and that helped a lot too and seeing and talking to some neighbors (while social distancing) was good for me.

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