Stress and Pelvic Floor Tension

Last Updated:

woman sitting cross legged on the floor with her eyes closed, one hand on belly, one hand on heart

Occasional stress is part of being human. These days, though, many people’s stress has escalated from once-in-a-while to chronic

You may be aware that chronic stress can wreak havoc on your cardiovascular health, digestive health, and mental health. There is also a connection between stress and pelvic floor tension. 

  • Problems peeing and pooping? Check.
  • Issues with sex and intimacy? Yep.
  • Pain down there? Uh-huh.

In short, physical and mental stress can cause our pelvic floor muscles to actively contract—the pelvic-stress reflex response—and that can lead to pelvic floor dysfunction and overactive pelvic floor muscles.

So, to take care of these uncomfortable issues, we need to address our stress.

Four Signs and Symptoms of Overactivity in the Pelvic Floor


An overactive, or hypertonic, pelvic floor happens when our pelvic floor muscles get too tense and are unable to relax fully. There are tons of reasons why this happens, including chronic stress!

Hypertonic pelvic floor symptoms include:

  • Painful sex
  • Painful sitting
  • Painful abdominal muscles
  • Problems pooping and peeing

Sign #1: Painful Sex

Painful sex is all too common—about one in five women report pain with intercourse. But sex isn’t supposed to hurt at all.

When pelvic floor muscles get too tense, they shorten and spasm. This causes vaginal penetration to be difficult—or even impossible. Pelvic floor tension can also cause:  

  • Pain with initial or deeper insertion
  • Pain during or after intercourse
  • Feeling tightness, tearing, burning, or rawness
  • Difficulty orgasming
  • Painful tampon insertion or pelvic examinations

Sign #2: Painful Sitting

The pelvic floor is connected to other muscles in the lower back, tailbone, and hips. When the pelvic floor is too tense, it affects all the muscles and nerves surrounding it.  

When nerves in the pelvic region are compressed by tense pelvic floor muscles, this can contribute to: 

  • Pain in the buttock that radiates down the back of the thigh
  • Sharp shooting pain into the anus or clitoris
  • Pain when wearing underwear
  • Pain in the vulvar region that’s relieved with standing or sitting on a toilet seat. 

Some conditions related to painful sitting are:

  • Coccyx or tailbone pain
  • Pudendal neuralgia
  • Sciatica
  • Vulvodynia  

Sign #3: Painful Ab Muscles

The pelvic floor muscles are closely connected with your organs, and conditions related to your pelvic organs can contribute to tension in your pelvic floor and abdominal wall. Even if you treat the organ condition, pain or tenderness in the abdominal wall can persist. 

Painful abdominal muscles can occur with:

  • Irritable Bowel Syndrome
  • Interstitial Cystitis or Painful Bladder Syndrome
  • Ovarian Cysts
  • Endometriosis

Sign #4: Problems Peeing and Pooping

Bathroom troubles? It could be your pelvic floor!

Pee-problems related to stress and pelvic floor tension include:

  • Straining to start your stream
  • Splayed or weakened stream
  • Burning with urination
  • Sensation of incomplete emptying
  • Constant urgency to pee
  • Urinary leakage
  • Bladder pain

And for those #2’s, common symptoms of pelvic floor tension are:

  • Chronic constipation
  • Straining during bowel movements
  • Sensations of incomplete emptying
  • Pencil thin or extra-hard poops
  • Sensation of incomplete emptying
  • Fissures
  • Hemorrhoids
  • Rectal pain 
  • Proctalgia Fugax

The Connection Between Stress and Pelvic Floor Tension. 

We often look for purely physical explanations for our pelvic floor challenges. But there’s also a mind-body relationship between stress and pain.

Depression, anxiety, and sleep disorders–all of which are worsened by stress and are stressors in and of themselves–are strongly associated with pelvic pain disorders in women.

Now, bear with me. We’re about to get science-y.

When stressed or anxious, the body responds via the hypothalamic-pituitary-adrenal (HPA) axis. This neurological feedback system is responsible for the release of important stress hormones–like epinephrine, norepinephrine, and cortisol.

Epinephrine and Norepinephrine

Epinephrine (adrenaline) and norepinephrine can contribute to pelvic pain. These stress hormones work together to increase blood flow in stressful situations and cause our muscles to go into fight-or-flight mode—which means they tense up. 

And when we’re constantly under pressure, our muscles are never able to fully relax.

Both epinephrine and norepinephrine tend to enter and leave our systems very quickly. However, when your stress or anxiety is a chronic concern, cortisol might be to blame for pelvic pain.


When we’re constantly stressed, cortisol is released into our systems over and over and over again. This stress hormone tends to stick around for hours after the stressor. Eventually, our bodies simply can’t make any more cortisol. This state of exhaustion creates more problems, like lower immune response, poor sleep, and pain. 

While the HPA axis is usually triggered in times of acute stress, if we’ve experienced chronic stress like trauma, abuse, sleep deprivation, hormonal fluctuations or even managing a chronic health condition, our HPA axis might be overactive. This means it could start responding to non-stressors as if they were stressors. And that creates a constant cortisol-producing-and-exhaustion cycle. 

This mind-body connection is often overlooked. So to truly treat pelvic floor tension and pain, we need to think more holistically.   

Easing Symptoms of Pelvic Floor Tension

#1 Address the stress.

Decreasing chronic stress can dramatically improve pelvic floor tension. The less stressed we feel, the more our muscles can relax! From practicing yoga to seeing a professional therapist, making small changes over time can help decrease toxic stress.

#2 Pause on Kegels.

Kegels and other tightening exercises can make matters worse. We need to use relaxation techniques before we can appropriately strengthen our pelvic floor muscles. So, stop the cookie-cutter Kegels to take the pressure off your pelvic floor.

#3 Practice diaphragmatic breathing.

Sometimes we just need to take a breath. Lie on your back with your knees bent. Put one hand on each side of your rib cage. Deeply inhale, inflating your ribcage, as if it’s opening up like an umbrella, then slowly exhale. Allow one breath to flow smoothly to the next and repeat for 10-20 breaths.

#4 Use lots of lube.

Not only does lube make things better in the bedroom, but it can also help decrease friction and sensitivity during sexual activity and decrease pain. Use a water-soluble lubricant or natural oil—like coconut oil—during intercourse and feel the difference. Or, try a CBD-based product. Your downstairs will thank you!

#6 Try vaginal dilators.

To start relaxing your pelvic floor, particularly before sex, tampon insertion, or a pelvic examination, try a little stretch. Vaginal dilators look like a set of tampons of increasingly larger diameter. Inserting these into the vagina can help desensitize your vaginal tissues, relax your muscles, and soften scar tissue at the vaginal opening.

#7 Perform pelvic floor massage.

A Therawand is a useful tool for relieving pelvic floor tension. It looks like a dilator with a curved tip at the end and can be used to apply pressure to tender, tense muscles to help them relax. This tool can be used in the deeper pelvic floor muscles or at the opening to soften pelvic floor muscles or any scar tissue. 

#8 Poop and pee the right way.

Did you even know there was a right way to go to the bathroom? To help you pee more effectively:

  • Sip water throughout the day to prevent concentrated urine from irritating your bladder.
  • Avoid drinking fluids two hours before bed to eliminate frequent nighttime wakeups.
  • Decrease your consumption of alcohol, coffee, carbonated drinks, and spicy or acidic foods to help urinary urgency.
  • Avoid hovering over the toilet, which clenches your pelvic muscles and prevents complete bladder emptying.
  • Skip those “just in case” pees. They can cause your bladder to shrink and increase urgency over time.
  • Avoid waiting too long to pee, which can overstretch your bladder.
  • Stop “power peeing,” as straining and pushing weakens your muscles.
  • Sit down, relax, and breathe when you pee!

And for pooping:

  • Avoid dairy and spicy and greasy foods, which make poop too soft.
  • Eat plenty of fruits and veggies for their fiber and magnesium.
  • Use a squatty potty or stool under your feet and lean forward to put your pelvic floor muscles in prime pooping position.
  • Hydrate, hydrate, hydrate to decrease constipation.
  • Exercise often to keep things moving.
  • Always poop when you have the urge to poop, as delaying leads to straining when you do decide to go. 

Stretches to Relax Pelvic Floor Tension

#1 Child’s Pose 

Kneel on the floor. Touch your big toes and spread your knees wider than your hips. Rock your hips backward onto your heels and stretch your arms forward. Exhale and move your torso closer to the ground. Hold the pose for 5-10 breaths.

woman demonstrating childs pose

#2 Cobra Pose 

Lie stomach-down on the floor. Place the palm of your hand on the floor next to your shoulder, and hug your elbows into your body. Press the tops of your feet, thighs, and pubic bone firmly into the floor as you inhale and straighten your arms, lifting your chest off the floor. Squeeze your shoulder blades together as you lift your chest up toward the sky. Hold the pose for 5-10 breaths. Breathe easy, exhaling as you release back to the floor.


#3 Happy Baby Pose

Lie on your back. Exhale and bring your knees to your belly. Inhale and grip the outside of your feet with your hands, opening your knees slightly wider than your torso. Bring your knees toward your armpits. To create resistance, push your feet up into your hands as you gently pull downward. Hold the pose for 5-10 breaths.

woman demonstrating happy baby pose


#4 Deep Squat Stretch 

Stand with your feet slightly wider than hip-distance with your toes pointed slightly outward. Slowly bend your knees and push your bottom back, as if you’re about to sit down. As you squat, put your elbows on the inside of your thighs, press your palms together, and imagine pulling your belly button toward your spine. Your heels can be lifted, or you can place a rolled towel or yoga mat under your heels for more support.  Hold the pose for five slow breaths and then slowly rise. If deep squats are new to you, try stacking a couple of yoga blocks on the floor to support your bottom during the squat. As you gain strength, you can remove one block and then both blocks.



The Relaxation Series is only available inside the V-Hive, an online membership platform with on-demand workouts to strengthen or relax your pelvic floor and core. You deserve to be free of chronic pelvic pain and tension. Join today!

Sources and Further Reading

Physiopedia. (n.d.). Impact of stress and cortisol levels on pelvic pain and pelvic stress reflex response. Physiopedia. Retrieved from 

Witzeman, K. (2021, August 25). The complex intersection of pelvic pain and mental health in women. Practical Pain Management. Retrieved from 

Join The V-Hive

Online pelvic floor fitness programs from a board-certified Women’s Health Physical Therapist. Your first week is free.

Free Pelvic Floor Guides

Download these free guides for some simple, do-able, totally-not-weird tips to take better care of your down there.

You might also like…

Caffeine and Pelvic Floor Dysfunction

Caffeine and Pelvic Floor Dysfunction

If you’re a coffee drinker, you may have a love-hate relationship with the stuff. On the one hand, it can offer a delicious, caffeine-induced productivity boost. On the other hand, it can cause frequent trips to the bathroom. Let's discuss how caffeine and pelvic...

read more
Pelvic Floor Exercises for Constipation

Pelvic Floor Exercises for Constipation

Constipation is a real pain in the...well…you know.  And while plenty of people assume that constipation is caused exclusively by food, there’s a lot more happening down there than you might expect. In fact, you can often blame the pelvic floor for all that struggling...

read more
Menopause and Painful Sex

Menopause and Painful Sex

Hot flashes. Sleep issues. Mood swings.  These are the three horsemen of the meno-pocalypse. And then there’s the fourth horseman—the menopause symptom no one talks much about, despite how common it is. Painful sex. Let’s talk about why you may have painful sex during...

read more

Join the V-Hive waitlist!

Enter your name and email below and you'll be the first to know when our new membership launches.

You have Successfully Subscribed!

How to Take Great Care of Your Pelvic Floor

6+ Simple Tips to Prevent or Overcome Pelvic Floor Problems

Pregnant? Postpartum? Struggling with peeing or pooping probs? Experiencing painful sex? Download this free guide for some simple, do-able, totally-not-weird tips to take better care of your down there.

Thank you! Check your inbox.

How to Take Great Care of Your Pelvic Floor

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

5 Myths We’ve Been Told About Pregnant Bodies

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

4 Signs of Pelvic Floor Muscle Tension

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

How to Prepare Your Pelvic Floor & Core for Childbirth

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

6 Exercises To Strengthen Your Pelvic Floor and Core

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

6 Exercises To Strengthen Your Pelvic Floor and Core

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

5 Pelvic Floor and Core Exercises for C-section Recovery

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!