The mental health of it all

Chicken, egg, or shredded chicken omelette?

Last week, I opened up a thread to my subscribers. It was an interview request for anyone willing to share their experiences at the interface of mental health and pelvic floor dysfunction.

When I [finally] got around to connecting with the folks who graciously volunteered, I wrote: I'm honestly not sure what direction this will take, other than the fact that I feel like it's a really important conversation to be having and I'm not seeing it elsewhere!

And this, friends, is my truth.

There is SO much to unpack here, so let’s get into it.

Here’s the tl;dr:

• Everyone’s story, body, and brain are different, so generalizations are totally useless in this arena.

• There can be a causal relationship between pelvic floor dysfunction leading to negative mental health outcomes, and vice versa. Often, it’s muddy and mixed — the shredded chicken omelette of it all.

• If you think there’s any possibility that mental health, mindset, limiting beliefs, or prolonged nervous system dysregulation are contributing to your pelvic floor symptoms, it’s worth considering support there, too.

  

  tasty!

Related reading:

• What the hell even IS the nervous system? A physiological primer on nervous system 101 and its relationship to pelvic health.

• Babe, I’ve gotta pee. The rundown on urge incontinence.

• What if the pain doesn’t quit? The intersection between chronic conditions that do cause tissue damage and nervous system dysregulation making pain even worse.

  

  Source: The Georgia O’Keefe Museum. Also, can we talk about this gorgeous, weird series she did of pelvic bones?

The deep dive:

Story time! The year is 2016. I’m an OT grad student who fought tooth and nail to get an observation rotation at an outpatient pelvic floor PT clinic. It’s an in-network clinic focusing on orthopedics — the kind with a big open gym and a lot ambient quad stretching.

My mentor had told me about this client who had persistent pelvic pain and vaginismus symptoms — and debilitating anxiety. She had been receiving manual therapy and was super compliant with her exercises for over a year, and nothing was shifting. My mentor was frustrated, and, in private before this person’s session, exclaimed, “I don’t treat anxiety! She’s not getting better!”

In an exacerbated and probably exhausted state, my mentor asked me to run the session while she caught up on notes in the background. Occupational therapists have a year of mental health training built into our curriculum, but I was still an absolute baby, not-even-graduated clinician. I didn’t know what the hell I was doing.

So, while stretching our inner thighs on a huge mat, I simply asked this client: “Hey, do you think the anxiety you’ve told me about might be contributing to your pelvic pain?”

“Of course. Absolutely. I’ve been anxious since I was a child, and I’m always tensing physically and I can’t seem to get it under control.”

I didn’t dig deeper — remember, she wasn’t actually my client, and at the time, I definitely did not have the skills and training to do so. (Nor do I think that a huge public gym is the place for the conversation at hand.)

And maybe it’s because I only saw her that one time, or because I was so young, but this person lives in my mind as the most clear-cut example of how mental health can affect pelvic floor function, and how many current treatment models fail to recognize or treat it.

It is usually much, much muddier.

But let’s look at some inverse situations first. There are a few examples that come to mind when I think about how pelvic floor dysfunction creates mental health distress.

Good old urinary incontinence has been shown to be an independent predictor of depression for postpartum people as well as men. One study showed that women with urge incontinence and/or mixed (urge + stress) incontinence have a higher rate of anxiety and depression than straight up stress incontinence (i.e. “I leak when I sneeze”).

This makes sense — it can feel stressful AF to feel like one’s body is out of control, particularly in such a vulnerable place, with potentially routine-changing implications (needing to wear pads, for example, or even going to pelvic floor therapy — probably wasn’t on your goals list).

The sensation of “What the ever-loving fuck is going on” can be compounded with a life shift, like having a kid or menopause. There are questions of bodily autonomy and betrayal here; of owning, using, and controlling one’s body as intended. Personally, I find that the folks who have the most difficult time with managing the identity fall-out of a pelvic floor gone awry are highly successful people, people who can solve anything if they just work hard enough, think hard enough. Until they couldn’t.

Who are we without control of our most private physical spaces?

For a moment, try to put yourself in a position of having a symptom you don’t currently have. Try on leaking urine, or leaking poop. Try on painful sex after an unexpected c-section. Try on never, ever being able to have sex because of pain since your teenage years.

You might be thinking, “No way, I’m fit/healthy/young/etc.” But I can assure you, this shit happens to everyone, and it can be so incredibly disorienting when it happens to you.

So much of what I do in this circumstance is to work with clients to recognize that their bodies, while fallible, are valuable and amazing. That a symptom is feedback, and we can use that feedback to give the body whatever it truly needs. And that while this is totally okay for this to suck, they’re still a whole human being.

So — yes — a pelvic floor condition can absolutely lead to mental health challenges. But what about when it’s more gray?

This is where nervous system dysregulation and mindset comes into play. The situation of pelvic floor dysfunction <> mental health challenges often arises when there are long term, chronic conditions at hand, frequently involving pain, but not always. Again — nothing is hard and fast here, and everyone is different.

What is important to acknowledge is that our bodies and brains do not exist in silos. They’re intertwined and weird and complicated, and they need to be treated as such.

Here’s the take-home:

If you’re struggling with how any pelvic floor dysfunction makes you feel about your body, please hear this loud and clear: You’re not alone. In fact, you’re in the company of many, many rad humans.

There are so many ways to approach the intersection of mental health and pelvic floor dysfunction, and in my opinion, there’s no correct way to do it. What’s important is that you address it in a way that meets you exactly where you are and feels safe. This could look like seeing a therapist who specializes in supporting people with chronic conditions, or simply ensuring that your pelvic floor therapist sees you as a whole person (not just a pelvis). It can also mean working with a coach, or a somatic practitioner, a yoga therapist — the list goes on. Do what works for you.

If you’d like a little slice of what I’m developing, you’re welcome to hang with me for group nervous system and nutrition coaching with my friend, Robin Randisi (a very rad functional nutritionist). There will also be some somatic movement led by me!

Current clients and paid subscribers come for free (respond to this email to request a code!) and if you’re struggling for funds, please reach out to me, too.

As always, I am rooting for you. I hope this helps you feel a tiny bit less alone out there.