Written by Maya Moody, PT, DPT
Reborn Pelvic Health and Wellness
When we think of the pelvic floor, we often just think about muscles living way down at the base of our hips. In reality, our pelvic floor is influenced by so many other structures, including our nervous system, and understanding that relationship can help explain why pelvic floor symptoms can sometimes feel complicated, persistent, or even surprising. The nervous system plays a role in how the pelvic floor moves, how it senses, how it responds to stress, and how it functions during everyday activities. Two important parts of this system are the voluntary nervous system and the autonomic nervous system.
The Pudendal Nerve: Sensation, Movement, and the Pelvic Floor
One of the most important nerves associated with the pelvic floor is the pudendal nerve. The pudendal nerve is formed from nerve roots originating from the sacral region of the spine. These nerve fibers travel through the pelvis and pelvic floor region, providing important motor and sensory information. The pudendal nerve is involved in sensation from the pelvic and genital region and plays an important role in bladder and bowel control, sexual function, and normal sensation throughout the pelvic region. This nerve is particularly interesting because of the pathway it takes through the pelvic floor. Like all nerves in the body, the pudendal nerve needs adequate movement, blood flow, and space to function well. When the surrounding muscles are excessively tight, overactive, or not moving well, the nerve may experience increased irritation or compression. The pudendal nerve can also be affected by things such as repetitive activity, prolonged compression, pelvic trauma, or childbirth. When the nerve is irritated, symptoms can include changes in sexual function or sensation, burning, itching, numbness, tingling, or discomfort in the genital or anterior pelvic region. This is one reason the health of the pelvic floor muscles matters so much. It is not simply about whether the muscles are strong. It is also about whether they have an appropriate length-tension relationship, can relax when needed, and can move effectively. In pelvic physical therapy, treatment may include manual mobilization, soft tissue techniques, movement retraining, breathing strategies, and exercises designed to improve pelvic floor coordination. The goal is to help the muscles move appropriately and create an environment where the nerves have the movement, blood flow, and space they need.
The Autonomic Nervous System and Pelvic Floor Tension
The autonomic nervous system is responsible for many of the things the body does automatically. It helps regulate heart rate, digestion, breathing patterns, sleep, and many other functions that occur without conscious thought. It is also closely connected to the body’s response to stress. This matters for the pelvic floor because the pelvic floor is part of a larger system of muscles, connective tissue, breathing mechanics, and internal organs. It is also closely connected with the diaphragm. When life becomes stressful, the body can respond by increasing muscle tension and changing breathing patterns. For some people, the pelvic floor becomes part of that response. This does not mean that pelvic floor symptoms are “all in the head.” The symptoms are real. Rather, it means that the nervous system and muscular system are constantly communicating with one another. A pelvic floor that is carrying significant tension may sometimes be influenced by the overall state of the nervous system. Breathing is one of the simplest ways to influence this system. A slow, comfortable, deep breath can help shift the body toward a more relaxed state. Because the diaphragm and pelvic floor work together as part of the body’s pressure system, changes in breathing can also influence pelvic floor movement and tension. Instead of thinking about breathing as simply getting air into the lungs, it can be helpful to think of each breath as movement throughout the trunk and pelvis. As the diaphragm moves during inhalation, the pelvic floor can respond with a corresponding lengthening and movement. During exhalation, the pelvic floor can gently recoil. This relationship is one reason breathing is frequently incorporated into pelvic physical therapy. Other strategies that help create a calmer environment for the nervous system can also be useful. Listening to calming music, spending time outside, using familiar scents, creating a peaceful environment, engaging in meaningful social connection, or simply taking time to rest can all be ways of helping the nervous system regulate. The goal is not to eliminate stress from life, that would be unrealistic. Instead, the goal is to develop strategies that help the body respond to stress and return to a more regulated state.
Why Does This Matter During Pelvic Floor Therapy?
Understanding the nervous system gives patients another piece of the puzzle. Pelvic floor symptoms can involve muscles, nerves, connective tissue, breathing mechanics, movement patterns, and the nervous system. These systems do not operate independently. They communicate with each other constantly. That is why pelvic physical therapy may involve more than strengthening exercises. Treatment may include manual therapy to improve tissue mobility, retraining the pelvic floor to relax and contract appropriately, breathing exercises, movement retraining, strengthening, education, and strategies for modifying activities that aggravate symptoms.
Understanding the relationship between the nervous system and pelvic floor can help make these symptoms less mysterious and provide more options for treatment.
If pelvic floor symptoms are interfering with daily life, exercise, sleep, bowel or bladder function, or sexual health, reach out to Reborn Pelvic Health and Wellness to schedule an evaluation with one of our wonderful providers. These concerns are common, and there are effective treatment options available.