On Dealing with Bladder Pain, Pelvic Floor Dysfunction, and Health Anxiety

This post is in honor of National Women’s Health Month, a time to focus on and prioritize women’s health in the US, Women’s Health Week in Canada, happening May 5-11, 2024, and International Day of Action for Women’s Health on May 28th.

Women’s pelvic health issues affect the well-being of millions of women throughout the world. In the United States, up to about 8 million American women suffer from bladder pain syndrome, and roughly one-quarter suffer from pelvic floor disorders. 

The impact on women’s mental health due to pelvic dysfunction is something to take seriously. Suicidal thinking is “alarmingly more common” for women who face chronic pelvic pain. Symptoms can sometimes be debilitating and keep them from working and enjoying their lives. Women may suffer from health anxiety, depression and hopelessness. It can truly be hard to enjoy life when you almost constantly feel you have to pee, suffer from incontinence, or deal with pain and urinary trouble day and night.

Many women have had negative experiences when seeking medical help. They might not receive adequate or appropriate treatments, referrals, mental health support, or the information they need. This is all the more a concern under the current federal administration in the US.

My ongoing journey healing from pelvic floor dysfunction and bladder pain started about six years ago. My symptoms have impacted my spiritual and emotional life and been an immense challenge at times. I have dealt with some common problems, including hypertonic pelvic floor, bladder pain syndrome, overactive bladder, and vulvodynia (vulvar pain and inflammation). I’ve found a lot of relief from pelvic pain, including bladder pain, even though at first it wasn’t clear this would be possible. My family doctor had told me my chronic pain didn’t have an effective path for treatment and he ignored its negative impact on my mental health. Later it became clear that he hoped without telling me it would clear up on his own, which it didn’t. I’m glad I sought out help from specialists who could do more to educate and help me (my gynecologist and pelvic floor therapist were the most helpful).

While I’m not an expert and I can’t speak to all the pelvic disorders that women face, I’d like to share some of what I’ve learned about pelvic floor rehabilitation and ways to deal with health anxiety about chronic pain.

For excellent information about the full range of pelvic floor health needs for both men and women, I highly recommend the Pelvic Health and Rehabilitation Center’s Blog, which often posts about helpful new insights and research findings, where you can easily browse articles about whatever pelvic health topics you want to learn about.

Bladder pain is often caused by tightness, weakness and dysfunction happening in the muscles around it

Bladder pain, difficulty peeing, urinary urgency and leaks are often caused by a pelvic floor that is weak, stiff and/or tight such that it is not relaxing or functioning optimally. The pelvic floor can become “hypertonic,” or chronically tense over time. We might clench the pelvic floor muscles like a fist as a natural stress response, as well as a reflex to help prevent loss of bladder control when we’re in fight or flight mode. We might hold these muscles tight because they and surrounding muscles are weak and we’re trying not to have urine leaks. Or we might overuse them during a urinary tract infection or due to dealing with overactive bladder. Also, the compression, stretching, and tearing that the pelvic floor undergoes during pregnancy can play a big role in women developing pelvic muscle weakness, dysfunction, and pain.

Pelvic floor tension creates pressure where the bladder sits, which can cause bladder irritation, pain, and overactivity. Pelvic clenching also makes it hard for the pelvic floor muscles to release and lengthen as we breathe, something that is meant to benefit and make space for our internal organs, including the bladder.

Your frequent bladder pain is probably not caused by UTIs

When I first had bladder pain, I was scared that I seemed to be having recurrent UTIs. Before my chronic pain started, I’d had a UTI that I didn’t manage to treat immediately due to my insurance situation. The infection had resolved, but UTI-like pain resurfaced. My doctor told me there was no infection, and a urologist told me my bladder looked perfectly normal inside. A pelvic floor physical therapist showed me that the root cause of my bladder pain and urgency was hypertonicity in my pelvic floor muscles. When she put pressure on muscles around the bladder, this replicated the unpleasant sensations I had been feeling that felt just like a UTI. She also explained that hip tightness and pain was connected to the tension and pain in my pelvic floor.

Pelvic floor dysfunction is the more common and significant culprit of bladder pain than the bladder itself. It’s true that the lining of the bladder can sometimes be sensitive, like the intestines can be. Spicy foods, highly concentrated urine or acidic drinks might irritate it or contribute to symptoms. If the lining of the bladder is sensitive, some women take an aloe vera supplement for the bladder throughout the day and report that this relieve symptoms. (I tried this and it made no difference for me). But unless you get a cystoscopy (camera bladder imaging by a urologist) that shows an issue with your bladder, or you have recurrent UTIs validated through urine tests, bladder pain and having too much urgency is most likely caused by what is going on with the muscles and tissues around your bladder.

Becoming confident my bladder pain and urgency were not due to infections helped me catastrophize less when I had symptoms and get in a calmer headspace. I also learned that vulvar irritation and inflammation that accompanied these symptoms for me was not caused by infections, but vulvodynia (chronic pain in the vulva) and was also caused by pelvic floor tightness and compression in the area. As I stopped worrying about what had seemed like chronic vaginal infections, many of the vulvodynia symptoms started fading and didn’t bother me much even when they flared up.

Below are some resources and practices for rehabilitating and finding relief from bladder pain:

Get help from a pelvic floor physical therapist and create a routine of rehabilitative exercise

A pelvic floor physical therapist can let you know what is going on in your pelvic floor and the connected muscles groups that affect it. This is a really valuable and important resource to tap into because it can be easy to misinterpret what is going on with your pelvic floor and what it needs and choose the wrong rehabilitative exercises if you’re just trying to figure things out on your own at home. A physiotherapist can provide and help carry out an expert plan on how to go about meeting your needs and treating your symptoms with rehabilitative treatments and exercises.

Recognize the whole body is connected to the pelvic floor

Doing internal massage with my first pelvic floor therapist to release the pelvic floor muscles directly didn’t really help relieve my pain much–everything still felt sensitive and would just tighten up again. A second therapist taught me that many other muscle groups are connected to and influence the function of my pelvic floor. Working on these muscles is helping me find pain relief a lot more than internal massage. Stretches I currently do everyday to prevent bladder pain include lying butterfly stretch, thoracic rotation, passive ROM extension, diaphragmatic (belly) breathing, happy baby, yogic squat, wide-legged forward bend, sideways child’s pose, and child’s pose to cobra.

Your physical therapist may give you exercises for your hips, glutes, core and back, even your feet, to counteract the dysfunction and pain. Yoga is also a good idea. Online pelvic health physical therapist Melissa Oleson offers workshops and classes that address pelvic floor pain and dysfunction that strengthen all these related muscle groups, including a free class on her you tube channel. The idea is that when you back, core, glutes, hips, etc. become stronger and better conditioned, they will better support your pelvic floor even in resting position, and will help promote better breathing that optimizes the pressure inside the abdomen.

If your pelvic floor is hypertonic and/or tends to tighten up, release and relax it daily

There are lots of helpful videos on you tube for this. Here is the one I personally found the most effective for helping me release my pelvic floor when it was really hypertonic: 4 Techniques To Relax A Hypertonic Pelvic Floor. Using belly breathing with the relaxation is really good for the pelvic floor. Even if things are really tight and discouraging at first, don’t give up. Daily efforts will make a difference. I also recommend this playlist of pelvic floor relaxation videos from The Flower Empowered. To know what kinds of stretches will help you most, its best to advise a pelvic floor therapist. 

Treat any constipation and minimize any pushing when you use the toilet

Pushing hard when you go to the bathroom is hard on your pelvic floor and can contribute to pain. If you’re struggling with constipation, treating this through a healthy diet with enough fiber, drinking plenty of water, and having a stable routine with you diet can help relieve patterns of pain. Miralax can help take the edge off of constipation and make things gentler on the pelvic floor. Also, avoid pushing when you pee, it is better to adjust your hips to help speed things along if peeing is slow. According to my therapist, you should also be in a normal seated position when urinating instead of squatting. (although using a “squatty potty” stool is great for constipation!)

Bladder training is helpful

When we have a lot of bladder discomfort and urgency, we pee frequently, and the bladder gradually reduces its capacity–that is, it will send signals for you to pee when there isn’t much in it. An adult normally shouldn’t start getting any messages that it’s time to start planning a trip to the toilet until there is about one cup of urine in the bladder. And ideally (though there is of course some variation with this) we should pee about 7 times in a 24 hour period. If you are peeing small amounts many times a day to find pain relief and you don’t have a UTI, bladder training can help address this.

Your pelvic floor therapist (or a physician) can help support you through this and give personalized instructions. You track how frequently you are peeing, and sometimes how much. You can buy toilet inserts that measure how much you are emptying if needed. To stretch your capacity, you gradually challenge yourself to wait a little longer than you’d normally empty (even just 5 minutes) so that you don’t gratify the bladder until it fills more. It takes patience and practice, but over a few months, your bladder’s capacity and your pelvic floor strength will improve, and urgency messages will decrease. 

Be in it for the long game

Physical therapy for pelvic floor dysfunction is usually not a quick healing process you finish and are done with, but a process of creating a life-long prevention and maintenance plan of stretches and practices to care for your body. The dysfunction can take a long time to change and improve, but change is possible and real. I’ve accepted I’ll be doing exercises to help my pelvic floor for the rest of my life, and this actually makes me happy because it gives me purpose and hope. Improvement is often slow, but what matters to me is that relief and improvement are possible.

Use Belly Breathing and Optimize your Posture to Promote Pelvic Floor Health and Decrease Bladder Pain

Improving your posture and breathing habits can go a long way in improving pelvic floor health. When we walk and sit, it benefits the pelvic floor to use a posture in which the rib cage is stacked above the pelvis like a lampshade that is sitting directly on top of a bowl (instead of tucking the pelvis forward), and to take full breaths (through the nose) that expand all four sides of the rib cage and that reach all the way to your sit bones and pelvic floor.

When you inhale deeply with this posture, the diaphragm descends, and the pelvic floor relaxes, lengthens and descends. When you exhale, the diaphragm ascends, and the pelvic floor contracts and ascends. It’s a constant flux and wave that supports the pelvic floor’s flexibility, strength, and function. Good breathing and posture also regulates abdominal pressure which is good for the bladder. If you can’t feel this happening in your pelvic floor, it’s probably because it is too tight. It’s easier to feel this happening while lying down on your back. Time, practice, and rehabilitative exercise can help restore this constant flow of the pelvic floor.

Avoid pelvic clenching during exercise, times when you are stressed, etc. The muscles should be used, then relaxed. Kegels at 100% contraction of the pelvic floor can actually be counterproductive for individuals struggling with pelvic pain, advise your pelvic floor therapist about what Kegels, if any, are right for you. I do Kegels at no more than 50%.

In a “Boss Bladder” workshop I attended, pelvic health specialist Melissa Oleson suggested leaning ever so slightly forward (4 degrees) while walking and hiking in order to optimize breathing and abdominal pressure, and better activate the glutes (which better help support a healthy pelvic floor when strengthened).

On Vulvar Pain and Garments 

If your pelvic troubles include vulvar irritation, redness, itchiness, and or swelling, here is some advice from the Mayo clinic: “Tight clothing limits airflow to your vulva, which can be irritating to the area. Wear 100% cotton underwear instead of nylon underwear. Try sleeping without underwear at night. Also make sure to wear loose pants and skirts. Choose thigh-high or knee-high hose instead of pantyhose.”

As others have discussed before on the blog, vulvar health is one reason the Church mandating women to wear garments 24/7 is a huge problem and really isn’t acceptable in light of women’s actual medical needs. Garment shorts are unsuitable for the vulva, which needs airflow. When I look back at all the time I was struggling with bad vulvodynia and sleeping in garment shorts, sometimes even with panties and pads underneath, I’m confident it made my symptoms worse. Give yourself a medical permission slip to do what you need to to treat your symptoms. 

I was personally inspired by this Exponent II post in which Shahnana shares candid, useful advice given to her by her gynecologist when she was struggling with recurrent vaginal infections: “my Mormon underwear wasn’t really made for a woman’s body which needed a little more room to breathe. [My doctor] suggested that I change into something that would allow my lady parts to air out at night while I was sleeping. I could wear them during the day all day but I just needed to allow for a little more circulation.”

Treat any health anxiety that may be exacerbating your pelvic and/or bladder pain

It is normal to develop health anxiety and patterns of panic and catastrophizing about chronic pain. When you’re caught up in the middle of this, it can feel like you’re the only person to have this kind of scary and overwhelming anxiety, but of course that’s not true. Your health anxiety follows the same old patterns as millions of other people– such as worrying it will never improve or go away, that it’s going to prevent you from doing certain things, etc. The problem is this anxiety can keep your mind in a fear state in which you don’t feel safe, which only makes it harder to release tension. 

Educational clips and meditations for health anxiety on Curable, an app dedicated to offering info. and exercises for treating health anxiety and chronic pain, helped me recognize that the crippling fear I was experiencing about the chronic pain was something millions of other people understood very well, and that it was only making my patterns of pelvic tension worse. Once I understood how health anxiety typically works, it’s like I saw through a broken framework that couldn’t have the same pull on me anymore. In addition to the Curable app, I recommend Barry McDonagh’s approaches to health anxiety and dealing with difficult sensations found in his book Dare: The New Way to End Anxiety and Stop Panic Attacks.

Cultivate a safer and more reassuring state of mind

One of the most powerful things you can learn to do with chronic pain is to learn to respond differently to pain flares, with kindness, mindfulness it will pass, and resilience instead of despair or panic. When symptoms flare up, the thing that helps most to change patterns is to send yourself messages of comfort, compassion, and safety rather than messages of danger and threat. This takes practice, but can be helpful. I’ve used meditations from Curable to help me reassure myself when I was in pain. One exercise has you say affirmations while placing your hand on your heart to invoke the comfort of a hug. The mantras include: “these sensations are safe,”  “this is just temporary,” “we’re in this together,” “this is not forever,” I’m gonna be okay,” and “we’re gonna get past this.” Another exercise I like helps you set a daily intention to create new and healthier thought patterns that help me feel safe.

The body and nervous system can adapt and change more readily when the mind is open to change and feels safe. While there is certainly a physical element to my pain, there is also a considerable mental and emotional one I’ve needed to address and learn to understand, and addressing this has helped me rehabilitate.

Open your mind to hope, and the reality of constant change

This is a key principle for finding relief from chronic pain. One thing that helps me be open to hope and healing is remembering that I’ve already had over forms of pain change immensely in my life. I had IBS from childhood through to my mid-thirties. It became debilitating around age 28–I lost forty pounds I didn’t have to lose, had trouble eating in general, and worried I’d never have a proper appetite again or improve. After a few years of medical support and experimentation with treatments in my early 30s, IBS is no longer a problem that looms over me or fills me with dread, just something that flares up pretty briefly every once in a while.

We and the things around us are always in flux and always changing, and even pain that is long lasting and forceful can change and fade. Even women in their 80s can improve their pelvic floor function through rehabilitative exercise. There is always more to learn and new approaches to try as we take care of ourselves. Pelvic muscle tone and function can change and evolve over months and years of tending to these things.

Let go of any narratives that God (or the universe) sent you pelvic or bladder pain or that you did something to deserve it

The hips and pelvis are a place many of us tend to store and tap into a lot of emotions, trauma, and feelings, so having chronic pain here can be extra emotional and confusing just because of this. I don’t care what mistakes or omissions you’ve made in taking care or your body, what lustful feelings you might have had, what’s going on in your relationships, or whatever flaws you might have. You haven’t done anything to deserve this pain, and God didn’t send it to you. As Adam Miller discusses in Original Grace, God doesn’t do evil or harm to humans. How could we love a God that hurts us, that treats us as not good enough or unworthy just for being born in and having learning experiences in this world? God extends grace and support and doesn’t want you to suffer. 

Be self-compassionate and don’t stop doing things you enjoy

Sit on the couch at the end of the day in whatever position relieves some of the pressure and pelvic and/or bladder pain– maybe with your legs up on the couch in a relaxed yogic squat, or with both knees to one side and then the other, or in a butterfly. Turn on a comedy. Schitt’s Creek, the 1996 version of Pride and Prejudice, whatever suits your fancy! In short, do what it takes to feel like yourself and to have something relaxing to look forward to. Take whatever breaks you can from pain. Plan and execute things you enjoy whether or not you’re in pain, don’t let it rule your life. 

You might also like to do loving-kindness meditations directed toward yourself should you have any self-loathing thoughts or a loud voice in your head that is really mad at you about the pain. It is possible to change our mental attitudes toward ourselves and our pain. 

Last Thoughts

I’m not fully rehabilitated from pelvic and bladder pain, and I have flare ups sometimes. I’m also in middle age now facing mid-life stress and responsibility, and pelvic issues can get more difficult in perimenopause and menopause due to hormonal changes and aging. But my life is livable and I have gathered resources and tools I didn’t have in the past. I’m living pain-free and health anxiety free the majority of my time and the issues don’t bother my mental health very much anymore. I’m currently going to physical therapy and I continue to learn about how I can counteract tendencies for pelvic trouble through stretching and rehabilitative exercise. I hope this post will help others with their pelvic floor issues and can help bring both emotional and physical relief. If I can improve and find relief and hope, I believe all other pelvic patients can too!

Images were downloaded from unsplash.com.

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