Have you ever struggled to hold your pee? Or have you ever ― out of nowhere ― really, really had to pee?
While this issue can be blamed on drinking too much water before a long car ride or chugging an iced coffee before a presentation, there could also be another reason for urinary issues: a pelvic floor that’s either too tight or too loose.
Multiple factors can cause a loose or tight pelvic floor, which can eventually lead to the urgent need to pee. And shockingly, your mental health is one of them.
First, what the heck is your pelvic floor?
“The pelvic floor, in the most basic sense, is really just what our pelvic organs sit on,” said Dr. Ariana L. Smith, the director of pelvic medicine and reconstructive surgery at Penn Medicine in Pennsylvania.
All humans have a pelvic floor, regardless of their gender. “And that floor is made up of muscles and fascia and connective tissues that support those organs and provide the environment with which they can optimally function,” Smith added.
When talking about the pelvic floor, experts are most commonly talking about the levator muscles, Smith noted. “These levator muscles make up a cradle around our bladder and rectum and uterus, but that cradle that’s sitting there, it can be too tight, it can be too loose, and this is where pelvic floor physical therapy comes into play.”
While lots of people are aware that they ‘hold’ their anxiety in their neck or upper back, they aren’t aware that they can hold that same anxiety in their pelvic region.
“Pelvic floor dysfunction, it basically means the muscles of the pelvic floor are dysfunctional, typically too tight, and when they are too tight, they create a variety of symptoms, which we think are mediated via inflammation,” said Dr. Maggie Mueller, the chief of gynecology quality at the University of Chicago Medicine. These urinary symptoms include urgency, frequency, feeling like you need to pee all the time, urinating often and feeling like you can’t fully empty your bladder.
Many things can cause pelvic floor dysfunction, including endometriosis, pregnancy, childbirth, irritable bowel syndrome and consistent straining when using the bathroom.
Some people are also more prone to pelvic floor dysfunction than others, Mueller said. “Certainly, we know that it’s associated with injuries in the lower extremities, so we see this oftentimes in women that have a knee replacement or hip replacement, they start walking funny because they’re recovering and the pelvic floor muscles basically get a little destabilized,” Muller noted.
What does your anxiety have to do with it?
Beyond the causes mentioned above, your mental health also plays a role in your pelvic floor health.
“Certainly anxiety impacts it,” Mueller said. Anxiety is not the sole cause of pelvic floor dysfunction, but could make it worse, Mueller noted. This is because pelvic floor issues are affected by the inflammation in our bodies, which increases when we experience stress.
“Anxiety is a huge contributor to having too tight of a pelvic floor,” Smith added.
While lots of people are aware that they “hold” their anxiety in their neck or upper back (evidenced by back pain or knots in their neck during a massage), they aren’t aware that they can hold that same anxiety in their pelvic region, Smith said.
“The tension in the pelvic floor area is not one that people really understand or attribute to their anxiety,” Smith said. When someone has anxiety, it can manifest as muscle and bodily tension in different parts of the body, she added, which can spiral into urinary problems.
“There’s this hyper-vigilance that people then develop because of all of that tension, and this can have an impact on the bladder,” Smith noted.
“The neurotransmitters that are involved as a result of having anxiety are also very similar to the pathways involved for things like urinary incontinence, bladder symptoms,” she added. “It’s not clean and neat in the sense that we know anxiety can lead to urinary incontinence and bladder symptoms, but we also know that bladder symptoms can lead to anxiety.”
Think about it: You’re about to start a work presentation when you suddenly have to pee, and not being able to run to the bathroom can create anxiety in itself.
Pelvic floor dysfunction can show up as urinary or rectal issues, pain during sex and more — in both women and men.
Pelvic floor dysfunction can happen in both men and women, but is more common in women, said Mueller.
In addition to urinary issues, pelvic floor problems can also cause symptoms in the vagina and rectum, according to Mueller, such as pain during sex, constipation, pain during bowel movements and more.
Someone with a tight pelvic floor may notice any of these urinary, vaginal or rectal symptoms, along with issues like shallow breathing, tension throughout the body and a general sense of feeling clenched in the abdomen or pelvic region, Smith said.
Pelvic floor experts can conduct a physical exam to determine if your muscles are clenched and tight, Smith noted. “Often what [patients will] say to us when we’re examining those muscles is … ‘Oh, wow, that’s really tender,’” Smith said.
If you do have a tight pelvic floor and some of the bothersome symptoms associated with it, there are treatments available.
“We do have really effective treatment ― pelvic floor physical therapy. I oftentimes tell [patients] that if their symptoms are spiking during times of stress, they’re going to need to work with someone, a mental health provider, to help dial down that stress and work on techniques like cognitive behavioral therapy to help with that,” Mueller said.
Treatment often takes a multipronged approach. “We just sort of adapt in our day-to-day life, and if you’re busy and you’re anxious, you’re not always attending to your bladder,” Smith said.
Pelvic floor therapy “helps patients attend to their bladder, to really give it the time that it needs,” Smith said. “When patients start to attend to their bladder and listen to their bladder, I think they do better, and they start to be able to integrate all of the things that they’re learning.”
If you think you have a tight or loose pelvic floor, it’s important to see a pelvic floor expert.
Pelvic floor therapy is a buzzy topic on social media, but instead of taking advice from a wellness influencer or buying some “quick fix,” seek advice from a professional.
“I think the important thing is be evaluated by someone, by a pelvic floor specialist, prior to engaging in many of these things that are marketed direct to consumer that have absolutely no scientific backing to support them,” Mueller said.
In rare cases, some of the symptoms associated with a tight pelvic floor can be signs of larger health problems, Mueller noted, which makes it even more important to talk to a doctor instead of assuming you know what’s going on.
While many of the causes of a tight pelvic floor are out of your control, Smith said researchers have looked at the kinds of things that can benefit bladder health.
“Healthy living, exercise, keeping your body mass index stable — not putting too much weight on your pelvic floor,” Smith said.
Attending to your mental health is also important. Anxiety can show up in many ways and can be limiting, especially when it impacts your daily bathroom habits.