Healing the Pelvic Floor: Understanding Trauma’s Impact on Pelvic Floor Dysfunction

As a trauma-informed pelvic floor therapy specialist, I have seen firsthand how trauma—both physical and emotional—manifests in the body, particularly in the pelvic floor. The pelvis is not only a biomechanical foundation but also a container for deeply rooted emotional experiences. Trauma, whether acute or chronic, can lead to significant pelvic floor dysfunction (PFD), causing pain, incontinence, sexual dysfunction, and a host of other challenges that impact a person’s overall well-being.

Understanding Trauma and the Pelvic Floor Connection

Trauma can be broadly classified into physical or psychological trauma that often is a result of childbirth injuries, surgery, accidents, sexual abuse, emotional abuse, or prolonged stress. The nervous system’s response to trauma—specifically, the fight, flight, or freeze response—can create muscular guarding in the pelvic region, leading to hypertonicity (excess muscle tension) and/or dissociation from this area of the body. 

For example, individuals who have experienced sexual trauma often develop a protective response in the pelvic floor muscles, involuntarily tightening them as a defense mechanism. Over time, this chronic holding pattern can lead to conditions such as vaginismus, dyspareunia (painful intercourse), and chronic pelvic pain syndrome (CPPS). On the other hand, some trauma survivors experience a disconnection from their pelvic region, leading to muscle underactivity.

The Role of the Nervous System in Pelvic Floor Dysfunction

The autonomic nervous system (ANS), which regulates involuntary bodily functions, plays a crucial role in pelvic floor function. Trauma disrupts the ANS, often pushing individuals into states of hyperarousal (sympathetic overdrive) or hypoarousal (dorsal vagal shutdown). In hyperarousal, the pelvic floor muscles remain excessively contracted, leading to myofascial pain and dysfunction. In hypoarousal, there may be reduced sensation, numbness, or lack of muscular coordination, making it difficult for individuals to engage their pelvic floor muscles effectively.

Furthermore, the fascia—connective tissue that surrounds muscles and organs—can become restricted due to trauma, further exacerbating pelvic dysfunction. Research suggests that trauma is stored in the body through fascial restrictions, which can perpetuate pain and dysfunction if not properly addressed.

autonomic nervous system

Pelvic Floor

Trauma-Informed Pelvic Floor Therapy: A Holistic Approach

Given the intricate relationship between trauma and pelvic floor dysfunction, a trauma-informed approach to pelvic floor therapy is essential. This involves acknowledging the impact of trauma, creating a safe and empowering environment, and incorporating both physical and psychological healing modalities. 

1. Establishing Safety and Trust

Trauma-informed care begins with establishing trust and safety. Many trauma survivors struggle with medical and therapeutic interventions due to past violations of bodily autonomy. A therapist must prioritize informed consent, offer choices during treatment, and allow the patient to dictate the pace of therapy. Grounding techniques, such as breathwork and mindfulness, can also help individuals feel present and safe in their bodies before engaging in manual therapy or exercises.

2. Addressing Hypertonic and Hypotonic Pelvic Floors

For individuals with hypertonic pelvic floor muscles, interventions such as myofascial release, biofeedback, and diaphragmatic breathing can help downregulate an overactive nervous system and encourage relaxation. Conversely, for those with hypotonic muscles, targeted strengthening exercises, functional movement training, and neuromuscular re-education can help restore muscle coordination and integrity.

3. Incorporating Somatic and Mind-Body Therapies

Since trauma is both a psychological and physiological experience, integrating somatic therapies can be highly effective. Yoga, guided meditation, and breathwork are valuable tools for reconnecting with the body and pelvic region in a non-threatening way.

4. Collaborative and Multidisciplinary Care

A trauma-informed pelvic floor therapist often collaborates with mental health professionals, physicians, and bodywork specialists to provide comprehensive care. Cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and psychodynamic therapy can be beneficial in addressing the psychological aspects of trauma while pelvic floor therapy addresses the physical manifestations.

Moving Forward: Empowerment and Healing

Healing from trauma-related pelvic floor dysfunction is a journey that requires patience, compassion, and a holistic approach. By recognizing the intricate connections between the nervous system, musculature, and emotional experiences, we can create more effective, compassionate interventions for individuals struggling with PFD.

As a trauma-informed pelvic floor therapy specialist, my goal is to empower individuals with the knowledge and tools they need to reclaim their bodies, restore function, and find lasting relief. Through a combination of evidence-based techniques, emotional support, and patient-centered care, true healing becomes possible.

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References

• Cohen, D. J., Gonzalez, J., & Goldstein, I. (2020). The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction. Sexual Medicine Reviews, 8(4), 509-522.

• Emerson, D., Sharma, R., Chaudhry, S., & Turner, J. (2009). Trauma-sensitive yoga: Principles, practice, and research. International Journal of Yoga Therapy, 19, 123-128.

• FitzGerald, M. P., Payne, C. K., Lukacz, E. S., Yang, C. C., Peters, K. M., Chai, T. C., & Hanno, P. (2013). Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. Journal of Urology, 189(4), 1183-1188.

• Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror. Basic Books.

• Levine, P. A. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books.

• Pukall, C. F., Goldstein, A. T., Bergeron, S., Foster, D., Stein, A., Kellogg-Spadt, S., & Bachmann, G. (2016). Vulvodynia: Definition, prevalence, impact, and pathophysiological factors. Journal of Sexual Medicine, 13(3), 291-304.

• Schleip, R., Findley, T. W., Chaitow, L., & Huijing, P. A. (2012). Fascia: The Tensional Network of the Human Body. Churchill Livingstone.

• Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. Guilford Press.

• van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.