Pelvic Pain: A Pandemic Perfect Storm

There’s been no shortage of commentary on the effects of the pandemic on our collective health. The mental health impact of social isolation and economic uncertainty. The debilitating physical symptoms that many long COVID patients are still suffering from, months after catching the virus. There’s a lot to consider. But how much thought have you given to your pelvic floor?

Over the last 12 months, Pilates teacher and pelvic health specialist Claire Sparrow has seen an increase in clients suffering from pelvic pain, caused by a little known issue called a high tone pelvic floor. Also referred to as a hypertonic or hyperactive pelvic floor, this describes a state where the muscles in your pelvis hold too much tension and are unable to relax.

Stress and an increased amount of time sitting around are big triggers for this type of pelvic floor dysfunction, meaning the pandemic’s been a perfect storm – particularly for anyone with pre-existing pelvic floor issues.

"The stress of 2020 has seen women breathing rapidly and more shallowly, holding things together for their family and friends. All of this has caused more hyperactivity in the pelvic floor muscles," Claire explains. "This can cause pain during intimacy or bowel movements, sciatica, hip and back pain, and incontinence."

Twenty-eight-year-old Rosie has struggled with pelvic pain for a decade but says she’s experienced worsening spikes of pain since the pandemic began. "I live with my parents, so I’ve felt extra pressure to keep them safe because they’re in the at-risk age category. My anxiety has been particularly bad any time I’ve ventured outside – whether it’s to the shops or to see a friend – because I get super panicky about bringing something home with me," she says.

"When I’ve been out, I’ve really, really noticed a spike in my pain levels. It’s been debilitating at times, and it takes a long time to simmer down. I’ve really been trying to limit how much news I’ve been taking in because I’ve definitely felt all of that anxiety in my body," she adds.

So what exactly is going on here? The pelvic floor is essentially a hammock of muscles which supports the organs in your pelvis: the bladder, bowel and uterus (or prostate). Weak pelvic floor muscles that are too relaxed can cause issues like incontinence (leaking pee or poo) or prolapse (when one or more of the organs slips down and bulges into the vagina).

You might have heard about this in the context of doing your Kegels (or pelvic floor exercises) to strengthen the muscles, particularly during pregnancy and after childbirth, both of which put extra pressure on the pelvic floor. The idea with Kegels is to practise tensing and relaxing your pelvic floor in order to strengthen the muscles. Like with any muscle-strengthening exercise, it’s important to be able to both tense and relax – too relaxed (low tone) and you’ll have a weak pelvic floor, too tense (high tone) and you’ll experience pain like Rosie’s.

The kind of stress-related pain Rosie describes is actually very similar to the way some of us might hold stress in our shoulders, according to pelvic physiotherapist Myra Robson. "At the end of a busy day slumped over your computer, your shoulders might feel tense, achy, a bit sore. If you massage them, it feels uncomfortable, but there’s also a release. It’s the same sort of thing in the pelvic floor," she explains.

We don’t really know how common this is, or why some people hold tension in their pelvic floor and others don’t, but Myra says it is more common in women who’ve experienced some kind of pelvic trauma – birth trauma, miscarriage, termination, or pain conditions like endometriosis, vaginismus or vulvodynia.

Rosie's issues began with a combination of vaginismus and vulvodynia. "It started with a common yeast infection but the burning pain in my vulva and vagina never went away." Both conditions cause sex to be painful, which, Myra explains, leads to a vicious cycle of the pelvic floor tensing up defensively in anticipation of the pain. "The pain causes the increase in muscle tension, the increase in muscle tension causes more pain, which in turn causes more stress, and so on."

In Rosie’s case, lack of sexual contact during the pandemic has been another aggravating factor. "When I’ve been in an intimate relationship with someone, that’s helped in a way because I can relax into being able to have and enjoy penetrative sex regularly," she says. "When I haven’t had that with anyone for a while, I sort of get into that panic of, Oh god, what’s going to happen when I go back to square one? That’s been a big thing too – even in a medical setting, no one has touched me in a long time."

Rosie recalls psyching herself up during a recent gynaecology appointment for an internal examination which didn’t end up happening. "The consultation itself was fine but within a few hours my pain spiked dramatically, almost as if I’d actually had the examination. It was like, because I’d been gearing myself up to it, my body responded to the anxiety anyway."

The important thing to know about a high tone pelvic floor is that your normal Kegel exercises may make things worse. "If you’re trying all the common sense stuff like pelvic floor exercises, and it doesn’t feel right, you need to change it; it may well be that you’ve got something else underlying that we need to address," Myra says.

Pelvic physio can help, both by massaging the muscles internally and by adapting pelvic floor exercises to focus more on relaxing the muscles and less on tensing them. "It’s a really, really bizarre experience, because it is basically somebody putting their fingers inside you and massaging the muscles that are tense, and coaching you through breathing," Rosie says of her own experience with pelvic physio – which, she adds, has been one of the most helpful things for her.

"I was also given pelvic floor and breathing exercises to do, and some sheets on how to massage different muscles," she explains. "That’s been another issue with the pandemic in fact; I’ve really fallen behind on my exercises because I just haven’t been able to get my head around doing it. I really have to get back into it."

If you’ve been struggling with any of the symptoms described, you can ask your GP to refer you to a pelvic health physiotherapist for specialist advice and support. Dublin-based pelvic physio Maeve Whelan also has some useful exercises on her website.