Guest Blog: How Trauma Can Affect the Pelvic Floor (From a Pelvic Floor Physical Therapist)
My name is Dr. Johanna Gaffney, and I am a pelvic floor physical therapist at HOPE Doctors in St. Petersburg, Florida.
When we think about trauma, we often think about its emotional effects. However, trauma can also have lasting effects on our nervous system and the way our bodies respond to stress.
One of my favorite books on this topic is The Body Keeps the Score by Dr. Bessel van der Kolk. One of the central ideas of the book is that traumatic experiences can leave lasting imprints on the brain, nervous system, and body. Even after the traumatic event has passed, the nervous system may continue to respond as though danger is still present. This can influence muscle tension, breathing patterns, movement, digestion, sleep, and even how we experience pain.
As a pelvic floor physical therapist, I work with many individuals who have experienced trauma. While every person’s story is unique, it’s common to see a nervous system that has become more protective. When the body remains in this protective state, the pelvic floor muscles may stay tense and become guarded without us even realizing it.
Over time, this persistent muscle tension can contribute to symptoms such as:
- Pelvic pain
- Pain with intimacy
- Urinary urgency or frequency
- Urinary incontinence
- Constipation or difficulty emptying the bowels
- Difficulty relaxing the pelvic floor
- Other muscular holding patterns or compensations, including lower back pain, hip pain, jaw clenching, neck tension, headaches, or persistent muscle tightness
Although we often associate trauma with a pelvic floor that is too tense, it’s important to recognize that pelvic floor dysfunction isn’t always that simple. A nervous system that has been under chronic stress can affect how the pelvic floor muscles coordinate, contract, and relax. For some individuals, this may contribute to increased muscle tension and pain, while for others it may contribute to changes in muscle coordination and function. Every person’s muscular presentation is unique, which is why an evaluation is so important.
It’s also very important to know that this does not mean your symptoms are all in your head. Your pain and your symptoms are real. Trauma can lead to objective changes in the nervous system and muscle function that may contribute to chronic pain and pelvic floor dysfunction. These changes deserve attention and patient-centered care.
This is why pelvic floor physical therapy requires a whole-person approach. Treatment may include education, breathing strategies, gentle movement, manual therapy when appropriate, nervous system regulation techniques, and exercises that help your body rediscover a sense of safety and rest. For many people, healing is most effective when pelvic floor physical therapy is paired with support from a mental health professional who is trained in trauma-informed care.
Healing from trauma is about guiding your nervous system into a state of safety again. It’s about addressing every piece of the puzzle, building the right healthcare team, and creating a strong support system that allows healing to happen over time. Healing isn’t linear, and everyone’s journey looks different. With the right support, recovery is possible!
At HOPE Doctors in St. Petersburg, Florida, we believe every patient deserves individualized, compassionate, whole-person care.
We don’t just treat muscles, we treat the entire person. We want to understand your story, your goals, and how we can best support you on your healing journey.
Whether you are local to the Tampa Bay area or live elsewhere, we offer in-person sessions, virtual consultations, and wellness services to help support you wherever you are.
If you are struggling with pelvic pain or any of the symptoms mentioned above, know that you are not alone. We are here to support you and walk alongside you every step of the way.
Dr. Johanna and her team at HOPE Doctors is one of our recommended and preferred providers. 
