What being able to physically feel emotions means for your pelvic floor and pain

When I ask people a question like, ‘when you feel anxious, what do you feel?’ people often tell me a thought. They tell me about what they are worrying about or how inconvenient the experience is. When I ask them what they notice physically in the body, people vary in their response. Some are quickly able to tell me they notice a shift in their breath, their heart, a tightness in their stomach or whatever their specific physical experience is. Whilst others really can’t feel very much physically at all. They might even be frustrated by the question. Eager to stop the inquiry, perhaps with thoughts about it being pointless or unhelpful.  

And yet, this experience of that line of questioning is important. It indicates an aversion towards turning towards emotions, somatically. There are many reasons this aversion happens – often due to the negative experience of physical symptoms themselves, which cause a disconnect between mind and body. Or because of a long-standing mistrustful relationship with your body due to illness, injury or a tendency towards emotional suppression. Emotional suppression by the way is often not a choice at all – but a physical default, when you have not had opportunity to safely feel (as opposed to think) feelings.

The consequence of not physically feeling emotions

 Not being able to physically feel your emotions, can significantly exacerbate chronic pain, pelvic tension, and pelvic floor dysfunction. When you are disconnected from your bodily sensations, your nervous system's ability to regulate itself becomes impaired, trapping you in a cycle of physiological stress and heightened pain sensitivity.

The brain is constantly calculating and projecting what you should feel, which means making calculations about the presence, absence or degree of pain, by combining signals from the body (like nerve signals, neurochemicals, brain activation, muscular tension) with emotional data, primarily from threat-processing centres like the amygdala. When difficult emotions are suppressed rather than physically felt (and therefore processed), this acts as a strong form of cumulative stress that keeps the sympathetic nervous system highly activated. Research by Saeedi et al. (2023) demonstrates that individuals who suppress the experience of pain and emotions show increased sympathetic activation and subsequently experience greater pain sensitivity compared to those who remain mindfully aware of their bodily sensations. Furthermore, Kober et al. (2019) found that mindful acceptance and allowing emotions to simply "be" physically down-regulates both pain and negative affect.

Sensation dial and interoceptive awareness

Disconnection from physical feelings represents a disruption of "interoceptive awareness". A term that describes observational non-vigilant bodily awareness. Interoceptive awareness (your ability to detect your bodily signals) relies on regions of the brain like the posterior insula. Harricharan et al. (2021) and Kearney & Lanius (2022) present research demonstrating that chronic stress or trauma can weaken connectivity between sensory processing regions and the posterior insula, leading to a "brain-body disconnect". This causes the brain to miscalculate or faultily process normal or mild bodily sensations as extreme threats, essentially turning up the "pain dial" and triggering sensory hypersensitivity even without new tissue damage (Crettaz et al., 2013; Rivat et al., 2010). This process can therefore have a larger impact where there are existing physiologic disruptions like tissue damage, inflammation, or muscular tension or strains.

Pelvic stress response

In the pelvic region, this mind-body disconnect frequently manifests as pelvic floor dysfunction and tension. In response to severe stress or emotional threat, the pelvic muscles can automatically tense as an involuntary guarding mechanism. This persistent muscular bracing creates increased muscle tone, known as a hypertonic pelvic floor, which sensitizes the nerves in the pelvic organs and disrupts bladder or bowel function. Research highlights that emotional trauma and the subsequent "shutting down" of bodily awareness is closely correlated with these complaints. For instance, Beck et al. (2009) and Stirling & Andrews (2022) demonstrate a significant link between sexual trauma, tonic immobility, and multiple pelvic floor complaints. Trauma or extreme stress does not have to be sexual in nature to have the same impact.

Ultimately, when the brain cannot safely process emotional and sensory data, it defaults to a baseline of hypervigilance, instructing the autonomic nervous system to brace the body's muscles without conscious thought. Conversely, therapeutic interventions that target emotional awareness and expression (EAET) have been shown to physically regulate the autonomic nervous system, reduce muscle guarding, and significantly improve chronic pain outcomes, sometimes even more effectively than standard cognitive behavioural therapy (Lumley & Schubiner, 2019; Yarns et al., 2020).

Nervous system reactivity, systemic inflammation & interoceptive awareness

The disconnect between mind and body, can also impact nervous system reactivity and systemic processes such as immune and neuroendocrine functioning.

Not only can high levels of stress or severe physical discomfort disrupt interoceptive awareness (awareness of bodily signals), but the disruption of interoception can also contribute to your body getting locked into an ongoing state of stress as the nervous system becomes more hypervigilant and physically reactive (Crum et al., 2017). In this state, the autonomic nervous system becomes highly activated, which creates a looping cycle of anxiety, heightened physical sensations, and emotional dysregulation. Conversely, interventions that target and improve interoceptive awareness can update how the brain relates to the body, physically regulating the nervous system and improving overall health outcomes (Datko et al., 2022; Edwards & Pinna, 2020).

Nervous system reactivity and systemic inflammation

This ongoing state of nervous system reactivity directly alters the body's primary regulatory systems (allostatic systems), which include the neuroendocrine and immune systems (McEwen, 1998).

Impact on Neuroendocrine Function: Psychological stress, emotional dysregulation, and lack of bodily safety trigger the Hypothalamic-Pituitary-Adrenal (HPA) axis, which is a central mind-body pathway (Kozlowska et al., 2020). The hypothalamus is the region of the brain that orchestrates the stress response, initiating a cascade of hormonal responses that affect the functioning of organs throughout the body. When you are constantly overwhelmed or disconnected from your emotions, the HPA axis remains continually activated, secreting stress hormones (like cortisol and adrenaline) and neurotransmitters that keep your body in a state of internal busyness and depletion (Kozlowska et al., 2020). Over time, chronic stress and/or trauma can also fundamentally disrupt the endogenous opioid system, which produces the chemicals needed to balance mood, regulate stress, and control pain (Nakamoto & Tokuyama, 2023).

Impact on Immune Function: The HPA axis is in constant, bidirectional communication with your immune system. The busier and more activated your HPA axis is, the more dysregulated your immune system becomes (Iob et al., 2020). This can cause the immune system to become overactive, leading to prolonged, chronic low-grade inflammation or autoimmune dysfunction, or it can cause it to become sluggish, meaning the body is less capable of fighting off infections and healing from wounds (Kozlowska et al., 2020). Groundbreaking psychoneuroimmunology research demonstrates that what you think, feel, and imagine physically alters your immune system's capacity to heal from wounds and fight pathogens (Kiecolt-Glaser et al., 1984).

Because the brain acts as the central hub communicating with these regulatory systems (McEwen, 2012), restoring mind-body connection and learning to acknowledge, somatically feel and process emotions can help at a central level. Psychological and somatic interventions that help the brain re-establish a sense of safety can successfully down-regulate HPA-axis hyperactivity, balance hormones, and consequently enhance immune system functioning (Carrico & Antoni, 2008)

What this means for you

If you find it hard or impossible to physically feel sensations related to emotional experiences, you can teach your body to make these connections safely. You can start with this free nervous system exercise. Over time, guage the change in the degree to which you are able to associate physical sensations with emotions. If you want more guidance or support doing this, the Body Mind Connect membership practices exercises related to this weekly.

References

Beck, J. J. H., Elzevier, H. W., Pelger, R. C. M., Putter, H., & Voorham-van der Zalm, P. J. (2009). Multiple pelvic floor complaints are correlated with sexual abuse history. The Journal of Sexual Medicine, 6(1), 193–198.

Carrico, A. W., & Antoni, M. H. (2008). Effects of Psychological Interventions on Neuroendocrine Hormone Regulation and Immune Status in HIV-Positive Persons: A Review of Randomized Controlled Trials. Biopsychosocial Science and Medicine, 70(5), 575.

Cornwell, B. R., Garrido, M. I., Overstreet, C., Pine, D. S., & Grillon, C. (2017).The Unpredictive Brain Under Threat: A Neurocomputational Account of Anxious Hypervigilance. Biological Psychiatry, 82(6), 447–454.

Crettaz, B., Marziniak, M., Willeke, P., Young, P., Hellhammer, D., Stumpf, A., et al. (2013). Stress-Induced Allodynia – Evidence of Increased Pain Sensitivity in Healthy Humans and Patients with Chronic Pain after Experimentally Induced Psychosocial Stress. PLOS ONE, 8(8): e69460.

Crum, A. J., Akinola, M., Martin, A., & Fath, S. (2017). The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, Stress, & Coping, 30(4), 379–395.

Datko, M., Lutz, J., Gawande, R., Comeau, A., To, M. N., Desel, T., et al. (2022). Increased insula response to interoceptive attention following mindfulness training is associated with increased body trusting among patients with depression. Psychiatry Research: Neuroimaging, 327, 111559.

Edwards, D. J., & Pinna, T. (2020).A Systematic Review of Associations Between Interoception, Vagal Tone, and Emotional Regulation: Potential Applications for Mental Health, Wellbeing, Psychological Flexibility, and Chronic Conditions. Frontiers in Psychology, 11.

Harricharan, S., McKinnon, M. C., & Lanius, R. A. (2021). How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD. Frontiers in

Iob, E., Kirschbaum, C., & Steptoe, A. (2020). Persistent depressive symptoms, HPA-axis hyperactivity, and inflammation: the role of cognitive-affective and somatic symptoms. Molecular psychiatry, 25(5), 1130-1140.

Kearney, B. E., & Lanius, R. A. (2022). The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Frontiers in Neuroscience, 16, 1015749.

Kiecolt-Glaser, J. K., Garner, W., Speicher, C., Penn, G. M., Holliday, J., & Glaser, R. (1984). Psychosocial modifiers of immunocompetence in medical students. Psychosomatic Medicine, 46(1), 7–14.

Kober, H., Buhle, J., Weber, J., Ochsner, K. N., & Wager, T. D. (2019). Let it be: mindful acceptance down-regulates pain and negative emotion. Social Cognitive and Affective Neuroscience, 14(11), 1147-1158.

Kozlowska, K., Scher, S., Helgeland, H. (2020). The immune-inflammatory system and functional somatic symptoms. In Functional Somatic Symptoms in Children and Adolescents: A Stress-System Approach to Assessment and Treatment, 175-201.

Lumley, M. A., & Schubiner, H. (2019). Emotional awareness and expression therapy for chronic pain: Rationale, principles and techniques, evidence, and critical review. Current Rheumatology Reports, 21, 1-8.

McEwen, B. S. (1998). Stress, adaptation, and disease. Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33-44.

McEwen, B. S. (2012).Brain on stress: how the social environment gets under the skin. Proceedings of the National Academy of Sciences U S A, 109 Suppl 2, 17180–17185.

Nakamoto, K., & Tokuyama, S. (2023).Stress-Induced Changes in the Endogenous Opioid System Cause Dysfunction of Pain and Emotion Regulation. International Journal of Molecular Sciences, 24(14), 11713.

Rivat, C., Becker, C., Blugeot, A., Zeau, B., Mauborgne, A., Pohl, M., et al. (2010). Chronic stress induces transient spinal neuroinflammation, triggering sensory hypersensitivity and long-lasting anxiety-induced hyperalgesia. PAIN, 150(2), 358–368.

Saeedi, Z., Ghorbani, N., Shojaeddin, A., & Sarafraz, M. R. (2023). The experience of pain among patients who suffer from chronic pain: The role of suppression and mindfulness in the pain sensitivity and the autonomic nervous system activity. Current Psychology, 42(18), 15539-15548.

Stirling, J., & Andrews, K. (2022). Somatic interventions therapists use when treating women presenting with sexual assault trauma involving tonic immobility. Body, Movement and Dance in Psychotherapy, 17(2), 117–132.

Yarns, B. C., Lumley, M. A., Cassidy, J. T., Steers, W. N., Osato, S., Schubiner, H., & Sultzer, D. L. (2020). Emotional awareness and expression therapy achieves greater pain reduction than cognitive behavioral therapy in older adults with chronic musculoskeletal pain: a preliminary randomized comparison trial. Pain Medicine, 21(11), 2811-2822