A challenge I often face as a doctor and fascial manipulation practitioner is changing how my patients perceive and address dysfunction in the body. They tend to think of the body as parts instead of a unit. Especially so when it comes to the pelvic floor.

“My pelvic floor is weak, so I need to make it stronger.” While this thinking seems logical, the cause and effect of body dysfunction is rarely this simple. We need to take a step back and consider what is making the pelvic floor weak in the first place.

One factor that affects the tone of the pelvic floor is the autonomic nervous system. When this system is imbalanced, it can wreak havoc on your pelvic organs’ normal function.

Let’s discuss the often overlooked neurology of the pelvic floor and explore holistic approaches to resolving pelvic floor symptoms.

The Pelvic Floor and Autonomic Nervous System

The neurology of the pelvic floor is complex, involving several branches of the nervous system.  Today, we’ll focus on the autonomic nervous system (ANS), which is further divided into two parts: the sympathetic (SNS) and parasympathetic (PSNS) nervous systems.

SNS and PSNS nerves travel through the spine and emerge from the thoracic, lumbar, and sacral vertebrae. From there, they converge with other nerve fibers to form neuronal plexuses (a group of closely related nerves) before supplying organs throughout the pelvis. All of these nerves are embedded in and protected by pelvic fascia until they reach their destinations.

The main sources of sympathetic supply to the pelvis are the inferior mesenteric ganglion, superior and inferior hypogastric plexus, and hypogastric nerves.

Meanwhile, parasympathetic innervation mainly comes from the pelvic sphlancic nerves and the vagus nerve. The vagus nerve is the longest cranial nerve in the body, exerting a major influence on parasympathetic tone throughout the entire body.

The SNS and PSNS serve opposite but synergistic roles in the pelvic floor. The former inhibits while the latter encourages secretions. They work together to control involuntary bodily processes such as defecation, urination, menstruation, and sexual arousal.

When your body perceives a threat, your SNS kicks into high gear, suppressing any activity that isn’t required to keep you safe in the present moment. That makes it harder for you to go to the bathroom or shake the sheets in bed.

This reaction is normal and necessary for survival. However, being in a state of chronic stress disrupts your autonomic balance and causes lasting pelvic floor issues.

Pelvic Floor Issues Influenced by the Autonomic Nervous System

Overactive Bladder

A healthy ANS is essential for the normal function of the lower urinary tract. Sympathetic nerves keep the sphincter (the muscle stopping urine flow) in a state of contraction. When the bladder is full, sympathetic tone decreases, and parasympathetic tone increases, relaxing the sphincter and allowing urine to pass.

Altered ANS activity can manifest as urinary problems, the most common being an overactive bladder (OAB). People with this syndrome frequently experience a sudden urge to urinate even when the bladder is not full.

Researchers who have investigated the link between ANS dysfunction and OAB found that participants with OAB have lower parasympathetic activity than those without. Thus, activating the PSNS goes a long way to alleviate OAB symptoms. One treatment option is sacral neuromodulation. It uses mild electrical pulses to stimulate the sacral nerves innervating the pelvic floor and lower urinary tract.

Erectile Dysfunction and Premature Ejaculation

The loss of sexual desire and impaired sexual performance are common consequences of autonomic dysfunction. Like bladder control, sexual function is mediated by the coordinated activity of the PSNS and SNS.

During arousal, parasympathetic neural cell bodies are activated. They release signals that trigger the penile smooth muscles to relax and fill with blood, leading to an erection. Parasympathetic activity also excites other sexual organs, including the vas deferens, seminal vesicles, and prostate.

In contrast, sympathetic activation inhibits erections. Sympathetic neurons release neurotransmitters that cause the smooth muscles in blood vessels to constrict, leading to the loss of erection. That’s why in REM sleep (when the SNS is at rest) you can get nocturnal erections.

Although the SNS impedes erections, its activation is necessary for ejaculations. Sympathetic neurons contract the smooth muscles of the to transport semen to the urethra. Sympathetic hyperactivity, however, has been linked to chronic premature ejaculation, indicating that too much sympathetic tone is overall detrimental to sexual performance.

Pelvic Pain

Autonomic imbalance can also manifest as pain in the pelvic region. Too much sympathetic tone causes the smooth muscles in the pelvic floor to spasm, which may result in pain. A few studies have observed abnormalities in the sympathetic nerves of individuals with pelvic pain. These results substantiate the mediating role of the ANS in pain.

Pelvic pain also tends to present with comorbidities that involve impaired autonomic function. These include chronic idiopathic nausea, migraines, fibromyalgia, depression, and panic attacks.

Regulating Your Autonomic Nervous System for a Healthy Pelvic Floor

Restoring the balance between your SNS and PSNS is necessary for the health of your pelvic floor. Increasing your parasympathetic tone is especially important for normal sexual and urological function.

Moderate exercise and deep full-body breathing are two proven methods of activating the PSNS. Both stimulate the vagus nerve, a key component of the PSNS.

Another way to promote ANS health is by improving the tone of the fascia. Healthy fascia is pliable and hydrated. When it becomes stiff and congealed, it can impinge on the pelvic nerve plexuses and disturb your ANS.

Rev6 is a fascia-based exercise system that incorporates full-body breathing into its program, making it efficient for regulating your ANS. We also have a program dedicated to helping your pelvic floor achieve the right tone and flexibility.

No matter if your pelvic floor symptom is neurological, fascial, or musculoskeletal in nature, a Rev6 Pelvic Floor Fitness class is sure to help.

I encourage you to try this safe approach to restoring your pelvic floor health. Sign up for our Pelvic Floor Fitness live-streaming class here, or check out our Pelvic Floor and Core Workout Bundle to get started!