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Impact of stress and cortisol levels on pelvic pain and pelvic stress reflex response

Online Course: Prostate Cancer Programme

Introduction

Oftentimes, people who experience pelvic pain do not realize stress is highly correlated to their symptoms.[1] This is a result of the pelvic stress reflex response, in which the pelvic floor muscles actively contract in response to physical, or mental stress.[1]

What Happens When the Body Is Under Stress?

Muscular Component - Pelvic Stress Reflex Response

The second layer of the pelvic floor includes the

Urethral sphincter (sphincter urethrae)

Compressor urethrae

Sphincter urethral vaginalis

These muscular structures help control the flow of urine through the urethra.[2] There is a passive and active component to the contraction of the sphincters.[2] The passive component involves transmitting intra-abdominal pressure to the urethra which mainly regulates the pressure at the neck of the bladder. The active component mainly controls the pressure distal to the bladder neck, which is important for urethral closure during stress conditions. The active component involves the reflexive contraction of external sphincter muscles. Thus, physical stress will increase the contraction via the pelvic stress reflex response which can lead to tightness and weakness of the pelvic floor muscles.[2]

Hormonal Component – HPA Axis and Cortisol



Response of HPA axis to stressors

HPA Axis

When the body identifies a stressor, it responds via the hypothalamic-pituitary-adrenal (HPA) axis.[3] This is a feedback system that maintains various body systems such as digestion, immune function, mood, energy and s*x.[3] Upon exposure to stress, the body perceives it using the hypothalamus which then releases corticotropin-releasing hormone (CRH).[3] CRH then triggers the pituitary gland to release adrenocorticotrophic hormone (ACTH) and finally signals the adrenal gland to release epinephrine

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