I recently evaluated a 75 y.o patient who presented with significant urinary urgency and frequency, voiding approximately every hour. She reported disrupted sleep due to nocturia, stating, “I can’t sleep at night because I keep getting up to go to the bathroom. They gave me medication to help me sleep, but it doesn’t work.”

Over the course of the visit, it became clear that she was also experiencing chronic anxiety. Anxiety permeated multiple aspects of her daily life, she worried about day-to-day events as well as events in the future. She reported that her urinary symptoms worsened during periods of heightened anxiety, and she had difficulty relaxing both her body and mind.

My initial clinical focus was nervous system regulation. I guided her to sit back comfortably and take several gentle breaths, emphasizing a prolonged exhalation with an audible sigh. She was instructed to consciously release tension throughout her body while maintaining attention on her breath. After only a few breaths, she smiled and reported that she already felt calmer.

Mental health, physical health, and pelvic health are all intricately connected through the nervous system. In my clinical experience, one of the most consistent challenges I have seen patients face is feeling overwhelmed, not just physically, but emotionally. Many of these patients carry invisible burdens of trauma, stress, and anxiety that may show up as pain, tension, fatigue, and even digestive and pelvic health issues. These patients often present with complex pelvic pain symptoms, which may be magnified, adding to their emotional distress.

A recent case involved a young postpartum woman who had delivered a 10 lb. 7 oz baby and was experiencing significant symptoms of symphysis pubis separation. While the physical discomfort was considerable, what deeply impacted her was the emotional toll — a profound sense of disconnection from and lack of control over her body.

Through a comprehensive, integrative approach that included body mechanics education, breathwork, acupressure, and nervous system self-regulation tools, she learned to reconnect with her body in an empowering way. This program not only addressed biomechanical issues but also helped soothe her nervous system, enabling her to meet herself with compassion and care.

As physical therapists who specialize in treating all genders and all conditions related to the niche practice of pelvic health, it has been a privilege for us to deliver whole-person care, emphasizing self-healing, nervous system regulation, and mind-body integration. We often see patients who are under high stress and anxiety, and even more so when they have no other options except surgical intervention.

One such case was a 71-year-old patient who came in with a rectal prolapse. She had experienced a 10 cm rectal prolapse post-defecation, and it had taken prolonged bed rest for half a day for spontaneous reduction to occur. This happened after every bowel movement. She was told there were no other options except surgery. She was afraid to undergo rectal surgery and was willing to try anything to avoid it. Over the course of the first visit, I also learned that she had a family member who was very ill, and she rated her stress and anxiety levels beyond 10/10.

Rectal prolapse is full thickness protrusion of the rectum through the anal canal. It can occur in both sexes, but is 6 times more likely in women. Overall, about 13% of women will undergo surgery for some form of pelvic prolapse at some point in their lives. The incidence of pelvic prolapse also increases with age, peaking in those over 70 years^1,2. Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, mucous rectal discharge, and fecal incontinence or constipation^2,3,4,5,6.

Mental Health is a very serious global concern! As a health care provider, I have seen my patients anxious, scared, confused, tearful, depressed, and sometimes in sheer panic with debilitating anxiety and pain. As they express these emotions, they look for a glimmer of hope and look up to me with the trust that I as their provider will be able to “fix” all their concerns. I have felt the immense burden they carry and many times their emotions cross over and affect me too.

At that moment, the only thought racing through my mind was how could I decrease their physical and psychological distress to help them “feel better.” How could I decrease the burden they carry not just physically, but mentally and emotionally, and how could I empower them with the tools and strategies to build both physical and mental resilience?

The American Physical Therapy Association (APTA) supports interprofessional collaboration at the organizational and individual levels to promote research, education, policy, and practice in behavioral and mental health to enhance the overall health and well-being of society consistent with APTA’s vision. Physical, behavioral, and mental health are inseparably interconnected with overall health and well-being. It is within the professional scope of physical therapist practice to screen for and address behavioral and mental health conditions in patients, clients, and populations. This includes appropriate consultation, referral, or co-management with licensed health services providers in the prevention and management of behavioral and mental health conditions (1) through its position statement HOD P06-20-40-10.

An Ancient Science with a Modern Evidence-Based Approach

A 15-year-old patient walked into the clinic with her mom presenting with symptoms of constipation, lower abdominal spasms, and pain with bowel movements. Over the course of the visit, I learned that she was on medication for depression and was also suffering from chronic anxiety. Anxiety pervaded every aspect of her life, from things happening during the day to her near and far future. Her symptoms were worse when her anxiety was high and she struggled to relax her body and mind.

So, in addition to teaching her a program with breathing exercises, self-abdominal massage, pelvic girdle stretching, and the use of a squatty potty, I also taught her perineal self-acupressure at the acupoint Central Vessel 1 (CV 1) for constipation and two self-regulation points Central Vessel 17 (CV 17) and Yintang (EX-HN 3) for alleviating her anxiety.

Did you know that you could access and regulate the Vagus nerve through Acupressure points in the ear?

At HWConnect last year, I had the pleasure of meeting the amazing Ramona Horton. Ramona introduced us to Acupressure points in the outer ear that can directly stimulate the Auricular branch of the Vagus nerve and here you can see us both practicing Auricular Acupressure.

Auricular therapy includes Acupuncture and Acupressure in the auricle. The ear is innervated by cranial and spinal nerves, which are separated into motor and sensory areas. The motor area includes the facial nerve, which controls the outer ear muscles. The sensory area is composed of Auricular branches of the Vagus nerve¹.

Rachna Mehta, PT, DPT, CIMT, OCS, PRPC, RTY 200 is the author and instructor of the Acupressure for Optimal Pelvic Health course. Rachna brings a wealth of experience to her physical therapy practice and has a personal interest in various eastern holistic healing traditions.

A Holistic Self-Regulation practice

A patient smiled at me as I gathered her history at the clinic, and declared in a resounding voice:

“I am a Type A personality honey! I have never been able to relax so good luck trying to relax me !!!”

Rachna Mehta, PT, DPT, CIMT, OCS, PRPC, RTY 200 is the author and instructor of the Acupressure for Optimal Pelvic Health course. Rachna brings a wealth of experience to her physical therapy practice and has a personal interest in various eastern holistic healing traditions.

According to the National Center for Complementary and Integrative Health (NCCIH), a branch of NIH, pain is the most common reason for seeking medical care (Pain: Considering Complementary Approaches published by National Center for Complementary and Integrative Health, 2019). There is a rising clinical interest in Integrative medicine for non-pharmacologic treatment options as our healthcare system faces a crisis of pills and opioid use (Monson, 2019).

Rachna Mehta, PT, DPT, CIMT, OCS, PRPC, RTY 200 is the author and instructor of the Acupressure for Optimal Pelvic Health course. Rachna brings a wealth of experience to her physical therapy practice and has a personal interest in various eastern holistic healing traditions.

As I walked into the room to greet a new patient, I quickly glanced at the prescription for Pelvic Floor Physical Therapy in her chart. The words “urinary retention” caught my attention. As I gathered her history, I learned that this patient had a history of high anxiety and had been to the ER twice within a few weeks with symptoms of urinary retention. She was now taught to self-catheterize herself to manage her symptoms. After comprehensive testing by her urologist ruled out obstructive and neurological causes, she was referred to pelvic floor therapy with a diagnosis of pelvic floor muscle tension and inability to relax her pelvic floor muscles.

Rachna Mehta, PT, DPT, CIMT, OCS, PRPC is the author and instructor of the Acupressure for Optimal Pelvic Health course. Rachna brings a wealth of experience to her physical therapy practice and has a personal interest in various eastern holistic healing traditions.