The Brain–Pelvic Floor Connection: Why Thoughts Matter More Than You Think
When we talk about pelvic floor dysfunction, we often think about muscles, fascia, or posture—but the real command centre for all of it? The brain.
🧠 The Brain as the Conductor of Pelvic Health
The pelvic floor doesn’t operate in isolation. It’s part of a deeply interconnected system, regulated by the brain through both the somatic and autonomic nervous systems. Motor signals from the brain travel down the spinal cord and out through nerves like the pudendal, directing muscle tone, contraction, and relaxation in the pelvic floor including the way the bladder functions
But there’s more—emotions, trauma, and even thoughts can change the brain’s outputs.
The Role of the Limbic System
The limbic system (particularly the amygdala, hippocampus, and hypothalamus) governs emotional responses. It’s closely tied to both the autonomic nervous system and the HPA (hypothalamic-pituitary-adrenal) axis, which regulates stress hormones like cortisol. Chronic stress, anxiety, or fear leads to:
Increased pelvic floor muscle tone (hypertonicity)
Poor coordination between breath and pelvic reflexes
Impaired pain processing (central sensitisation)
Inhibition of voluntary pelvic floor relaxation
This can lead to symptoms like urinary urgency, pelvic pain, or difficulty releasing during bowel movements—not because the muscle is “weak,” but because the brain is stuck in a protective loop.
🌀 Thoughts as Signals: From Mind to Muscle
Dr. Daniel Amen, a psychiatrist and brain imaging expert, has long advocated for understanding how thought patterns influence brain function—and, by extension, physical health. Using SPECT scans (Single Photon Emission Computed Tomography), Dr. Amen’s clinics have mapped the differences between healthy and unhealthy brain activity across thousands of patients.
He’s found that:
Negative thoughts increase activity in areas associated with worry and rumination (like the basal ganglia and anterior cingulate gyrus), which can create physical tension and behavioural paralysis.
Positive thoughts activate prefrontal regions associated with planning, motivation, and resilience—often leading to healthier behaviours and faster recovery.
Repetitive negative thinking suppresses the immune system and dysregulates autonomic control—key components in healing and pelvic floor balance.
Put simply: negative thoughts fuel inaction and contraction, while positive thoughts foster motivation and healing.
🧠 Meet the Brain's Control Crew: Basal Ganglia & Anterior Cingulate Gyrus
When it comes to how we move, focus, and feel — and yes, even how our pelvic floor behaves — two often-overlooked brain areas quietly run the show behind the scenes:
The Basal Ganglia: Your Brain's Habit + Movement Manager
Think of the basal ganglia as a behind-the-scenes coordinator for movement, motivation, and habits. This group of deep brain structures helps us:
Initiate and fine-tune movements
Learn and repeat patterns (like walking, lifting, or even how we hold our posture)
Regulate our emotional responses
Manage transitions between rest and action
💡 Why this matters for pelvic floor health:
If the basal ganglia aren't firing well — due to stress, neurochemical imbalances, or even postural patterns — we might feel sluggish, stuck in unhelpful habits, or tense in ways that impact the core and pelvic floor reflexes. It's also implicated in conditions like Parkinson's, where movement control and continence can be affected.
The Anterior Cingulate Gyrus (ACG): The Mind-Body Messenger
Now meet the anterior cingulate gyrus — part of your brain's limbic system, sitting just above the corpus callosum. This area is your internal tuning fork between emotion, attention, and body signals.
It helps you:
Detect internal "errors" or changes (like needing the toilet or feeling unsafe)
Focus and shift attention (key for breath awareness!)
Manage pain, empathy, and decision-making
Modulate the stress response
💡 Why it matters for healing and breathwork:
The ACG lights up when we’re tuned in to the present moment — such as during mindful breathing, Hypopressives, or TRE. It helps you notice what's happening in your body without reacting in panic. If overactive, it can amplify pain or urgency signals (like frequent urges to pee). If underactive, we might disconnect from body awareness altogether.
🤯 Why Are the Basal Ganglia and Anterior Cingulate Gyrus Linked to Worry & Rumination?
🌀 Basal Ganglia: Habitual Loops, Including Mental Ones
The basal ganglia don’t just automate physical habits — they also reinforce mental ones.
🔁 When we overthink, catastrophise, or ruminate, the basal ganglia can get "stuck in a groove" — repeating the same mental script over and over.
🌀 In conditions like OCD, anxiety, or trauma, this part of the brain often shows up as overactive, making it hard to shift gears from threat or worry back to calm.
🔥 Anterior Cingulate Gyrus: Emotional Amplifier & Error Detector
The ACG is like your brain’s internal alarm system. It constantly scans for:
Errors or threats
Pain or discomfort
Whether something feels "off"
💡 When it's overactive, the ACG can amplify sensations — making urgency, pain, or fear feel more intense than they are.
📌 It’s also the brain region most involved in "why won’t this stop?" thinking — which is classic rumination.
🌀 Together, They Shape How You Move, Feel, and Heal
The basal ganglia and ACG aren’t just about brain function — they deeply influence how you carry your body, how your nervous system balances tension and release, and how easily you can retrain pelvic floor patterns.
Whether you're learning to relax your pelvic floor, breaking the habit of breath-holding, or reprogramming how you respond to stress — these areas are involved. And the good news? Through breath, movement, and awareness, we can help them work better.
✨ Thoughts That Heal, Thoughts That Freeze
Negative thinking can drive dysfunction:
Triggers the sympathetic nervous system (‘fight, flight or freeze’)
Causes breath-holding, shallow breathing, and tension through the diaphragm
Inhibits vagal tone, reducing parasympathetic activity
Promotes a state of "bracing"—locking the body, clenching the pelvic floor, holding in rather than letting go
Positive thinking opens the healing pathway:
Supports the parasympathetic nervous system (‘rest and digest’)
Improves vagal tone and fascial glide
Enhances breath–pelvic floor synchrony (especially during exhale-based practices like Hypopressives)
Encourages action, commitment, and the capacity to regulate through choice—not reactivity
Neuroscientist Dr. Rick Hanson describes this as neuroplastic optimism: by repeatedly cultivating positive thoughts, we can reshape our neural pathways to favour healing, resilience, and improved bodily function.
🪷 The Brain–Body Loop in Pelvic Floor Recovery
In my own work with women healing from pelvic floor dysfunction, the shift often begins not with the perfect exercise—but with a change in mindset:
“Maybe my body isn’t broken. Maybe I just need to feel safe enough to move again.”
This isn’t toxic positivity. It’s functional neurology: every encouraging thought signals safety, downregulates hypervigilance, and invites the pelvic floor to soften, the breath to deepen, and the body to heal.
The Brain–Bladder–Pelvic Floor Loop: A Two-Way Street
The bladder and the pelvic floor aren’t just physical neighbours — they’re deeply intertwined through a finely tuned neural feedback loop. At the heart of this connection are the levator ani muscles (including the pubococcygeus, puborectalis, and iliococcygeus), which help support and lift the pelvic organs, including the bladder. These muscles contract and relax in coordination with the detrusor muscle of the bladder to control urination — but it’s the brain and nervous system that orchestrate the show.
When the bladder fills, stretch receptors in its walls send signals up to the brain via the pelvic and hypogastric nerves, letting us know it’s time to go. In response, the brain (specifically the pontine micturition centre) decides whether it's appropriate to urinate — and sends signals back down via the pudendal nerve to either maintain tone in the levator ani (hold it in) or allow them to release (go). This is not just about muscles doing what they’re told — it’s a dynamic, reflexive relationship built on communication between bladder sensation, muscle coordination, and brain interpretation.
When this loop is disrupted — by trauma, chronic holding patterns, birth injury, or nervous system dysregulation — the messages can become garbled. That’s when symptoms like urgency, frequency, leaking, or retention may arise. Supporting the nervous system (through breathwork, movement, and release work) is often the missing piece in restoring healthy bladder and pelvic floor function.
🧭 Try This: A Thought Reframe + Breath Practice
Notice the thought: “Nothing I try works.”
Reframe: “I’m still learning what helps my body feel safe and supported.”
Anchor it with breath: Try 3 rounds of lateral costal breathing, feeling the breath move into your ribcage and down into your pelvis. Inhale to expand, exhale to soften.
Repeat this daily. You’re not just changing your mood—you’re changing your nervous system, your pelvic tone, and your entire healing trajectory.
Final Thoughts
Healing doesn’t begin in the pelvic floor—it begins in the brain. The stories we tell ourselves shape the messages our brain sends to our body. As Dr. Amen puts it:
“You are not stuck with the brain you have. You can change it. And when you do, you change your life.”
So the next time your mind tells you “I can’t,” pause. Breathe. Then ask: What would change if I believed I could?
Ready to reprogram your nervous system, one breath and one thought at a time?
Book a session with me and let’s start where it matters most — your brain and positive thinking!
