• Amy Wolkin PT, DPT, MBA

Mindful - or out of your mind?


Look at the image above. First, what do you see? How would you describe the lines? What smells would you associate with the image? What would you picture yourself doing? Who if anyone would you be with? What would the air feel like? Think about the 5 senses.


We tend to pride ourselves on how much we juggle or multitasking. But this constant input can impact physical sensations, emotional wellbeing, and relationships. It also can relate to pelvic floor conditions!


Focusing on the image above was a practice in mindfulness. A number of studies have found evidence using mindfulness as an intervention for pain desensitization and improved mind-body awareness. Mindfulness provides a way to regain control of our thoughts, emotions, and sensations and slow down the hectic pace of life. A number of barriers to mindfulness exist including time constraints, feeling awkward, constant sensory input, life, and a cultural lack of acceptance.


When there is a lot going on, take time to step back and think RAIN. This can be to help improve awareness.




The RAIN practice can help:

R – recognize what is going on

A – acknowledge the experience to be there, just as is

I – investigate- explore and be curious

N – not identifying with the experience and instead natural awareness








There have been studies specifically finding how mindfulness and affect conditions that patients are treated for in pelvic floor physical therapy. Mindfulness can be an effective adjunct for physical therapy treatment for those with chronic pelvic pain, sexual dysfunction, constipation, bladder pain, and endometriosis. It can also be used in preparation for birth.


Mindfulness can help to increase the parasympathetic nervous system and down-regulate, resulting in slower heart rate and breath rate. Reasons include decreasing central sensitization, meaning that the body will change the pathways of how it perceives pain. Often in those that are stressed the pelvic floor muscles have increased tone and patients have difficulty with relaxation of the pelvic floor. Mindfulness can help to promote relaxation of tissues and calming of the nervous system.


Like other exercises, mindfulness can be challenging to dedicate time to and to focus on. The mind often wanders. Staying focused on mindfulness can take practice. There are a number of apps now available. Also, one can become more mindful by doing activities such as puzzles, journaling, paint by numbers, or yoga. Try listening to an app or doing one of these activities. A physical therapist can also help to incorporate mindfulness more specifically into a patient’s home exercise program based on presentation and symptoms.


Dewitte M, Borg C, Lowenstein L. A psychosocial approach to female genital pain. Nat Rev Urol. 2018 Jan;15(1):25-41. doi: 10.1038/nrurol.2017.187. Epub 2017 Nov 28. PMID: 29182603.


Vandyken C, Hilton S. Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain. Sex Med Rev. 2017 Jan;5(1):20-30. doi: 10.1016/j.sxmr.2016.06.004. Epub 2016 Aug 3. PMID: 27498209.


Alsubaie M, Abbott R, Dunn B, Dickens C, Keil TF, Henley W, Kuyken W. Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clin Psychol Rev. 2017



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