Why Trying Hard and Still Feeling Bad Doesn't Make You a Failure

Some people arrive at an integrative health clinic having already done everything. The diet. The supplements. The pelvic floor physiotherapy. The meditation. The acupuncture. They are trying extraordinarily hard, but they still feel terrible.

What tends to happen next is one of the most quietly damaging patterns in chronic pelvic pain: the sense that because the effort isn't producing the expected result, something must be fundamentally wrong with them.

The Shame of Trying Hard

Dr Katy Hansen describes this with unusual clarity. The person doing all the right things who keeps having flares often develops a layer of internal shame on top of the physical suffering: the belief that if they were doing it correctly, they would be getting better.

"It's almost like this internal shame of like, I'm trying so hard. Because I'm trying so hard, what am I doing wrong? Should it be working? And so it's also a place to create space for, you could be doing everything right and you might still have a flare." ~ Dr Katy Hansen

Pelvic pain and mental health are deeply connected, and that connection runs both ways. Shame and self-blame activate the stress response. The stress response amplifies pain. The amplified pain feels like further evidence of failure. The cycle continues.

Baby Birding

One of the most useful frames in this episode is what Dr Katy Hansen calls baby birding. Hold a baby bird too tight and you kill it. Let go entirely and it runs away. The work is to hold just loosely enough: seeking agency where it exists, releasing the grip on outcomes that were never in your control to begin with.

This shows up most clearly in the boom and bust cycle that so many people with chronic pelvic pain recognise: going in hard on every treatment at once, burning out, getting disillusioned, withdrawing from care, and then starting the whole cycle again. Each round leaves a little more exhaustion and a little less hope.

What You Can and Can't Control

Sleep is a clean example of the distinction. You can control when you stop drinking caffeine. You can control whether you look at your phone in bed. You cannot control how many hours you sleep. Linking your sense of success to the number (an outcome outside your control) creates a setup for failure even when you are doing everything right.

"Linking success not to ‘did my pain go away?’, but ‘did I focus on the things I could control’ and then feeling good about those things." ~ Dr Katy Hansen

The same logic applies across the whole landscape of pelvic pain and mental health management. Most of the interventions Dr Katy Hansen and Shelli describe (sleep hygiene, nervous system regulation, nutritional shifts, movement practices) are things that are good for any human being. Central sensitisation doesn't change that. It just means the stakes feel higher and the margin for self-criticism gets smaller.

Making It Proportional

One of the most practical things this episode offers is the proportionality principle. If you can mostly function and you have flares, the plan is a few targeted tweaks. If you cannot get out of bed, the plan is more comprehensive. Making the intervention proportional to the actual impact, rather than throwing everything at it at once, is one of the most consistently underused approaches in this space.

Listen to the full conversation  with Dr Katy Hansen and Shelli Burton to hear how to find the right level of effort for where you actually are right now.

Resources can be found here.