Breath & Pelvic Floor Connection

The pelvic floor, deep core, and diaphragm (our breathing muscle) have an important and interconnected movement relationship. If there is inefficiency or impaired coordination of these muscles this can lead to weakness or inversely, overactivation of these muscles. You can sometimes experience both. In the day to day, this can present as back or pelvic pain, incontinence, or other signs of pelvic floor dysfunction. 

The pelvic floor mimics the movement of the diaphragm when breathing. When we breathe in the diaphragm and pelvic floor drop down while the chest wall expands out. When we breathe out the diaphragm and pelvic floor lift up and the chest wall moves down and in. These muscles work together with the deep abdominal muscles including the transverse abdominis, internal obliques, and multifidi to regulate intra-abdominal pressure. This pressure and coordination of muscles helps facilitate spine and pelvic stability. When that relationship is not symbiotic this can lead to pain and dysfunction. Physical Therapists understand the relationship of these muscles and can identify inefficient breathing and movement patterns, posture, and load transfer that can be the root cause of your symptoms. Then most importantly we can treat and provide education and corrective strategies to improve those patterns.

As mentioned prior, sometimes symptoms may be present because of weakness. In this case your physical therapist may focus on the activation and contraction of the pelvic floor during forced exhalation through pursed lips. When you breathe out your diaphragm returns up to its resting state and your pelvic floor lifts or shortens. If tightness or overactivation is present then pelvic floor training may be centered on the inhalation part of respiration, which is when the pelvic floor muscles are lengthening or relaxed. Spoiler alert: kegels are NOT always the answer. Again, at times you can experience both tightness and weakness. While the focus on this article is on the relationship of the pelvic floor with breathing, it is important to note that evaluation by a pelvic floor physical therapist will help determine what technique you need to focus on and at times you may also need manual release, dry needling, manual facilitation or cuing, as well as additional strengthening to optimize your outcomes. 

Additional Resources:

Dr. Beth is discussing the relationship with breathing and the pelvic floor in this video.

This video is a great animation that shows how the ribs move when you breathe and then adds in the diaphragm around 20 seconds. You can see on the inhale the ribs move our and the diaphragm drops downs as the lungs fill with air. This is when the pelvic floor is in a lengthened or relaxed state.