The diaphragm and the pelvic floor are designed to function as a team to regulate pressure in our abdomen and give us stability as we move. When you take a deep breath, the diaphragm moves down towards the pelvic floor, allowing the lungs to expand. At the same time, the pelvic floor mirrors the diaphragm’s motion and drops down further too. They truly make a great pair when it comes to essential functions of breathing and stability. However, a saying in our Pelvic Health PT world is that what functions together tends to dysfunction together. This is never truer than with the diaphragm and pelvic floor. If one of the two begins to have issues, the other likes to follow suit. Prolonged incorrect strategies of breathing can worsen and even cause pelvic floor dysfunction. Thankfully, there’s something we can do. If we can work on improving the function and quality of movement of the diaphragm and pelvic floor, we can make improvements in both.
What does diaphragmatic breathing even look like?
The most efficient breathing strategy is driven by the diaphragm. The diaphragm is a dome-shaped muscle at the base of the lungs that attaches to the ribs and spine. When you inhale, your diaphragm tightens and moves downward. This creates more space in your chest cavity and allows the lungs to expand and fill with air. At the same time, this push downward of the diaphragm increases the pressure in the abdomen causing the belly to rise and the pelvic floor to stretch downward. When you exhale, the opposite happens as your diaphragm relaxes and moves upward in the chest cavity. The belly comes back in and the pelvic floor moves back upward. Simply put, the diaphragm and pelvic floor mirror each other’s motion as we breathe. Sometimes we call this “belly breathing” as the most noticeable movement occurring is the belly doming upward as we inhale and falling back down as we exhale.
How does this pattern help the pelvic floor?
The pelvic floor has a hard job. It has to carry the weight of our pelvic organs, manage pressure in the abdomen, give us stability, maintain bowel and bladder control, and allow for healthy sexual function. What often prevents it from completely throwing its hands up and calling it quits is the gentle, wave-like stretch it gets as we breathe. The subtle up and down motion as it stretches and contracts helps prevent the pelvic floor muscles from spasming into a tight (and painful!) position under its tremendous workload while still maintaining appropriate control of the pressure in the abdomen.
So what does improper breathing look like and what does it do to the pelvic floor?
Breathing is mission critical for the body. It has multiple back-up plans to make sure we get the air we need to live, regardless of whether the diaphragm is onboard. We can use muscles in the chest, neck and shoulders to try and lift outward on the chest cavity to help the lungs fill. This strategy technically works, though not nearly as well, to get at least some air into the lungs. What this strategy does not do is partner with the pelvic floor. The pelvic floor, without its beloved wave-like stretch, is incredibly prone to tightening.
How do I fix this?
Short answer: practice! It probably took your body quite a long time to begin using non-diaphragmatic breathing patterns, and it had probably been doing so for quite some time before symptoms began to appear. Be prepared for it to take a while to re-teach your body the correct breathing patterns once again. The more frequently you can coach your body through diaphragmatic breathing exercises the better.
Diaphragmatic Breathing Exercises
- When you are first learning this pattern, it can be easiest to start while lying on your back so that you can focus on the belly rising and falling as you breathe. Once you’ve gotten comfortable with the motion, this can be done in any position. If you are doing this in sitting or standing, make sure that you have an upright posture. (Posture is key for correct breathing, as it is for so many other things, and we will talk more about this in an upcoming post!)
- Place one hand on your belly and one on your chest. The hand on your belly should rise as you inhale and fall back as you exhale. The hand on your chest should not move. It can be helpful to inhale through your nose and exhale through pursed lips to emphasize this motion further. Breathe slowly, but not to the point that you become winded.
- Once you get the belly motion down pat, see if you can emphasize slight rib motion to the side. Place your hands on either side of your lower ribs and try and breathe into this area. Make sure that your shoulders still do not lift upward and your upper chest does not rise as you inhale.
- Lastly, we are going to integrate the pelvic floor into this motion. As you inhale, visualize and begin to sense your pelvic floor moving downward toward your feet. As you exhale, gently sense the pelvic floor muscles moving upward toward the belly.
One last note about diaphragmatic breathing and the pelvic floor! As we discussed, issues with the way we breathe can create pelvic floor dysfunction, but this does not mean that only those with breathing concerns benefit from emphasis of diaphragmatic breathing. The pelvic floor has about 10,000 other reasons why it can dysfunction other than breathing issues. The good news is that it can benefit from emphasized diaphragmatic breathing paired with gentle, controlled pelvic floor movements no matter what the cause may be. We can adjust the diaphragmatic breathing exercises depending on what is going on with your own pelvic floor and neighboring structures. Talk with your pelvic health provider to find the strategy best for you!