Are your breathing mechanics affecting your pelvic floor function?

Updated: May 18

Can changing how you breath improve your pelvic floor function and reduce the symptoms of incontinence and pelvic organ prolapse?


Breathing is fundamental to good pelvic floor function but is often overlooked. I had a client several years ago who was referred to me from her woman’s health physiotherapist. She had a bladder prolapse and a very hypertonic (overactive or tight) pelvic floor caused by baring down when she tried to engage the pelvic floor she was also having issues with urge incontinence. For more information on urge incontinence check out my blog on bladder irritants and "Managing Urge Incontinence"


This lady was a very driven “A Type” personality and initially came to see me the week she retired from a pretty high powered career… she was just off to celebrate her retirement with a six month trip of a lifetime around the world. So she said to me that she wanted one easy to remember exercise that required no equipment that she could do everyday while she was traveling and she would come back and see me in six months when she got home.


Given that we only had one hour I spent our session explaining urge incontinence and how to reprogram the communication between the bladder and brain to resolve the urge incontinence and then we went through the basics of diaphragmatic breathing.


Given how driven she was and the fact that some of her issues where due to her pelvic floor being over active I didn't want to give her pelvic floor strengthening exercises as these, in isolation, would make her pelvic floor even more overactive and possibly exacerbate her prolapse symptoms as well. So I gave her diaphragmatic breathing and the diaphragmatic pump as her "One exercise”... i know strictly speaking thats two things but I got away with it.


Six months later when she was back in town she came to see me again and she confessed she had been very sceptical about my choice of exercise. However, the tips I gave her to deal with the urge incontinence had been so helpful that she decided to give the breathing a shot.


By the time she arrived back in Edinburgh the urge incontinence was a thing of the past and she felt much more connected to her pelvic floor and was using the diaphragmatic pump that I had taught her to both release and strengthen her pelvic floor. Her prolapse symptoms where much improved… she also found that her hip and thoracic mobility had also improved… and subsequently so had her game of tennis.


I love this story as it is a great example of how much of a difference changing your breathing mechanics can make.


So you're probably thinking... why does this work and how can you learn to do this for yourself?


"Conscious breathing heightens awareness and deepens relaxation" – Dan Brule

Our Bodies can employ many different breathing patterns for many reasons both conscious and unconscious, and I’m not going to label any as inherently good or bad… however some breathing patterns can inhibit pelvic floor engagement or increase intra-abdominal pressure while others will encourage thoracic mobility or help us increase our awareness and ability to engage our pelvic floor. From this point of view I break breathing down into the following categories.

  1. Chest Dominant breathing and “in-hauling”

  2. Belly dominant breathing

  3. Lateral Breathing

  4. Back Breathing

  5. Balanced Diaphragmatic Breathing


#1 - Chest Dominant breathing & "In-hauling"

Chest dominant breathing is a very common breathing pattern and can be caused by

  • Tightness in the diaphragm.

  • Stress, anxiety or anything else that encourages shallow breathing

  • Lack of mobility in the ribs or thoracic spine.

  • Abdominal pain especially chronic pain due to chronic endometriosis or inflammatory bowel disease for example.

  • Wearing tight corsetry or restrictive clothing.

  • Postural habits.

  • Pregnancy will encourage chest dominant breathing simply because the baby is taking up space. Especially if the baby is sitting fairly high or causes allot of rib flare it may take a while or need some conscious effort to reverse this habit after baby is born… particularly if you have then had a C-Section or an episiotomy or perineal tear you may continue to breath this way to protect the wound site. Don’t worry if this sounds like you women find they can quickly improve this once they are aware of what is happening and how to change it.

With chest dominant breathing we hold the diaphragm very still and breath up into the upper ribs… as we try to get more air in we will sometimes start to “in-haul”. “In-hauling” is what I call the action of shrugging the shoulders upwards in an attempt to haul air into the lungs. This tends to cause allot of tension in the neck, shoulders, throat and jaw… teeth grinders take note!


Typically with chest dominant breathing you will feel little or no movement in the belly. You may find that that as you inhale the ribs and chest lift upwards belly draws in and up with the ribs rather than softening outwards. If this is your pattern you may find it difficult to connect to or sense the pelvic floor at all as all the awareness is in the ribs and chest.



#2 - Belly dominant breathing

Here you have the opposite of chest dominant breathing. You will feel all the movement in the belly and no movement in the ribs and chest… often I see this as the result of people being over eager to avoid chest dominant breathing and/or over enthusiastic in their attempts to breath diaphragmatically… this is also why I personally never describe diaphragmatic breathing as “belly breathing”.


This breathing pattern can create increased pressure in the abdominal cavity and you may feel like you are bearing down or experience an increase in pelvic floor symptoms especially if you have Pelvic Organ Prolapse (POP) or a hypertonic or overactive pelvic floor or pelvic pain… In fact bearing down and bracing the belly outwards can be a response to pelvic pain.


#3 - Lateral Breathing

This describes breathing sideways into the ribs. Lateral breathing is unlikely to be a default breathing pattern but is a great exercise to develop awareness and encourage movement through the ribs. It is especially useful if you are very tight in the ribs or have asthma or hay fever and want to improve lung expansion and mobility through the ribs… particularly if you are recovering from a cough, chest infection or similar.


#4 - Back Breathing

Just like the lateral breathing this is unlikely to be a default breathing pattern but is great for encouraging movement through the back of the ribs and to help improve breathing in the back lobes of the lungs which tend to be underused. And obviously a side effect of the emphasis being on lifting the ribs and chest in chest dominant breathing leads to a lack of movement through the back of the body.


I love to focus on back breathing in a slumped seated position with your elbows resting on your thighs or in child pose. These positions really help “In-haulers” improve movement through the diaphragm so they can allow the neck and shoulders to relax.



#5 - Balanced Diaphragmatic Breathing

With a well balanced diaphragmatic breath you will breath three dimensionally into all areas of the ribs and belly in a balanced and easy way… after all this is just breathing.


Diaphragmatic breathing is my chosen technique when working with clients with pelvic floor issues as it supports pelvic floor function.


The pelvic floor doesn’t work in isolation. It is part of a cylinder of muscles I call the core canister.


In very simple terms the pelvic floor is the base of that canister.


The deep abdominal wall (transverses abdominis) create the front and sides of the canister.


The back of the canister is the two multifidi muscles (sausage shaped muscles that run either side of the spine)


Finally the top of the cylinder is the diaphragm.


This canister functions like a closed pressure system to manage your intra-abdominal pressure.


For the body to manage this pressure with the changing loads, movements and positions that the body works in the pelvic floor and diaphragm need to be strong and flexible and have the ability to engage and equally to release and relax responsively.


So what happens during a breath?

We inhale because the diaphragm contracts and descends or flattens creating a vacuum in the lungs that draws air into them.


In response the pelvic floor and belly will soften their resting tone reflexively or yield to the pressure created by the diaphragm descending to prevent increasing the intra-abdominal pressure.


Then when we exhale the diaphragm relaxes and draws or domes back up into the ribcage.


In response the pelvic floor and deep abdominal wall will gently increase their resting tone, drawing up, in and back... you may be able to feel an increase in muscle tone in the pelvic floor or the lower abdominals (between the pubic bone and belly button) particularly at the end of your exhalation.



Whats your default breathing pattern?

You may already be aware what your default breathing pattern is... If you're not try sitting or standing with good posture in front of a mirror. Place one hand on your chest and one on your belly. Try inhaling deeply and exhaling fully and observe what happens beneath your hands and in the mirror.

  • If you see your shoulders shrug up towards your ears this is what I call in-hauling and is often seen in conjunction with chest dominant breathing.

  • If you notice that your chest, ribs and shoulders lift on the inhale but your belly stays still or draws in and up then you are likely defaulting to chest dominant breathing.

  • If you notice no movement in the ribs or chest but feel your belly bulging outwards excessively especially if you feel an increase in pressure or pelvic floor or pelvic organ prolapse symptoms then you are likely defaulting to belly dominate breathing.

  • Ideally you will feel your ribs, chest and belly expand softly as you inhale and on the exhale you will notice that your ribs and chest sink a little as your belly and pelvic floor gently suction in and up.


How can I practice diaphragmatic breathing?

Start sitting on a firm surface like a dining chair, maintaining good posture inhale deeply allowing your ribs, belly and pelvic floor to open release and expand. Then as you exhale feel how the ribs narrow and the deep abdominal wall and pelvic floor draw in and up. For most people getting the breathing this way round is a challenge as many of us reverse our breathing mechanics so just practice the following

  • Inhale deeply and evenly into the ribs and belly allowing the belly and pelvic floor to release or soften their resting tone.

  • Exhale notice how the pelvic floor and the deep abdominal wall increase their resting tone a little, you may feel the lower abdominal wall (between the pubic bone and bellybutton) draw in and up.

And remember this is just breathing, it should not feel forced or braced... Make sure you aren't over-inflating your belly and baring down through the pelvic floor or shrugging your shoulders up towards your ears... and in the words of the somatic therapist, Carla Melucci Ardito

"Learn how to exhale, the inhale will take care of itself" – Carla Melucci Ardito

This is great advice... if you get really stuck just focus on the out breath... Your brain will make sure you inhale.


Taking this to the next level

Once you have mastered diaphragmatic breathing the next step is what I call the "Diaphragmatic Pump" This is essentially the exact same thing but with more focus on actively engaging the pelvic floor on the out breath. At this stage I would only focus on the pelvic floor. While you may find the abdominals engage too don't over focus on the abdominals

  • Inhale deeply to release the belly and pelvic floor

  • Exhale fully to engage the pelvic floor and the deep abdominal wall. You should notice the pelvic floor and abdominal wall drawing in and up. Make sure you are not baring down through the pelvic floor or recruiting your gluteals (buttocks) external obliques or your inner thighs.


So will this work?

Back to my lady who just worked on diaphragmatic breathing and the diaphragmatic for six months while she was on holiday... Yes it worked for her... and way better than I expected at the time to be honest. Give diaphragmatic breathing a go. If you would like more information check out my Free 5 day pelvic floor course. Or contact me about my full Adore Your Pelvic Floor course or One-2-One coaching. I am currently teaching the Adore Your Pelvic Floor course online as well as live/in-person at.

Pointe Ahead Pilates, Edinburgh

Complete Movement, Haddington.

 

If you would like more support check out my Free 5 day pelvic floor course. Or contact me about my full Adore Your Pelvic Floor course or One-2-One coaching. I am passionate about helping women with pelvic floor dysfunction wether that is incontinence, pelvic organ prolapse or chronic pelvic pain.


If you would like to work with me I do offer One-2-One training either Online or in Person I also have an online “Adore Your Pelvic Floor” course that will not only give you the practical skills to heal your body but the education and knowledge you need to feel empowered to make educated decisions for yourself so you are able to live your best life.


This course is split into two halves. The first is a comprehensive educational program that will give you a deep understanding of the anatomy of the pelvic floor, how it functions, what can go wrong and how to effectively train your pelvic floor.

This runs alongside a 16 week pelvic floor conditioning program that will take you from the basics of pelvic floor recruitment through to impact and loaded exercise…. in other words get you back to running, jumping, dancing and anything else you want to do so you can live your best life.


If you would like to work with me One-2-One https://www.fionacarterpilates.com


If you would like to access my Online Adore Your Pelvic Floor Course https://fiona-s-school-a743.thinkific.com/courses/adore-your-pelvic-floor-with-fiona-carter


If you would like to train to become an Adore Your Pelvic Floor Coach https://adoreyourpelvicfloor.co.uk/courses/teacher-education-classes/


 

This Blog is not meant to be used as a treatment programme. While I hope you find the information I have shared interesting it is based on what I have found usefu