The relationship between breathing and our pelvis is not widely known, yet the coordination of these areas serves a vital role for many things that we do, and ways that we move. It’s especially important to have harmonious function here before, during, and after pregnancy.
The pelvis houses the “pelvic floor”, which is composed of three separate layers of muscles that sit like a bowl inside of the pelvis and are surrounded by connective tissue (fascia). These muscles help in supporting all bowel, bladder, and sexual functions. The pelvis is also home to vital organs including reproductive viscera (uterus, cervix, ovaries), bladder, urethra, and rectum. Function or dysfunction in this region of the body depends upon the health of our pelvic floor muscles- and their function relies on how we breathe. Read that again: how we use the bathroom, move, and engage intimately (should we choose to) is related to how our pelvic floor muscles work. And how well our pelvic floor muscles work depends on how our breathing works.
Wondering how? Allow me to explain:
When we inhale, air moves into the lungs at the same time that the diaphragm muscle- located at the bottom of the ribcage- begins to move down. This helps to create more space inside of the ribcage for the lungs to expand. When we exhale the opposite happens: the lungs deflate, so the diaphragm muscle moves upward to its resting position.
See the below image.
How does this relate to the pelvic floor muscles, you might ask? Take a deep breath, then keep reading.
The pelvic floor sits parallel to the diaphragm muscle and way down below it (in the pelvis), so when you take a breath in (picture on left) your pelvic floor moves in the same direction: downward. On the exhale? You guessed it: upward. This relationship serves to impact how we perform other things besides breathing at rest. For example, it impacts how we cough, jump, run, sneeze, or stand from a chair. When there are big pressure changes that happen and the diaphragm muscle is involved (say, when you cough)- the pelvic floor should move in the same direction as the diaphragm.
Often for reasons unknown, our pelvic floor muscles don’t always coordinate with the breathing diaphragm muscle. They may lower downward on an exhalation, a jump, or a cough and this can push a small (or large) amount of urine out (called incontinence or leaking). The medical term for this is “stress incontinence”. The incontinence occurs because of a change in pressure in the abdomen, and the muscles aren’t coordinated when this pressure change happens.
The pelvic floor muscles may also play a role in urinary frequency or urgency, constipation, pelvic pain, tailbone pain, hip pain and/or prolapse. If any of the above sounds familiar, know that you are not alone! Also: I want you to know that there are specialists who work with patients to treat symptoms just like yours.
Just because something is common doesn’t mean it is “normal”, nor does it mean it is something that can’t be improved! Too often incontinence gets normalized or laughed off. We are told kegels are the only solution, or we feel that after a certain age or stage of life that intimacy with a partner may not be feasible.
Pelvic floor rehabilitation is a specialty practice area of physical therapy that focuses on the musculature that sits inside of the pelvis. We evaluate patients as a whole, incorporating lifestyle, diet, movement, and functions into our assessments. We strategize to build a comprehensive plan, partnering with our patients to meet goals.
Often, this treatment begins with using our breath, and incorporating the diaphragm muscle. The utilization of healthy diaphragmatic breath coordinated with movement of the pelvic floor is a key component to maintaining health. Our pelvic floor is the base of our core and trunk, and it assists with stability during walking, running, sitting, squatting- any movement!
If you want to start incorporating your diaphragmatic/pelvic floor breath into a daily routine, here are some tips I use with patients:
On the in breath: peace
On the out breath: love