The Importance of Breathing

By Dr. Brooke Meinema PT, DPT, FAFS

TLDR: Breathing mechanics can be helpful for a wide range of problems with the pelvic floor including diastasis recti, pelvic floor tension, and prolapse/weakness. It can be difficult to coordinate your breathing to help your specific issue, so getting an individualized approach can sometimes be very helpful.

A deep breath can be a useful tool for an array of problems, especially when it comes to our pelvic floor. It is a really safe and simple way to start focusing on our pelvic floor health making it a great first step. To start thinking about this, let’s get into some of the basics of breathing and its impact on core and pelvic floor. First, let’s go over what intrathoracic/intra-abdominal pressure is; intrathoracic pressure refers to the pressure in our abdomen. Visualize this as a can: the top of the can is our diaphragm, our core muscles around our abdomen are the sides, and the bottom of the can is our pelvic floor. Any disruption in the pressure distribution in the can may lead to pressure pushing down into the bottom of the can (pelvic floor prolapse/leakage), towards the front of the can (diastasis recti), and through the top (difficulty getting a good deep breath in/out, which can trigger anxiety). Keeping this in mind with activity can help us navigate different issues that may arise with our core and pelvic floor.

Breathing and the pelvic floor:

If you exhale, and then try to force the last bit of air out of your lungs (cough, yell, etc.), you may feel the pressure pushing down on your pelvic floor muscles. Now, if you try this again, but inhale before you force the air out of your lungs, there is less pressure. It is important that we don’t hold our breath during strenuous tasks: the pressure in our abdomen has nowhere to push but down, which can lead to leaks and heaviness. Visualize the can and what would happen if you quickly squeeze the sides of it: the pressure will try to push down through the bottom of the can.

Image: the picture on the right is the exhale without air in the abdomen, the right is after an inhale. Having a good amount of air in our abdomen to exhale can help prevent the pressure down and prevent some of the leaks or heaviness.

Breathing and diastasis recti:

With a weakness and a separation between the abdominal muscles, this can be an easy place for air to go during a deep breath. After pregnancy, it can be hard to coordinate breathing mechanics due to ribs changing position to allow for a growing belly, as well as changes in posture with increased curve in the low back. These postural changes don’t necessarily return to their previous state after delivery, which can make it harder to recover from a diastasis. Coordination training with breathing mechanics can be frustrating when trying to get the hang of things, but this can be very helpful to close that gap.

Breathing and pelvic floor pain and tension:

For people with pelvic floor tension, it can be difficult to breath into the pelvic floor musculature. Just like other muscles in the body, these muscles need to be able to contract and relax based on the stimulus presented, but when the muscles of the pelvic floor are always tight, they may be unable to stretch, even with a downward pressure. One way to work on improving some of the relaxation and flexibility of these muscles is to focus on deep breathing and directing the air down into the pelvic floor muscles. Imagine the pelvic floor is a trampoline, now try to take a deep breath forcing the trampoline down (stretching the pelvic floor muscles downward). This can be a very difficult concept to coordinate and even more difficult to break through that tension, so if that is the case, don’t get frustrated! There are different stretches and exercises you can work on to address this, it just takes some time and some individualized help!

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