How to Properly Perform Diaphragmatic Breathing for your Pelvic Floor
You've probably been told to practice breathing by many people...counselor, therapist, physical therapist, fitness coach, workout teacher, meditation app, and google, to name a few.
But what actually IS diaphragmatic breathing, and how does it connect to the pelvic floor and nervous system?
Diaphragmatic breathing is one of my foundational teachings I do with my patients because so many of us are a little wound up and don’t really know how to breathe, and it does make a difference for your pelvic health, your endocrine system, and your parasympathetic nervous system.
1 - What is breathing?
Sounds simple, right? If you're watching this video or reading this blog, then you are breathing. I'm breathing while talking and typing this.
But when I talk about breathing from a muscular perspective, I'm talking about activating the diaphragm with your breathing, which is our main muscle of respiration (another fancy term for breathing).
The diaphragm is a dome-shaped muscle that is housed right underneath your ribcage.
Since it's a muscle, it needs to be worked to get stronger. This muscle has nerve supply by branches of the parasympathetic nervous system, which is why we can affect this part of our nervous system here and can tap into that.
The job of the diaphragm is to be the primary mover of respiration (breathing). So that means we can work out the diaphragm to get more efficient and better at it's job - breathing.
This means that you have to learn how to correctly activate this muscle, the diaphragm, just like you have to spend time learning how to activate your arm muscles and your core muscles. You likely aren't good at activating them the first few tries.
What happens so often is that our intuition is to use our chest muscles, which are our accessory muscles of respiration, meaning they should only kick in AFTER the diaphragm or in place of the diaphragm when it can't do it's job (like in the case of pulmonary disease, such as COPD).
These chest muscles - the upper trapezius, sternocleidomastoid, scalenes, intercostals - are really not as efficient in helping us achieve that deep breath to completely fill the lungs with air.
2 - How do you know if you're using your accessory muscles of breathing and not your diaphragm?
When you engage these chest muscles are your primary movers of respiration, you can actually see the neck and the chest lift. You may even see bulging at your neck.
There should be some movement of the ribcage and chest, but it should look fluid and not draw your attention to the area so much.
If you're taking your breath like this, it's an inefficient pattern of breathing. The lungs aren't able to completely fill, and you can't get good activation of the diaphragm or the parasympathetic nervous system.
3 - What does this inefficient muscle pattern lead to?
This does happen during pregnancy, especially the third trimester, as the diaphragm becomes pushed up more by the uterus and growing baby. If you're pregnant, see if you can tell if you're using this pattern to take your breaths.
To take this one step further and explore what happens to the abdominal cavity during this breathing pattern, chest breathing actually creates an over-compensation of the rectus abdominis (looks like sucking in) and increases your intra-abdominal pressure.
This may sound technical, but what you need to know is that this can lead to weakness in our important transverse abdominal core stabilizers and more time increasing intra-abdominal pressure, which puts pressure and strain onto the pelvic floor and worsens conditions like prolapse, urinary leakage, and diastasis recti abdominis in pregnancy.
You can end up in this pattern of what I call balloon squeezing. Instead of everything moving up and down together, the diaphragm is moving the wrong way, the pelvic floor is not engaged at the right time, and your abdominal cavity is getting squished like a balloon.
If you stay in this pattern, it likely translates to other parts of your life, like lifting weights. If you're straining and chest breathing, now you're setting yourself up for even more strain and pressure in the abdominal cavity and onto the pelvic floor and spending more time increasing your cortisol levels.
4 - What is the nervous system connection?
Instead of using that diaphragm muscle, which has its nerve supply by branches of the parasympathetic nervous system - our rest and digest system - you're quieting that system by not using it and not getting that activation there.
So you end up spending more time activating your sympathetic nervous system - the fight or flight system - which increases cortisol, increases heart rate, increases respiratory rate (makes you breathe faster and take shallower breaths), decreases digestion, decreases feelings of calmness, decreases your ability to fall asleep, and affects your skin.
When you have high levels of cortisol circulating for long periods of time, it goes into the inflammatory loop and insulin resistant loop. It's also linked to IGF1, which has been found in research to increase cystic acne and pimples.
Wow! That's a lot of complicated physiology. What you need to take away from this is that breathing matters, and the way you breathe can help tap into all of the beneficial effects of the parasympathetic nervous system that helps to negate those other effects.
5 - How do you start to practice diaphragmatic breathing?
With my patients, I'll assess their breathing and see which pattern they fall into. Then we can start to put the pieces of the puzzle together to see if this breathing pattern is a contributing factor to their stress, pelvic pain, urinary leakage, prolapse, or difficulty pushing their baby out.
You can assess yourself in a seated position by placing one hand on your belly and one hand on your chest. Take a deep breath in, and try to see if you can tell which hand is m
oving more. If your belly hand moved more, that's great! You are probably taking a good, deep inhalation and activating your diaphragm. If your chest hand moved more and you can even see your chest rise and see the muscles form in your neck, you may be chest breathing.
You may also try to place one hand on the side of the ribcage and leave the other hand in the middle of the belly. So we should not only fill the belly forward with air but also the sides of ribcage and obliques to get what is called a 360 breath, which is the most efficient for lung filling and pelvic floor health.
6 - What is the pelvic floor connection to the diaphragm?
When you breathe like this, the pelvic floor is set up in a more efficient pattern - without you even knowing it!
The pelvic floor is a sling of muscles that goes from pubic bone to tailbone and from sits bone to sits bone. It has several functions, including supporting our core and pelvic organs, keeping our urine and poop in, and supporting our sexual function.
As you take a good 360 breath, the diaphragm descends, and so does the pelvic floor. On your exhale, the pelvic floor rises back up. This is a motion that we should all have without even thinking about it. But this movement up and down of the pelvic floor can get derailed when you aren't properly breathing with good diaphragm activation.
Video courtesy of @myPFM on instagram
With my patients, I will assess their pelvic floor internally while they're performing their breathing pattern to see if this up and down reflex is working properly.
If it's not, it can lead to symptoms of urinary incontinence (leaking urine), prolapse, pelvic pain, pain with intercourse, difficulty letting go of the pelvic floor and clenching, to name a few.
Where I often see patients have the most difficult time is in standing and dynamic exercise positions. You're definitely on your way if you can properly activate your diaphragm in a seated, unloaded position. However, what is happening when you're squatting with a barbell or lifting your baby? You have to practice these mechanics under the new loaded conditions to protect your pelvic floor.
7 - Putting it all together
I hope all of this information helps you to understand why breathing is mentioned so often in our lives. I know if can be hard to practice without the understanding of what is even happening and being affected in the abdomen and pelvic floor with something that sounds so simple.
Just by getting engaged with your breathing and learning how to do it properly can be a great starting point to let go of some of your pelvic floor muscle tension, increase the calming effects of the parasympathetic nervous system, and get relief from pelvic floor issues.
So go ahead and practice - see what this feels like and which position it feels best for you!
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