Any Pelvic Floor Physiotherapist worth their salt knows how important it is to assess a women’s breathing if she is having symptoms of pelvic floor dysfunction (i.e. bladder leakage, prolapse or pain). So often we get hyper-focused on doing “kegels” for things like bladder leakage, and I would argue that -- for most women -- kegels are actually just a small piece of the puzzle.
Many people have no idea that the way we breathe directly influences the dynamics of the pelvic floor. In terms of shape and orientation, the diaphragm (the breathing muscle inside our ribcage) is like a mirror-image of the pelvic floor. Both muscle groups lie horizontally in the body, creating a “top” (diaphragm) and a “bottom” (pelvic floor) to our abdomen.
The two muscle groups move together in a perfectly timed, coordinated way, in order to manage the pressure inside the abdomen. Poor coordination between the diaphragm and the pelvic floor --> poorly managed changes in abdominal pressure (think: a big sneeze…) --> bladder leakage, increased symptoms of prolapse, etc. In other words, the way we breathe affects the ability of the pelvic floor to do it’s job.
Of course pelvic floor weakness is very often a significant part of the problem, but very often issues like bladder leakage and prolapse are rooted in (or made worse by) poor breathing patterns, like habitual breath-holding. (And when that is the case, no amount of kegels will fix your symptoms completely!)
Breath-holding is a habit most people don’t realize they have. Some women hold their breath briefly to get up off the couch or to lift a heavy carseat or basket of laundry; others use a breath-hold (whether consciously or unconsciously) during elements of their work-outs like lifting weights, doing sit-ups, or during sports.
Breath-holding involves “locking” the diaphragm (and is often accompanied by bracing the abdominal muscles) and although it feels very stable, it in fact pushes all of that force downward into the pelvis.
So if you leak urine when you get up off the couch, lift a carseat or a heavy basket of laundry, or while you lift weights at the gym (as just a few examples), check to see if you’re holding your breath while you do these things. You might be shocked to realize your body has been doing this without your knowledge! You’re adding more pressure to an already heavy load.
The first step to optimizing pelvic floor function and overcoming symptoms like stress incontinence, prolapse, and pain is simply to breathe better. Look for breath-holding throughout your day, then think “Blow Before You Go” and replace those breath-holds with a smooth exhale. Think about pursing your lips and blowing out birthday candles as you lift that heavy carseat or go to get up off the floor. This essentially allows the pressure to escape upwards, and prevents it from building up and “leaking out the bottom”. Importantly, the breath should start before the movement, so you start exhaling just before you lift or move.
In a perfect world you should also be training your pelvic floor muscles to engage as you move, because we should be training the whole system in a functional way. There aren’t many muscles in our body that work in isolation, so training just one muscle group will rarely be successful at achieving perfect results. We really need to integrate muscle groups and practice having them work together. (So, if you’ve ever been told to just do 100 kegels per day sitting at your desk, I would argue this is not a super effective way to improve bladder leakage with running, or heavy lifting, for example.)
In my professional opinion, the simplest and best place to start is with your breath. Just make a goal to watch and correct your breathing over the next week. Over time your body will start to do this automatically, as it’s a much more efficient way to move and less strenuous on the body. This is not to say better breathing is guaranteed to resolve your symptoms; every person is different, with different bodies and different histories. But it’s something I always address when I’m assessing someone for the first time.
If you would like some help learning how to coordinate your core and get your system working again, consider an assessment with a Pelvic Health Physiotherapist in your area. Whether you are a high level athlete or a grandmother who wants to be able to play with her grandkids without leaking or pain, physiotherapists can teach you how to train your core to work better, from top to bottom :)
For more information, check out www.thepelvicfloorpt.com or email cmacmillanpt@gmail.com. To book an assessment with me in Greely, call Cooper Physiotherapy Clinic at (613) 821-1662.
