Diaphragmatic Breathing for Pelvic Floor

“Breathing is the FIRST place not the LAST place one should investigate when any disordered energy presents itself.” Sheldon Saul Hendler, MD Ph.D., The Oxygen Breakthrough


How you breathe can influence the health of your pelvic floor and greatly improve your well being. Most people don’t give a second thought to the act of breathing unless they run out of breath! Proper breathing comes from the diaphragm, the area between the rib cage and belly button.

We breathe about 14 times every minute, more than 20,000 times a day, and no fewer than 526 million times in an average lifetime. Most of our breaths are automatic; respiration requires little thought, but most of us do a bad job of it!

“The reason is that almost no one uses their diaphragm as it’s intended—as the body’s primary breathing muscle,” says Bill Hartman, C.S.C.S., co-owner of IFAST in Indianapolis.

It’s a consequence of modern life. Chronic stress, repetitive habits, and skewed ergonomics cause your diaphragm to be misused. Instead of helping you breathe, it’s redirected to shore up posture and stability. “The result is disastrous,” says Hruska. Read more

What is Diaphragmatic Breathing?

Diaphragmatic breathing or abdominal breathing is a breathing exercise and technique that promotes deep breathing using your main breathing muscle – your diaphragm. The diaphragm is a dome–shaped muscle that sits under the lungs. The diaphragm helps to stabilize the core. It forms the top of the core working with the internal and external obliques, quadratus lumborum, pelvic floor, and transverse abdominus.

When you breathe in normally, your diaphragm contracts and moves downwards into your abdomen. This downward movement creates a vacuum inside your chest causing air to enter and fill up your lungs. You breathe out when your diaphragm relaxes and moves back up into your chest allowing air to leave your lungs.

Louis Libby, M.D., a pulmonary physician and former chief medical officer at the Oregon Clinic states “Very few of us actually breathe efficiently.”For most of us, the diaphragm is never in a position to support optimal posture or breathing…and the net effect is that we become chest breathers.” 

Bill Hartman, C.S.C.S., co-owner of IFAST teaches that “Your pelvis and pelvic floor tilt down, and your ribs and diaphragm tilt up.” You lose your ZOA (Your zone of opposition). And just like that, your primary breathing muscle flickers offline. Other muscles pick up the slack. Your intercostals (several groups of muscles that run between the ribs, and help form and move the chest wall) take over most of the work, and your scalenes and pecs chip in as well. 

How to Practice Diaphragmatic Breathing

To locate your diaphragm, place your hand above your belly button, just below your ribcage. Keep it there for this exercise. Some people like to place their other hand on their chest to ensure that it is not raising throughout the exercise.

Take a moment and close your eyes and become aware of your breathing. Notice the way the air feels as it travels in through your nostrils and then back out again. Now, take a long, slow deep breath inward, bringing the breath all the way down into your abdomen. Try to push out your lower hand with your abdominal muscles. Can you breathe using your belly only so that your rib cage and upper hand do not move?

When you’ve taken your breath inward, pause briefly and then exhale slowly through your nose or mouth, depending on your preference.

Continue this exercise taking 5–10 slow, deep inhalations and exhalations. Keep breathing slow and rhythmic. To help you slow down, practice counting to four on the inhalation and exhalation, pausing in between. Consider following this process.

Inhale to the count of four 1…2…3…4. Pause 2 seconds, then exhale to the count of four 1…2…3…4.

Some people say/think a word to themselves on the exhalations. For example, inhale 1…2…3…4. Pause for 2 seconds and then think the word R-E-L-E-A-S-E as they exhale.

Continue this process 5–10 times. If you start feeling light-headed, take a rest for 30-60 seconds and then begin again.

Some Benefits of Diaphragmatic Breathing

Diaphragmatic breathing is thought to benefit overall health in a vast number of ways:

Improves circulating oxygen levels

Improves core deep abdominal and pelvic floor muscle function

Reduces fatigue with exercise

Decreases blood pressure

Improves core deep abdominal and pelvic floor muscle function

Diaphragmatic Breathing and Core Muscles

The way you breathe affects the tone in your deep abdominal and pelvic floor muscles. Our core is comprised of the diaphragm, pelvic floor, transverse abdominals and multifidus. For optimal health the diaphragm and pelvic floor need to move in sync. A strong functional core helps maintain healthy alignment for every day activities and enhances athletic performance. Dysfunctional breathing patterns weaken the core and contribute to low back and pelvic pain.

Learning diaphragmatic breathing technique and practicing breathing exercises can help you promote the coordinated activity of your deep abdominal and pelvic floor muscles. This is a vital first step in undertaking pelvic floor rehabilitation for prolapse or incontinence problems in women and men.

This video by Biomechanist Katy Bowman explains the mechanics of optimal breathing, and the exercises that will train the muscles to increase oxygen intake! You can purchase the whole video here

Posture, Breathing and Pelvic Floor Problems

Do you slump when you sit? Did you know that if you slump forward your abdominal contents slumping - poor -posture - pelvic-painbecome compressed and your diaphragm can’t move downwards. This creates the need to use your upper chest muscles to help you breathe. Slouching while breathing with the upper chest muscles increases pressure on the pelvic floor and the pelvic floor muscles can’t work well to counteract this increased pressure. Correct posture is very important! It helps your diaphragm, pelvic floor and abdominal muscles work well together.

When to Do Diaphragmatic Breathing Exercises?

At regular intervals throughout the course of your day try to breathe slowly and deeply using your diaphragm to inhale and let the air passively leave your body. Try not to force the air out of your lungs! A minute or two of diaphragmatic breathing when starting out is terrific. Try to build on this until you reach 5-10 minutes.

If you feel a little out of breath when starting out, take a break and try again later! Remember the ultimate goal is to promote a pattern of diaphragmatic breathing and reduce upper chest breathing throughout your day. Regular daily practice will enable you to achieve this goal.

I enjoyed this video by the Franklin Method that discusses how not to grip your pelvic floor and abdominal muscles when breathing. 

Restoring Breathing for a Good Night Sleep with Lois Laynee is a neat way to breathe. It helps with sleep apnea, stress reduction, weight loss, etc…

I highly recommend this course by Julie Wiebe, PT An introduction to Piston Science, this 2.5 hour online course presents an alternative model for creating central stability in patients and clients through the relationship between the Diaphragm and Pelvic Floor.  

Demo of The Pelvic Floor Piston

Finally, if you like Yoga poses, try this out – Shelly Prosko, Physical therapist and professional yoga therapist, demonstrates Viparita Karani (Legs up the wall) yoga pose in conjunction with pelvic-abdominal diaphragmatic breathing and lower extremity movements to help enhance circulation, lymphatic drainage, and facilitate pelvic floor relaxation & the full natural pelvic floor movement.