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BREATHING: The basis of pelvic floor strength

Where do we even begin with pelvic floor strength? Kegels. Right? Well, sort of. Kegels are an essential piece to the puzzle of pelvic floor strengthening, however, they are not the whole kitten-kaboodle. If it isn't just Kegel exercises, then what is it?


We all breathe, right? Well of course. We wouldn't be here Ali. Duh. But let me ask you again- Do we all breathe RIGHT? No. Most of us do not properly use our diaphragm when breathing. Think of how many times throughout the day that you hold your breath. You might not notice at first, but paying attention is key.

One of the very first things I teach my patients is diaphragmatic breathing. This used to be called a "belly breath", however, when I attended CSM 2019 in Washington D.C., I listened to some of the pioneer pelvic floor physical/physiotherapists repeat over and over that it is more than JUST the belly.

Our bodies love movement. If we stay stagnant, things will eventually begin to hurt (whether you feel that now or in 20 years). So, in order to breathe, our lungs must move. Our ribs must move. Our belly, our diaphragm, our pelvic floor must MOVE. But how does this relate to the pelvic floor?

Something that has been so cool to me is to watch my newborn son breathe. When he inhales, his belly and lungs expand (chest and belly rise), and when he exhales, his belly and lungs return (chest and belly fall). That is the biological way that we were meant to breathe. So what gets in the way?

Stress. Busy lifestyles. Stress. Stress. Stress. Stress.

Okay, I get it. Stress. Well why? The diaphragm, as well as the thoracic spine (midback), house many of the body's sympathetic (fight or flight) nerves. So, if we are not breathing properly, we are unable to turn on the parasympathetic (rest and digest) system, causing up-regulation to occur. Here's the thing, though. The sympathetic nervous system can get a bad rep due to its overproduction of cortisol and all the negatives that happen from stress. But we have that system for a reason! It just happens to get abused. That is a post for later though- I'll get back to the point.

So the diaphragm is important in regulating stress. It is also important in the movement of the pelvic floor. When we breathe in, our diaphragm expands downward towards the pelvic floor. So, when we inhale, our belly and chest expand, and our pelvic floor rests and expands downward. When we exhale, the pelvic floor returns to the start. The breath is an important, key piece to engaging our pelvic floor. They work together as a team. The breath is also important in learning to poop, but again topic for another post. I could write a book (people already have though).


1. Lay down on a flat, comfortable surface. Begin by noticing your breath. Is it shallow, long, short? Does it feel forced? Do you breathe in your nose, or your mouth?

2. Place one hand on your belly, just below the ribs, and one hand on your chest. Begin by allowing your belly to expand and feel your chest rise and fall.

-Try not to breathe "up and down" meaning your shoulders are shrugging. Think about breathing in and out, allowing the chest to move up and down. Shoulder shrugs cause activation of the accessory breathing muscles, which we want to avoid.

3. Take a gentle, slow breath in through your nose. Feel your chest rise and belly expand. Then, when you feel you are at the end of the breath, gently exhale the air out through your mouth. (In yoga, sometimes a "yogi breath" is taught in through nose, out through nose. This is okay too!)

4. Try to connect to each part of your body. Your diaphragm. Your ribs. Your lungs. Your muscles. Your pelvic floor. What does your breath do to these areas of your body?

5. Start at your head and move to your feet. Are you clenching your teeth? Squeezing your fists? Crossing your legs? Try to assess and release.

6. Practice for 5-10 minutes daily. This is a great way to start and end your day in order to calm whatever stress you are going through, or even just to set an intention while you pray, reflect, or just be still.

7. This does not have to be done sitting. Perform anywhere! Remember- this does not replace "normal shallow breathing". I don't want you "thinking" about breathing all day. Just when you need it!

See resources below for a great example of the 360 breath by Vanessa Barker.

So friends, stop for a minute. Take a breath. Live in the moment and quit worrying about tomorrow.

Feel ready to tackle kegels? Read here to learn how.



This content is created in order for individuals to learn more about the pelvic floor. I am in no way giving medical advice or medically assessing the pelvic floor through this blog. If you ever have any health questions or concerns, please consult with your physician or midwife. If you are ever unsure if you are performing exercises correctly, it may be beneficial for you to get a referral from your physician to a pelvic floor therapist for further evaluation. My blog posts are for educational purposes only! I am not liable or responsible for any damages resulting from or related to your use of this information.

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