People who have issues such as pelvic pain, incontinence or minor leaks, or bladder irritability quite often have problems with the coordination of their pelvic floor muscles. They can be too tight (unable to relax) or too weak (unable to contract). A simple place to start to address this imbalance and re-educate the right muscle pattern is through breathing.
Many people tend to breathe in as they try to engage a muscle such as their tummy or pelvic floor muscles. Actually, the complete opposite will help.
Learning how to breathe in a different way can help to relax the muscles, calm the nervous system and contract your pelvic floor in a more effective way.
Most people do not realise there is a connection between your diaphragm and pelvic floor. The diaphragm is a dome shaped muscle in the bottom of the ribcage and is the main breathing muscle in the body. Your pelvic floor is a group of muscles that sit at the bottom of your pelvis and act as a sling or hammock for the organs above. These muscles act as the roof and floor of your abdominal cavity and act in a coordinated way along with your abdominal muscles to control pressure in your abdomen.
Before you start any strengthening exercises, you must ensure the muscles of the tummy and pelvic floor are completely relaxed. You may find that for most of the day you walk around holding your tummy in. For example, after having a baby and you may be conscious of how much your tummy has been stretched. Keeping your tummy muscles engaged all the time means you are also keeping the muscles of the pelvic floor engaged. You may also be actively holding in the pelvic floor muscles if you feel that you have any issues such as prolapse or a tear after delivery of your baby. This constant work for these muscles causes them to become tight (hypertonic) and fatigued. Then when you sneeze, cough or lift something heavy you may find that you leak urine or pain occurs. Or when you are desperate for the loo you may be unable to hold it in.
If your muscles are already engaged and then you try to contract your pelvic floor muscles you may feel like nothing is happening. When you contract your pelvic floor muscles from a relaxed state you will feel a bigger difference.
Breathing through your diaphragm to relax these muscles can also help to stimulate the part of the nervous system that promotes stress reduction and reduces general fatigue.
As you breathe in your lungs inflate causing your diaphragm to flatten and lower. This compresses the abdominal contents causing your tummy to expand. This also causes a slight tightening of the abdominal muscles and a lengthening (or stretching out) of the pelvic floor muscles. When you breathe out, the lungs shrink, lifting the diaphragm causing the abdominal muscles to relax and the pelvic floor muscles to shorten and contract. It is easier to relax the pelvic floor muscles as they lengthen, during a breath in. And if you are trying to do a conscious contraction of the pelvic floor muscles, it is easier to do this when they are naturally shortening and contracting as you exhale.
Try this exercise
Lie on your back with your knees open and feet together. Knees can be resting on pillows or over a bolster if you have one. Place your hands on your lower rib cage. (like the picture at the top of the page)
Take a slow breath in. As you do this allow your tummy to expand and relax and imagine widening through your lower rib cage under your hands. Visualise your diaphragm flattening and lowering and your pelvic floor relaxing. As you breathe out relax further still. Do this for 5 – 10 breaths.
Then continue with the in-breath as above, relaxing, and then as you breathe out visualise the lifting of the diaphragm and pelvic floor as you consciously contract the pelvic floor – imagine an elevator – closing the doors at the entrance and lifting though the floors up to the tummy button. As you breathe in imagine the lift travelling back down and the doors opening as you relax and allow the tummy to expand again. Repeat this for several breaths, relaxing and allowing the tummy to expand on the in-breath; engaging the pelvic floor on the out-breath.
Learn this way of breathing and practice regularly so that it becomes second nature. This is a good way to start the rehab of your pelvic floor muscles. As you progress on to harder and more challenging exercises you can continue to use the breath to help. These breathing techniques can also help to release tension in the pelvic floor muscles, which may contribute to pelvic pain.
Our Women’s Health Physiotherapists' Megan and Anna specialise in pelvic floor rehab. Book a Women's Health consultation or post natal MOT for a pelvic floor assessment or join one of their antenatal/postnatal classes and learn how to relax and strengthen your pelvic floor.