Diaphragmatic breathing, pelvic pain, peeing and pooping

In Bladder Dysfunction by pelv_admin5 Comments



Diaphragmatic breathing aka deep belly breathing – how is that an exercise? Many of my patients are surprised when I prescribe and emphasize diaphragmatic breathing in their home exercise programs. Historically, they have associated physical therapy and/or exercise with strengthening, stretching or the need to get the heart rate up. However, with the pelvic floor muscles, especially for patients with pelvic pain or dysfunctional urinary/bowel conditions, this exercise that may appear relatively low level can do great things for relaxing the pelvic floor.


The diaphragm is a nice, big dome-shaped muscle that sits beneath the rib cage, separating the thoracic and abdominopelvic cavities. In addition to your abdominal muscles and those tiny muscles between the ribs, the diaphragm helps you breath. Because of its position and size, it is your most efficient breathing muscle. When you take a deep breath in, the diaphragm drops down into the abdominopelvic cavity and then naturally recoils back up as you exhale.  So how exactly does the diaphragm help facilitate pelvic floor muscle relaxation you ask?  Well, if we go back to how the diaphragm and pelvic floor muscles are positioned, we can see that they both run horizontally or along the horizontal plane. In part, because of this positioning, when you take a deep belly breath allowing air to fill your lungs, the abdominopelvic cavity expands and the pelvic floor muscles drop down/lengthen. That’s all fine and dandy but why is it important for individuals with pelvic pain or dysfunctional urinary/bowel emptying to achieve this pelvic floor muscle lengthening and relaxation? Good question!


Ⓒ By OpenStax College


As Shannon discussed in a prior blog on pelvic floor anatomy, the pelvic floor are a group of muscles that sit at the base of the pelvis. These muscles run from the pubic bone and attach back toward the tailbone. Just like any other muscles in the body, the muscles of the pelvic floor have to be able to appropriately contract AND relax. A lot of my patients that present with pelvic pain, as well as many others with dysfunctional urinary or bowel symptoms, have difficulty relaxing their pelvic floor muscles. Let’s briefly separate these two conditions so we can understand why pelvic floor muscle relaxation is important for managing pain and dysfunctional voiding/emptying:


  • Pelvic Pain: As we previously mentioned, the pelvic floor are a group of muscles that must be able to contract and relax. And just like any other muscles in the body, the muscles of the pelvic floor have nerves and blood vessels that run through and supply them. If your pelvic floor muscles are not relaxing as they should, this may impair the mobility and function of the nerves and blood vessels, causing pain. It’s kind of like flexing your biceps all day long – it would be painful, right? The same sort of rationale applies to contracted or high tone pelvic floor muscles. For patients with pelvic pain, I recommend that they practice their diaphragmatic breathing at least five to 10 minutes, one to two times a day. I also typically recommend that my patients try to incorporate their breathing throughout the day to help counteract all the tension they may be accumulating.  Additionally, this is also a great tool to help manage flares in pelvic pain symptoms. You can further help facilitate pelvic floor muscle relaxation by practicing your belly breathing with different positions such as a deep squat or child’s pose.
  • Dysfunctional Urinary/Bowel Emptying: If we take a look at the pelvic floor anatomy again, we can see that the pelvic floor muscles surround the openings of the urethra and anus. If the pelvic floor muscles are super tight or if they they are not able to appropriately relax down, it may be difficult to easily or completely empty the bladder or bowels. Oftentimes, if a patient has issues starting their flow of urine or difficulty evacuating stool, I have them practice their diaphragmatic breathing while on the toilet; (proper positioning with something like the squatty potty can also come in handy! As you start to do your deep breathing, the pelvic floor muscles should relax down, allowing your urethra and anus to more easily open.


Ⓒ SUNY Downstate Medical Center


How exactly does one perform a diaphragmatic breath?

  1. Lie on your back with your knees slightly bent and head supported. Place one hand on your chest and one hand on your abdomen. This little trick will help you know if you are performing the breath correctly.
  2. Breathe slowly through your nose and allow the air to flow from the thoracic cavity down to your abdominopelvic cavity. As you take your deep breath in, the hand on your chest should remain as still as possible, while the hand on your abdomen should rise. It’s important to note that you are not using your abdominal muscles to push out your stomach, but rather, allowing the air to fill the abdomen.
  3. Exhale slowly through your mouth and allow the abdomen to recoil back down to its resting position. The hand on your chest should continue to remain as still as possible.


Depending on how your pelvic floor muscles are resting, you may or may not be able to notice initially that your pelvic floor muscles are relaxing down with your breath. That’s okay! This should develop as you start to regularly practice your breath and become more in tune with your pelvic floor. You can also consult with a pelvic floor physical therapist who can give you cues/hints to help you become more familiar with how your pelvic floor is moving.


Are you unable to come see us in person? We offer virtual appointments!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page


  1. Stress and anxiety have made proper breathing very difficult for me to do. Almost impossible. Bee breathing seems to be the only way I can fully empty my lungs and thereby take a deep breath. About a week ago, I had my pundendal nerve frozen. I went in with 8 pain and left the hospital with 0 pain. I was euphoric, but my relief lasted only a matter of hours. I seem to be back at square one. I am an asthmatic, and think I subconsciously taught myself not to breathe too deeply, as in those early days, deep breaths seemed to trigger attacks as did exercise. With improvements in medicines. I can now breathe and exercise. I would love to take a yoga-type class where all the instructor works on with me is proper breathing.

  2. Marvellous, informative and simple. I will be trying the lying down exercise. I believe this has major benefits for digestion also since the breath and diaphragm “massage” this area and enable better overall circulation and function of the organs.

  3. It turned out that the last article on inguinal hernia did not apply to me but this definitely does. I have urinary incontinence problems while running and walking and pelvic floor pain after intense exercise. My pelvic floor tightness was causing high blood pressure. However, I noticed that when I practiced deep breathing my BP went back to normal. Now this article brings everything into a full circle.

  4. Thank you for this informative write up about breathing.
    I have been dealing with what I suspect is Pudendal Neuralgia. So much striking pain and itching all in the pelvic region from pelvic bone to tail bone. Deep deep nerve pain.
    OBGYN doesn’t understand the nerve pain and wants to prescribe so many medications.
    I just had an ultra sound to see what the issue is. I feel I know what it is, but not why it has happened.

    I breathe like this at night when I wake from pain and it settles me down.
    I so wish I could find someone like you in my area.
    Thanks for all you do.

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