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?
- 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.
- 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.
- 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.
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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.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
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.
great post to share with patients! Thanks
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.
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.
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.