By Nicole Davis
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!
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.
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.