Part I: Breathing Techniques for Pelvic Floor Health

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By Melissa Patrick, PT, DPT and Jennifer Keesee, DPT


The Basics


Breathing may seem like a very simple task, but many of us breathe incorrectly. Poor breathing mechanics can affect us physically, mentally, and emotionally. Research has shown that breathing exercises can positively impact our nervous, cardiac, and musculoskeletal systems.  When we pay attention to, and learn how to control, our breathing we can change how we feel almost immediately. 


When it comes to the pelvic floor, how we breathe can acutely impact the muscles at the base of your pelvis. Many folks tend to breathe with their upper neck and chest muscles, which causes a decrease in movement of the respiratory diaphragm. If your respiratory diaphragm isn’t moving well, then that likely means your pelvic floor muscles aren’t moving well either. This can lead to decreased strength and increased presence of painful trigger points in the pelvic floor which may lead to urinary, bowel or sexual troubles. 


Folks who are currently working with pelvic pain may have more shallow breathing patterns; this is due to the ongoing painful stimulus causing ‘fight or flight’ activation in the nervous system. This becomes a difficult feedback loop of pain causing shallow breathing and shallow breathing causing more pain. One of the best ways to break this cycle is by practicing breathing exercises. 


The Diaphragms


Let’s take a closer look at the anatomy involved in breathing. The diaphragm is a dome shaped structure that runs horizontally at the base of the ribs, this forms the top of the abdominopelvic cavity. The pelvic floor muscles form the bottom of this cavity. With every breath, the pelvic floor and the diaphragm are designed to work together to create and regulate pressure in the abdomen. 


As you inhale, the diaphragm descends and presses on the abdominal organs. The pelvic floor should follow by dropping to ensure the pressure in the trunk is regulated. On exhale, both diaphragms passively recoil coming back up and in. Breathing exercises help to improve this coordination between the pelvic floor and the respiratory diaphragm, which is essential for pelvic floor muscle health!


Breathing Exercises & Pranayama


There are a variety of ways to manipulate the breath to evoke a specific physiologic change in the body, aside from muscle coordination. Most breath exercises can be used as a tool to balance the nervous system. By balancing the nervous system regularly with breath practice, you may find that your body is more able to rest, digest and repair. 


Many breathing techniques originate from the teachings of yoga and are referred to as ‘pranayama’. This term can be broken into two parts with ‘prana’ translating to ‘life force’ and ‘yama’ translating to expansion. Life force energy is the flow of oxygen throughout the entire body and pranayama is the practice of increasing that flow. The ancient origins of pranayama date as far back as 7000 years and since then have served as a powerful tool to heal illness and correct mental imbalances. Pranayama has well documented health benefits in addition to prevention and management of disease – see below for a short, but not complete list. 


Below, we will review basic diaphragmatic breathing, which serves as the foundation for all of the other breath techniques. Take your time with diaphragmatic breathing, the more comfortable you are with it, the more success you will have when trying the other techniques in Part II of this blog. Stay tuned, in Part II we will cover specific pranayama techniques and other breathing exercises to help you reap some of the benefits below! 


Benefits of Breathing Exercises:


  • Facilitate the relationship between the pelvic floor and the respiratory diaphragm
  • Reduce levels of anxiety and depression
  • Assist with emotional regulation and stress management
  • Improve mind-body connection and overall quality of life 
  • Non-habit forming pain management 
  • Lower heart rate and blood pressure
  • Increase delivery of oxygen & nutrients, removal of waste products throughout the body


Prepare to Practice


To practice breathing techniques, begin by finding a comfortable way to sit upright. Support your body in a way that allows your spine to be straight, this is important to optimize breathing mechanics and alertness. You can try leaning against a wall or using a lumbar support pillow. If you are unable to sit comfortably, you can perform (some of these exercises) lying on your back.


The first step to maximizing your breath practice is to simply become aware of how you are breathing. Breath awareness practice gives folks the opportunity to start to notice the correlation between breath, tension and pain. Then, changing and regulating your breath using breathing exercises to manage tension and reduce pain increases your ability to manage how you are feeling. Using breathing exercises empowers you to effectively self-regulate, improving your chances of changing a painful experience. 


A Note on Trauma


Practicing pranayama and breathing exercises can be a great tool for trauma survivors who are struggling with overwhelming anxiety, dissociative coping mechanisms and hyperarousal. Because breath practice is one of the fastest ways to shift your physical and mental state, it can support trauma survivors in their ability to tolerate distressing feelings and memories. However, it can also intensify these challenging feelings initially, so please pace yourself and feel free to pause or remove yourself from the practice if the sensations become too intense. As long as you can tolerate what is coming up for you, see if you can sit with the feelings, identify them and acknowledge them. You can always return to these exercises and work up to the time parameters mentioned below.


Each of the breathing techniques listed in both Part I and Part II of this blog are meant to be calming for the nervous system. Nadi Shodana pranayama or alternate nostril breathing, for example, clears the mind by balancing the left and right hemispheres of the brain. It calms hyper arousal of the nervous system and alleviates tension, anxiety, and internal states of panic. Alternate nostril breathing is a grounding practice and helps to alleviate the sense of being frantic that many trauma survivors struggle with regularly. Stay tuned for Part II to learn more about Nadi Shodana pranayama. Keep in mind, other pranayama practices not listed in this post or in part II, are much more vigorous and may be too activating for the nervous system of a trauma survivor. 


Tips for Finding Ease


Upon beginning a breathing exercise, many folks tend to over effort. Labored breathing will not induce calm in your nervous system or in your body so let’s think about finding a balance between effort and ease. Always try to be patient with yourself as you practice these techniques. 



As you get comfortable with diaphragmatic breathing to start, think less about inhaling “deeper” and more so about inhaling “longer, smoother, softer”. You can even think about “sipping” the breath. This will help you to be more calm and patient with the breath without rushing or forcing it. 



Allow your exhale to “last and linger” without forcing it out. Explore the depth of your exhale, perhaps you are able to empty more completely than you previously felt possible.



Be sure, at the end of any breathing exercise, to pause. Sitting or laying quietly, simply observe the sensations in your body after you have completed the breathing. You may notice you feel a shift in your mind or body. It is important to give yourself the time, space and permission to feel what may come up for you. 


Now that you’re informed and curious about your breathing, let’s jump in! Don’t forget: trust your breath and see if you can listen to what your body may be telling you. 


Breath Technique Guides 


Diaphragmatic Breathing


Using your largest breathing muscle, the respiratory diaphragm, takes more practice than you think! Take your time with this exercise and imagine the diaphragm moving in a 360* fashion. If you have a good handle on this technique, it will surely help you maximize the other breathing exercises. 


  1. Find a comfortable position either laying on your back with your knees bent or in a chair.
  2. Breathe slowly through your nose and visualize drawing the air down towards your low belly and pelvis. As you take your deep breath in, think about breathing into yes, the belly, but also the sides and back of your ribs. Try placing your hands on the sides of your ribcage to feel this expansion. 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. 
  4. You may place your hands on your chest and belly for this exercise to help you focus on feeling the breath in the middle of your belly and less in your upper chest. 
  5. Perform for 5-10 minutes. You can even practice a few diaphragmatic breaths during moments of stress or anxiety to avoid activating your body’s ‘fight or flight’ response.

breathing benefits


Stay tuned for Part II of this blog post to learn more about other breathing techniques and pranayama practices, watch instructional videos and learn about the benefits of each technique. 


yoga zoom

If you are interested in working one on one with Melissa Patrick, our physical therapist who offers virtual therapeutic yoga, please visit our website here to learn more and sign up! She can assist you with practicing these techniques and help you to incorporate them into your existing stretching routine or yoga practice to optimize your pelvic health. 



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