Managing pressure - when pressure pushes down into the pelvic floor on the exhale

When it comes to managing pressure, leaking and pelvic organ prolapse, the first thing I teach women is how to get a good exhale from the bottom up.

When we consider the relationship between the diaphragm and the pelvic floor what we want to see is a 360 inhale, expanding the rib cage into the front, back and side to side, and down into the abdomen with gentle pressure pushing into the pelvic floor creating length (relaxation).

On the exhale we want to see that the pelvic floor and deep abs are switching on, pushing pressure back up into the the diaphragm as it ascends (domes up) into the rib cage.

Check out Sarah Duvall’s video below demonstrating this relationship.

This relationship can be disrupted through changes in posture, pressure management and breathing strategies (like belly breathing). And the pattern can also be reversed.

Instead of the optimal relationship described above sometimes we might see a pattern where the diaphragm contracts and descends, pushing pressure down, but the pelvic floor ALSO contracts and tries to push pressure up at the same time (instead of eccentrically lengthening) - meaning all the pressure gets pushed out the belly.

This is where we might see a belly pooch on someone who is quite lean. It’s not always body composition, but could be due to pressure and the guts being push forward. In this scenario we need to re-coordinate the diaphragm and pelvic floor relationship, build deep core strength and mobilise the rib cage.

Being able to breathe well is a skill that can make a huge difference to your pelvic floor healing with that pressure having somewhere else to go (not just out the belly) AND it can make a big difference in how your core looks too.

When pressure pushes down on the exhale

The other issue I often see is that women can get a good inhale with 360 expansion into the rib cage and down into the pelvic floor to create length, but then on the exhale they will try to cinch in the at the mid belly and compress or knit the rib cage in together, which inadvertently pushes pressure back down on the exhale, instead of up into the rib cage.

Check out the video below of me demonstrating what this can look like, plus a simple fix to try.

Here’s what I went over in the video:

• what chest only breathing can look like - pressure never gets past the front/top of the rib cage to allow for the diaphragm and pelvic floor to work together - AND the rib cage is stuck in a flared position. The exhale comes from pulling the ribcage/down and in (rectus ab gripping) and pressure pushes down

• when you can get a good 360 inhale, but then on the exhale there’s cinching in at the waist and low ribs (more rectus ab gripping) - pressure pushing down

• diaphragmatic 360 breathing will mean the belly expands a little, however this occurs due to an “overflow” from the whole core canister expanding. What we don’t want to see is the belly expanding like a balloon without any movement in the rib cage or down into the pelvic floor (this was me!)

• a simple fix to try: rest one hand on your low abdomen, right between your hip bones and practice your 360 breathing by expanding the whole thorax and abdomen like a canister. Visualise the pressure of your breath filling your whole rib cage and gently pushing pressure down into your pelvic floor. You should feel the expansion under your hand. On the exhale, begin with a gentle pelvic floor contraction, visualising the bones of the hips drawing in together and up towards your nose (feel how your low belly draws away from your hand?), then through the mid abs, internal obliques and the rib cage with the low ribs melting down towards the floor (no cinching in). You’ll know if you’re ab gripping if your whole chest/sternum pulls down.

• This is something you may need to practice repeatedly to begin to build a new pattern. It won’t happen overnight if you’ve been belly breathing or chest only breathing for a long time.

In order to better manage pressure, we need a dynamic ribcage and pelvic floor and core awareness which allows for that bottom up breath.

We breathe around 22,000 times a day, so you'd think we'd all have it down. But changes in posture or shallow breathing patterns can disrupt the diaphragm/pelvic floor relationship and change how we manage pressure.

If you’re not sure if you’ve got the 360 breathing right try this tutorial.

The breath and pelvic floor healing

The breath is the foundation for pelvic floor healing. Just like building a house, we begin with strong foundations to set us up for the best results.

Our diaphragm, pelvic floor and deep core muscles all work together, so working to build on these foundations means pressure off the pelvic floor and ab wall to aid in closing diastasis, resolve leaking issues and relieve symptoms of POP.

Getting the breathing down can take time, and can sometimes feel boring, but it’s what sets us up going forward.

If you’d like to practice some other breathing positions to get expansion in the rib cage and get pressure up off the pelvic floor check out my Pressure Management Playlist

I’d love to know if you tried the bottom up exhale and if you could tell where pressure was pushing. Do you have any other strategies you like to help with this?

Zoe xx