This post explores relearning how to breathe in order to help your pelvic floor function better. Additionally, we’ll discuss how much or how often you should be contracting your pelvic floor.
Changing your breathing pattern might sound intimidating or even annoying, but it is an imperative step to helping you move and feel better. Because breathing is something that we do all day long (roughly 25,000 times), if you knew there was a better way to breathe, wouldn’t you want to do it? Especially if it could help get your abs back or stop that urine leakage that happens more often than you’d like to admit since your first pregnancy? Breathing more effectively can minimize or eliminate any nagging back pain too (1, 2).
To get started, let me introduce “Core Connection Breathing” with a 360 degrees of expansion breathing pattern. This requires connecting your core to your breath (more on how to do that in a moment) to make your core muscles work better for you.
But first, what do I mean by the core? Picture a cylindrical canister, like a can of soda.
The top of the canister is your diaphragm muscle. The bottom consists of your pelvic floor muscles. The front is made up of your deep transverse abdominis muscles, and the back consists of your deep multifidi muscles.
Due to this innate structure, the pelvic floor muscles don’t contract in isolation but rather in cooperation with all of these muscles that make up your abdominopelvic canister (3).
So how exactly do I connect all of those muscles that make up my “core” to my breathing pattern?
Watch these two short breathing video to learn how:
Taking it one step further, engage the muscles of the abdominopelvic canister.
So putting it all together:
First – Inhale through your nose.
Breath in through your nose into your belly, back, and sides for 360 degrees of expansion.
Next – Exhale through your mouth.
Breath out gently through pursed lips as if you are breathing out through a straw.
Then – Contract your muscles from the bottom up.
By exhaling and thinking about contracting your pelvic floor muscles first at the bottom and then your deep transverse abdominal muscles at the front of your canister, it helps prevent getting mixed up and “bearing down” which is not ideal for your pelvic floor in regards to managing pressure.
Now, what you may have suspected but not realized, is that if you followed the last step in the instructions in the video, you just did what most people call a “kegel.” And you did it the right way. Unfortunately, most women doing kegels aren’t doing them correctly because they’ve never really been taught how to do them. Just being told to “squeeze down there” is not enough. It’s a disservice to women that they are not instructed in more detail.
You now know the proper way to do it. Any time you attempt a kegel, remember to Exhale and Engage simultaneously. E + E = keeps away the pee.
Now that you’ve been taught how to use your breath to make your core muscles more effective, spend some time relearning, reconnecting, and reinforcing this pattern.
Exhale from the bottom up to do a KEGEL the RIGHT WAY.
On average, a person takes 12-20 breaths per minute. This means that in a 24 hour period, the average human takes about 25,000 breaths. That is a lot of opportunity to practice!
Practice this lying on your side first, then while lying on your back with your knees bent up. Eventually, try it while you’re sitting and standing too. You can do it while you are driving in your car, reading your children books at night, or waiting in line at the grocery store. Make it a habit to incorporate it into your daily routine. Some opportunities may be each time you sit down to nurse your baby or while you’re trying to fall asleep at night because your mom-mind won’t slow down thinking about all it needs to get done the next day.
How many kegel exercises should you do? That is a loaded question and unfortunately, hard to answer since it should be based on each individual person’s symptoms and needs. The research reveals a variety of protocols ranging from five to 200 repetitions per day! It is clear that there is no consensus on the amount of exercise required to improve pelvic floor function because multiple factors contribute to outcome (4).
Some research recommends doing six sets of 10 repetitions per day to see real improvement (if you have mild pelvic floor dysfunction) (5). I encourage you to attempt this, but do not become frustrated if you aren’t able to reach this number. It’s more important that you are activating your core muscles effectively. Quality is far more important than quantity when it comes to doing your kegels and breathing in a better way will help ensure you achieve this. Breathing better and doing kegels the right way post-partum could help you decrease your risk of incontinence and minimize back and pelvic girdle pain (6). This alone will help you move better in order to mom better.
And yes, those mamas who’ve had a cesarean section, you should care too. You aren’t protected against changes in pelvic floor anatomy (7), but more importantly, this approach will help your abdominal muscles heal to expedite recovery from the major abdominal surgery you underwent.
One quick word of caution though: Kegels are not for everyone. If something feels odd or causes pain or discomfort as you try these suggestions, see a women’s health physical therapist. Remember, inhaling and relaxing is just as important as exhaling, especially in cases of chronic pelvic pain.
- Kang, Jeong-Il, et al. Effect of exhalation exercise on trunk muscle activity and oswestry disability index of patients with chronic low back pain. Phys. Ther. Sci. 2016; 28: 1738–1742.
- Smith MD, Russell A, and Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Australian Journal of Physiotherapy. 2006; 52: 11-16.
- Hankyu Park, M, et al. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J. Phys. Ther. Sci. 2015; 27: 2113–2115.
- Marques, A., et al. The status of pelvic floor muscle training for women. Canadian Urological Association Journal. v.4(6); 2010 Dec PMC2997838.
- Hagen, Suzanne. A randomized controlled trial of pelvic floor muscle training for stage I and II pelvic organ prolapse. Urogynecology Journal 2009;20(1):45-51 doi: 10.1007/s00192-008-0726-4.
- ElDeeb, Abeer M. Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation. 2019; vol. Pre-press, no. Pre-press, pp. 1-8.
- G.A. Van Veelen, et al. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy. Ultrasound Obstet Gynecol 2014; 44: 476–480.