Pelvic Floor Exercises: Breathing Techniques, Benefits, and Common Mistakes

How to Breathe When Doing Pelvic Floor Exercises?

Proper breathing is paramount when performing pelvic floor exercises, primarily involving exhalation during the contraction phase and inhalation during relaxation to optimize muscle engagement, manage intra-abdominal pressure, and enhance overall core stability.

The Interconnectedness of Breath and Pelvic Floor

The pelvic floor muscles are an integral part of your "inner core" or "core canister," working in synergistic harmony with the diaphragm (your primary breathing muscle), the transversus abdominis (deepest abdominal muscle), and the multifidus (deep spine stabilizers). This system is designed to manage intra-abdominal pressure (IAP) and provide stability for movement and posture. When you inhale, your diaphragm descends, increasing IAP and causing the pelvic floor to naturally descend and lengthen. Conversely, when you exhale, the diaphragm ascends, reducing IAP, and the pelvic floor naturally lifts and shortens. Understanding this intrinsic connection is fundamental to effective pelvic floor training.

The Foundation: Diaphragmatic Breathing (Belly Breathing)

Before coordinating breath with pelvic floor contractions, it's crucial to master diaphragmatic breathing, often called "belly breathing." This ensures you're not using accessory neck and shoulder muscles for respiration, which can create tension and dysfunctional breathing patterns.

How to Practice Diaphragmatic Breathing:

• Position: Lie on your back with knees bent, feet flat on the floor, or sit comfortably upright. Place one hand on your chest and the other on your belly.
• Inhale: Breathe in slowly and deeply through your nose. Focus on allowing your belly to rise, feeling your hand on your belly lift, while your chest remains relatively still. Imagine filling your lower lungs.
• Exhale: Exhale slowly and completely through your mouth, letting your belly gently fall. Feel your hand on your belly move inward.
• Focus: Maintain a relaxed jaw and shoulders. The movement should primarily be in your abdomen, not your chest.

Coordinating Breath with Pelvic Floor Contractions: The Standard Approach

The most widely recommended and effective method for coordinating breath with pelvic floor exercises (Kegels) is to exhale on the contraction and inhale on the relaxation. This strategy aligns with the natural mechanics of the core canister and helps manage intra-abdominal pressure.

1. Exhale on Contraction (The Lift):

• As you begin to exhale slowly through your mouth (imagine blowing through a straw or sighing), gently engage your pelvic floor muscles.
• Action: Think of drawing your pelvic floor muscles up and in, as if you're trying to stop the flow of urine, hold back gas, and lift a blueberry with your vagina (for women) or lift your testicles (for men).
• Why: Exhaling causes the diaphragm to ascend, which naturally facilitates the upward lift of the pelvic floor and helps to reduce intra-abdominal pressure. This synergy allows for a stronger, more isolated contraction without straining or bearing down.

2. Inhale on Relaxation (The Release):

• As you inhale slowly through your nose (diaphragmatically), completely release your pelvic floor muscles.
• Action: Allow your pelvic floor to fully lengthen and descend. This is as crucial as the contraction itself, as it prevents muscle hypertonicity (over-tightness) and allows for full blood flow and recovery. Think of "letting go" or "blossoming open."
• Why: Inhaling causes the diaphragm to descend, naturally encouraging the pelvic floor to lengthen and relax. A full relaxation is vital for muscle health, elasticity, and optimal function.

Practical Application:

• For "Quick Flicks" (Fast Contractions): Inhale, then as you quickly exhale, perform a rapid pelvic floor squeeze and lift, immediately followed by a full release as you inhale again.
• For "Long Holds" (Endurance Contractions): Inhale, then as you exhale, perform your pelvic floor lift and hold the contraction for the desired duration (e.g., 5-10 seconds). Continue to breathe normally (diaphragmatically) while maintaining the lift, ensuring you don't hold your breath or strain. Then, fully release on your next inhale.

Advanced Breathing Considerations and Techniques

While the exhale-on-contraction approach is standard, it's important to understand other breathing patterns and their implications.

• Reverse Breathing: This is a dysfunctional breathing pattern where the abdomen draws in on inhalation and pushes out on exhalation. It is generally NOT recommended for pelvic floor strengthening exercises, as it can increase intra-abdominal pressure during inhalation (when the pelvic floor should be relaxing) and potentially contribute to pelvic floor dysfunction or prolapse symptoms. While some advanced practitioners may use specific reverse breathing patterns for release or mobility in very specific therapeutic contexts, it should never be the default for general strengthening.
• Valsalva Maneuver (Holding Your Breath and Bearing Down): This involves taking a breath, holding it, and then straining or bearing down, often seen during heavy lifting or bowel movements. This should be strictly avoided during pelvic floor exercises. The Valsalva maneuver dramatically increases intra-abdominal pressure, which can push down on the pelvic floor, potentially exacerbating weakness, contributing to prolapse, or causing hemorrhoids. It also raises blood pressure significantly.

Common Breathing Mistakes to Avoid

• Holding Your Breath: This prevents proper pressure management and can lead to straining.
• Shallow Chest Breathing: Does not engage the diaphragm or effectively coordinate with the pelvic floor.
• Bearing Down/Pushing Out: This counteracts the lifting action of the pelvic floor and can cause harm.
• Tensing Other Muscles: Clenching glutes, inner thighs, or abdominal muscles excessively indicates improper isolation.
• Reverse Breathing (for strengthening): As discussed, this is generally counterproductive for strengthening the pelvic floor.

Integrating Breathing into Pelvic Floor Exercises

• Conscious Practice: Always begin by consciously coordinating your breath with your pelvic floor contractions.
• Daily Activities: Once you've mastered the coordination, try to incorporate it into everyday movements like lifting objects, coughing, sneezing, or getting up from a chair. Exhale and gently engage your pelvic floor before the effort.
• Exercise Integration: Apply the same principle during other exercises. For example, when performing a squat, exhale and engage your core and pelvic floor as you stand up.

Benefits of Proper Breathing for Pelvic Floor Health

• Optimized Muscle Engagement: Synergistic action leads to more effective and targeted strengthening.
• Improved Intra-Abdominal Pressure Management: Reduces strain on the pelvic floor and prevents downward pressure.
• Enhanced Core Stability: Contributes to a more functional and stable core unit.
• Better Posture: An engaged core and pelvic floor support spinal alignment.
• Reduced Risk of Dysfunction: Proper technique helps prevent or alleviate issues like incontinence and prolapse.
• Stress Reduction: Diaphragmatic breathing itself promotes relaxation and reduces stress.

When to Seek Professional Guidance

If you are experiencing persistent pelvic floor dysfunction (e.g., incontinence, pelvic pain, prolapse symptoms), or if you find it difficult to identify and control your pelvic floor muscles, consult with a Pelvic Floor Physical Therapist. These specialists can provide a thorough assessment, personalized guidance, and advanced techniques to ensure you are performing exercises correctly and safely.

Mastering the coordination of breath with pelvic floor exercises is not merely a technicality; it is a fundamental pillar of effective and safe pelvic floor training. By harnessing the power of diaphragmatic breathing and aligning your exhalation with contraction, you unlock the full potential of your pelvic floor muscles, contributing significantly to your overall core health and functional well-being.