Breath-Driven Pelvic Floor Regulation: The Missing Link In Your Training & Pelvic Floor Dysfunction
Let’s talk pelvic floor, breathing, and tension. A lot of people are told “you just need to do kegels” or “you just need to do breathwork.” Cute. Also incomplete. What’s actually going on is biomechanics: pressure, position, and coordination between 4 main players that act like one pressure system.
Those players:
Diaphragm (your main breathing muscle under your ribs)
Deep abdominal wall (transversus abdominis, internal obliques, etc.)
Pelvic floor muscles (hammock at the bottom of the pelvis)
Back and pelvic stabilizers that wrap around all of that like a built-in weight belt
These guys team up to control intra-abdominal pressure (IAP) — basically, how much “push” is happening inside your belly canister when you breathe, lift, cough, poop, carry a toddler, etc.
When they coordinate well:
You get spinal support and pelvic stability without gripping.
You can generate force (lift, run, jump) without leaking.
You can relax and lengthen the pelvic floor when you’re not supposed to be “on.”
When they don’t coordinate well:
Pelvic floor stays “on” all the time (hypertonic / overactive).
Hips, low back, tailbone, pelvic pain.
Pee when you sneeze / urgency / feeling like “there’s pressure down there.”
Constipation or “I can’t fully empty.”
That’s not always a weak pelvic floor. Very often it’s a tight pelvic floor that can’t let go. (Yes, those two can exist at the same time. Tight does not mean strong. Ask literally any clenched-up upper trap.) Let’s map what’s supposed to happen so you see why breath work matters.
Meet Your Diaphragm (aka The Ceiling of the Pressure Can)
The diaphragm is a dome-shaped muscle under your rib cage.
When you inhale:
The diaphragm contracts and drops down.
That drop increases pressure in the abdominal canister.
The pelvic floor responds by yielding (lengthening, lowering slightly) to accommodate that pressure. Think “trampoline gently loading,” not “bottoming out.”
When you exhale:
The diaphragm relaxes and rises back up.
The deep abdominals and pelvic floor co-contract and lift, helping push air out, stabilize spine, and regulate pressure. Pelvic floor acts like an expiratory muscle in synergy with the low abs.
So inhale = pelvic floor lets go a bit / lengthens.
Exhale = pelvic floor recoils / lifts.
That rhythmic up-down is how the pelvic floor stays mobile, springy, and responsive instead of “always clenched and pissed.”
Now guess what happens if you are a chronic chest breather, stressed 24/7, and your diaphragm never really drops?
Yeah. The pelvic floor never really gets that natural lengthening input. It just sits there braced. All day. High alert. Sirens on. Then people tell you to kegel more and you kegel on top of a spasm. That’s like squeezing your fist tighter to solve a hand cramp.
Intra-Abdominal Pressure (IAP): Why This Is Not Just “Take a Deep Breath”
Intra-abdominal pressure = the internal pressure your diaphragm, abs, and pelvic floor generate together.
It’s not bad. You literally need pressure to lift, carry, cough, and stabilize your spine. Co-contraction of the diaphragm + abdominals can raise IAP in a way that actually protects the spine by sharing load through the abdominal canister instead of dumping it all into passive structures.
But here’s the catch:
If you only know how to create pressure by bearing down (like you’re trying to poop or “push out”), all of that force aims south.
Over time that can contribute to pelvic heaviness, prolapse-y symptoms, leaking, and irritation in tissues that are already overworked. We’ve seen that abnormal pressure strategies during exertion are linked to pelvic floor dysfunction, especially in people who constantly strain or valsalva poorly.
So the goal is not “never create pressure.” The goal is “create pressure in a way your system can handle without slamming it all into your pelvic floor.” That comes from coordination. Not max clench.
Pelvic Floor ≠ Just Squeeze
Let me be super direct: research keeps trying to figure out why pelvic floor muscle training (PFMT) works for issues like stress urinary incontinence. There’s decent evidence it helps, and PFMT is first-line care internationally.
But the mechanism is not as simple as “just strengthen.” A scoping review looking at proposed mechanisms behind PFMT in women found weak to no evidence that “just getting stronger” alone explains symptom changes, and more support for improving timing / coordination and neuromuscular control.
Translation to human-speak: It’s not only “more pounds of force in your pelvic floor.” It’s “does your pelvic floor show up at the right time, with the right amount of tension, and then chill out when the job is done?”
That right there is why breath work matters. Because breath work is literally motor control training for that timing.
Can Breathing Alone Help with Tension?
Short answer? Yes. Especially if you are someone whose pelvic floor is overactive, clenched, or guarding.
We’ve got emerging evidence that diaphragmatic breathing exercises (especially ones that cue 360° expansion with ribs, belly, back, pelvic floor) can improve pelvic floor symptoms and diaphragm function, and even help with incontinence, when paired with or sometimes even compared to standard pelvic floor training.
Why that matters:
Diaphragmatic breathing encourages the pelvic floor to lengthen on inhale instead of staying in “elevator stuck at floor 10” mode. Slow, resisted exhale asks the pelvic floor to lift and recoil instead of bear down. Over time, that restores the “piston rhythm” between diaphragm and pelvic floor, which is a huge part of down-training an overactive floor.
We also see that when pelvic floor training improves, diaphragm excursion (how well it moves) and rib cage movement can improve, suggesting this is a two-way street. In other words, changing how you breathe can change how your pelvic floor behaves, and changing pelvic floor control can change how you breathe.
Nerd note: this is not mystical. It’s neuromuscular coupling. These muscles literally share pressure and reflexive recruitment patterns. Your body wires them together for postural control, continence, and respiration.
So yeah. Sometimes step one for pelvic pain, urgency, “I always feel clenched,” or tailbone ache is not “strengthen harder.” It’s “teach your pelvic floor how to let go with your inhale, not panic.”
How to Actually Try This (the zero-equipment version)
This is the practical piece I give lifters, runners, postpartum athletes, desk gremlins, anyone with pelvic tension, jaw clenchers, anxious over-breathers, so, basically everyone reading this.
We’re doing coordinated 360° breathing + pelvic floor down-regulation. Here’s how:
1. Position
Start supported and safe. My go-tos:
On hands and knees / crawling position (hips over knees, hands under shoulders)
Child’s pose-ish with elbows propped
On your back with knees bent and feet on the floor
One your back with legs straight up on the wall
Why these? Crawling/quadraped positions seem to increase synergy between the diaphragm and pelvic floor in people with pelvic floor dysfunction where the muscles talk to each other better there. Also, being supported lets you stop “sitting up straight and sucking in,” which is fake core engagement and real pelvic floor tension.
2. Inhale
Breathe in through your nose, slow.
Visualize the air going wide, not just “belly out.” Send expansion into:
low ribs (360° around, front + sides + back),
low belly (but not only just belly)
pelvic floor (imagine your sit bones gently widening / hammock melting / perineum dropping a couple millimeters).
This is not a push or a bear down. It’s “pelvic floor receives pressure and yields.” Soft. Lazy. Melt. If you feel pressure dump straight down like you’re about to pee or poop? That is a red flag for bearing down instead of yielding. Back off the inhale volume. Smaller, quieter breath.
3. Exhale
Exhale through pursed lips like you’re slowly blowing out a candle, long and controlled.
As you exhale, think: lower belly gently wraps in and up, ribs come in, pelvic floor lifts subtly like an elevator going from floor 1 to floor 2.
Not max squeeze. Think “pick up a blueberry, don’t crush it.” (classic cue, still useful when not weaponized into shame.)
4. Repeat for 2–3 minutes
Not 30 seconds. You need enough reps for your nervous system to register “oh, we’re safe, we can drop baseline tone.”
5. Bonus: check jaw and glutes
If your jaw is clenched or your butt is squeezed, your pelvic floor is almost always co-clenching in solidarity. Unclench both every couple breaths. Yes, really.
What this is doing:
It’s reteaching your pelvic floor to cycle (lengthen / recoil) instead of living at max resting tone.
It’s regulating sympathetic drive. Slower exhales shift you toward parasympathetic, which alone can drop pelvic floor guarding, because your pelvic floor is absolutely part of your stress response. (If you’ve ever almost peed from being scared, hi. Same system.)
This is the base layer before we load. You don’t earn (ugh that word) squats and deadlifts by “fixing” your breath first (you can lift while you work on this) but if you’re chasing pelvic floor symptoms and you never address pressure, you’re basically trying to fix a leaky sink by mopping the floor forever.
When This is NOT Enough (and when to get help)
Breathing drills are powerful. They’re not a magic wand.
You 100% should get a pelvic floor PT eval or work with our pelvic floor physical therapist, Dr. Claire, remotely, especially if you have:
Persistent leaking with impact or heavy lifts
Pelvic heaviness, bulging, “tampon is falling out” sensation
Pain with penetration, tampons, pelvic exams
Pelvic pain that spikes with stress and never fully calms
History of birth trauma, endometriosis, pelvic surgery, or abdominal surgery
Chronic constipation / straining
Why? Because sometimes your “tightness” is actually guarding around something irritated, sometimes your symptoms are load-related strength deficits, and sometimes we need hands-on work, coordination drills, AND progressive strengthening (yes, including lifting decently heavy) in smart positions. Recent trials are literally combining pelvic floor muscle training with targeted diaphragm work and seeing better outcomes for continence and function than respiratory work alone.
So, breath can downshift tone and improve coordination. Breath alone is not a full rehab plan for everyone. Anyone selling you “just do this one breathing hack to heal prolapse” is selling vibes, not evidence.
The TL;DR You Can Screenshot
Your diaphragm (top), abs (sides), and pelvic floor (bottom) are one pressurized system, not separate muscles. They share load and timing to stabilize your spine, support organs, and keep you continent.
On a normal inhale, the diaphragm drops and the pelvic floor yields/lengthens. On a normal exhale, the pelvic floor recoils/lifts.
If you live in high tension (stress, posture bracing, always “hold your core in”), that natural cycle can shut down. Hello pelvic floor tightness, urgency, pain.
Diaphragmatic / 360° breathing in supported positions can retrain that cycle and reduce baseline tone, and early research shows it can improve pelvic floor coordination and symptoms.
This is step one, not step only. If you’re in pain, leaking, or feeling pressure, get evaluated by someone who treats pelvic floors like part of a system, not as an isolated “just kegel harder” project.
Your pelvic floor is not supposed to be locked “on” forever. You’re allowed to unclench.
And yes, that includes your jaw right now. UNCLENCH.
If you don’t know how to navigate this on your own, and want the help of professionals who know lifting, running, living, AND the pelvic floor, apply to work with me and my team!
