But First – Just Breathe!

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Common Breath Cues in Pelvic Rehab

Alignment first
Expand on inhale/contract on exhale
Relax on inhale/ engage on exhale
“Blow before you Go” – start your exhale before exerting effort (i.e. lifting, standing)
Umbrella breathing – open rib cage around the spine on inhale and allow it to close on exhale your rib cage
Pelvic Floor Cues – Drop/open on inhale, close and life on exhale

Wowza that’s a lot of instruction!!! Since when was is it so freaking hard to breathe?!?! Unfortunately, a common experience for folks in pelvic rehab is the perception that they are breathing “wrong” and therefore they have to relearn how to breathe “properly”. The amount of effort that is often asked of people to learn how to breathe “correctly” can be incredibly overwhelming, making the breath seem far too complicated.

Don’t get me wrong! I use these cues and they can be very helpful. BUT… I think that we, your guides on this journey (OTs/PTS/Yoga instructors/fitness Pros/ETC), need to be much more intentional about the language that we use during this process to help you connect with your breath in ways that promote healing vs. contribute to rigidity, fear and stress.

What the heck does my breath have to do with my pelvic floor?

One of the functions of the pelvic floor muscles is to work in collaboration with our other deep core muscle groups (the diaphragm/breathing muscle, the transverse abdominus/the deepest abdominal layer, and the multifidus/muscles running along our spinal column) to regulate the changes in pressure in our chest, abdominal, and pelvic cavities as we breathe and move throughout the day. TYPICALLY as we inhale, the rib cage expands, the diaphragm descends, and the abdominal and pelvic floor muscles relax to accommodate the breath. As we exhale, the pelvic floor muscles recoil, the abdominals are gently drawn back in towards the spine, the diaphragm ascends, and the rib cage closes around the spine. This generally happens without much effort.

But…is it a problem if these actions are not happening with every breath? NO!!!!!!!!!! In fact, the capacity to VARY our breath and the action of these muscles groups in response to different types of movement and demands can be incredibly adaptive!

So WHY do we use “the typical breath” and these cues to facilitate pelvic health recovery?

Pelvic floor dysfuntion is OFTEN a sign that we could benefit from more variety in our breathing or movement patterns as opposed to the philosophy or perspective that we are breathing or moving “wrong”

We can use a couple of cues to guide you to connect to these TYPICAL breathing patterns in order to help you to build a map/connection to these deep core muscles so that you can more readily access them as you play with variation in your breathing and movement. Accessing & integrating this TYPICAL (NOT ‘CORRECT’!) breathing pattern into movements or activities that are triggering for your symptoms (i.e. pain, pressure, leaking, bulging) can be particularly helpful. We are playing with new strategies to find what feels good for YOU!

A pathway into the nervous system

With most (if not all) pelvic health challenges (i.e. persistent pelvic pain, urgency, pelvic organ prolapse), the nervous system plays a central role in the experience of symptoms. When we are in pain, feeling very anxious, or otherwise feeling threatened, the sympathetic nervous system (SNS; our fight/flight) system is leaping into action. The SNS is a branch of the autonomic nervous system (ANS) which operates largely outside of our conscious control. However, we can tap into the ANS by intentionally manipulating the breath in ways that inform the nervous system that you are safe and that bring about a sense of calm. This can have a huge impact on pelvic health symptoms. Connect on Social Media as I provide some tips/tricks for tapping into the nervous system using the breath in our Wellness Wednesdays over the next several weeks!


Before we try to manipulate or cue the breath for connection, variability, and self-regulation, it can be useful to practice simply observing the breath! The breath can be an informative window into the body , nervous system and believe it or not, even our beliefs about our body and how it “should” look and function. How our muscles tend do move (or don’t) with the breath can tell us where there may be tension. The rate, depth, and balance of our inhale/exhale can tell us about the balance within our autonomic nervous system in a given moment. These observations are not good or bad but USEFUL. This process often prompts a conversation about how you may have been told you “should” be breathing and even some thoughts you might have related to body image (i.e. is it difficult to let your tummy relax?). These observations and conversations can help with identifying the type of work that will best support you with reconnecting to your body AND finding variations that feel good to you and reduce your experience of symptoms.

The Breath As An Anchor

There is an individuality as to whether or not the breath is a helpful tool for managing high levels of anxiety or distress. Without manipulation, some find it helpful to observe the breath in order to get anchored back into their body and the present moment. However, for others, observing or trying to manipulate the breath (as discussed above) can contribute to further anxiety. In these instances using the senses OR movement to get anchored back to the body and the moment can be a a useful approach! The breath will follow without conscious effort! Check out this strategy called, Dropping Anchor, which uses the senses as opposed to the breath.

***As always, connect with a pelvic health therapist for individualised support!***

Written by: Lara Desrosiers O.T. Reg. (Ont.), Occupational Therapist