Breathe For Your Pelvic Health

It may appear a little strange to write a blog about breathing, when it is something that we do 24 hours a day, 7 days a week and have been doing so consciously and subconsciously since we were born!  However, just because breathing is automatic, it doesn’t mean that we do it effectively!  Many people hold their breath without realising, they breathe into their upper chest only, or they don’t breathe in and out all the way.  Being more aware of our breath and optimising the way we breathe can have a profound impact not only on our pelvic health, but our health in general.  

Our Autonomic Nervous System

To understand the effect of breathing on our pelvic health, we first need to understand how the autonomic nervous system works.  The autonomic nervous system is a part of our nervous system that controls the automatic functions of the body that we need to survive.  You may be familiar with the ‘flight or fight’ nervous system (aka the sympathetic nervous system) and the ‘rest and digest’ nervous system (aka parasympathetic nervous system).  Both of these systems are part of your autonomic nervous system.  
The sympathetic nervous system is responsible for increasing our state of alertness and is activated when there may be a threat of danger.  When this system is in play, blood pressure and heart rate increases and pupils dilate (amongst many other processes); whilst digestion, immune response and insulin activity decreases.  These are all  protective responses that prepare our body for ‘fight’ (ie ward off the threat) or ‘flight’ (ie run away from the threat), and reduce activity of other parts of our body that aren’t a priority at that time (eg digestion & reproduction).
The parasympathetic nervous system is responsible for increasing digestion, our immune response, our reproductive system, oxygen circulation to organs and our ability to socially interact with others.  It decreases our defensive responses and allows us to experience joy, compassion, mindfulness and a connection with yourself and others.  This part of our nervous system is working when we have a sense of calmness and safety in our body.
It is commonly thought that we are either in a sympathetic OR a parasympathetic state, where you are in one or the other and there is no middle ground between the two.  However, neuroscience research tells us that our autonomic nervous system acts more like a continuum or a spectrum, meaning that we travel backwards and forwards towards and away from one system to the other.  It is also also often thought that we cannot influence our autonomic nervous system, because it is automatic.  However, neuroscience research also tells us that this isn't true.  We can consciously head towards or away from one nervous system or the other, and breathing is just one way that we can achieve this. 

What Does Breathing Actually Do To Our Nervous System?

Think of breathing as the remote control of the automonic nervous system.  When you need to be in a higher state of alertness eg when you are about to exercise/play a sport or head into an important meeting, heading towards a sympathetic state is helpful.  Have you noticed in this situation that your breathing becomes shallow, faster or you might even hold your breath?  This turns the dial on the remote control towards the sympathetic system.  On the other hand, when you feel calm and relaxed, you might breathe slowly and more deeply into your belly, which means the dial is turned towards the parasympathetic nervous system.  
If the dial on the remote control is turned towards the sympathetic state for prolonged periods of time, it can lead to other problems of pain, muscle tension, anxiety or low/uncontrolled mood swings, just to name a few.  We say this is when your nervous system has become turned up and edgy.  This is commonly associated with pelvic health problems, like pelvic and abdominal pain, pain with sex, constipation or difficulty emptying bowels.

How Does Breathing Relate To Pelvic Health? 

Breathing and the Pelvic Floor Muscles

Think of your torso like a cylinder.  The top of the cylinder is your diaphragm and the bottom of the cylinder is your Pelvic Floor Muscles (PFM).  The sides of the cylinder are made up by your abdominal, back and buttock muscles.  For breathing to be effective, all parts of the cylinder need to be working in harmony.  
A correct breathing in pattern should include:
  • Diaphragm moving down as the ribs and lungs expand
  • Abdominal and back muscles expanding
  • PFM moving down to accept the change in pressure coming from above
If the PFM are too tense or tight, they may not move downwards enough when you breathe in.   This can lead to the diaphragm also not moving downwards and instead, people breathe into the upper parts of their lungs.  This turns the sympathetic nervous system dial up.  In relation to pelvic health, this can lead to pelvic pain, bladder and bowel urgency or difficulty emptying the bladder or bowel.

Breathing and Pelvic Pain

We talked earlier about how the sympathetic nervous system is activated when it senses threat or danger.  Pain is another way that the body tries to automatically protect us from threat or danger. In some situations, this is extremely helpful (eg if you put your hand on a hot plate, you rely on the experience of pain to tell you to move your hand away before you burn your hand).  For people that experience persistent pain, this pain response can be over protective. 
If the sympathetic nervous system is ‘activated’ for prolonged periods of time, this can lead to our nervous system as a whole becoming more sensitive.  When this happens, people may feel that it doesn’t take much activity to experience pain (eg a short walk can cause pain) or they notice that their muscles feel tense or tight, or their bowels become sluggish. 

Breathing and The Bowel

We know how calm, deep breathing stimulates your parasympathetic nervous system, triggering the rest and digest response in your body.  As your lungs expand when you inhale, the diaphragm should descend about 10 cm which almost has a massage effect on your abdominal contents. This helps to aid digestion, thereby assisting with the bowel emptying process.
When we empty our bowels, breathing out completely whilst the belly expands outwards helps the back passage to relax completely, leading to more a more complete sense of emptying.

Breathe For Your Pelvic Health

If you stop and pay attention to the following, it may provide clues that your breathing isn’t  optimal:
  • Your shoulders and upper chest moving up and down when you breathe in
  • Periods of holding your breath (often without realising!)
  • Not feeling like you can breathe in completely
Simply recognising patterns of breathing behaviour can be a huge step forward to making changes to your breathing.  In saying this, we take upwards of 22,000 breaths per day, so it is unrealistic to expect that we are going to get every breath right!  We also aren’t aware of our breathing when we sleep, so we need to be able to train our unconscious mind to breathe well!  We do this by becoming aware of our breath whilst we are awake and improving our breathing patterns during the day.  This leads to our subconscious eventually learning the new way of breathing and starts to adopt this overnight.  
Check in with your breathing by placing one hand on your upper chest and the other on your belly.  Ask yourself:
  • Does my hand on my chest rise and fall more than the hand on my lower  belly?
  • Do I hold my breath at times?
  • Is my inhalation longer than my exhalation?
If you answer yes to any of these questions, these can be signs that there are opportunities to improve your breathing patterns.  When you notice this, stop for a moment and take a few deeps breaths into your lower belly, hold for a couple of seconds and then exhale slowly (exhale longer than your inhalation).  By doing this, you are telling your nervous system to calm down! 
If you feel that your breathing is not optimal or you want to explore the effect that breathwork can have on your pelvic health, talk to one of our Pelvic Health Physiotherapists who can perform a thorough assessment and prescribe you with exercises and strategies to get your breathing (and your pelvic health!) back on track.
June 2023