Is your breathing affecting your pelvic floor?

Written By Katie Brydges

Breathing mechanics, strength, and pelvic floor health

As a personal trainer working with women, pelvic floor issues come up all the time - often quietly, often brushed off, and very often misunderstood.

Pelvic floor dysfunction (PFD) is highly prevalent among women. It can present as incontinence, pelvic organ prolapse, pain, and reduced quality of life.

Leaks when you sneeze/walk/jump/run, feelings of heaviness or dragging, pain or discomfort - they all count.

The pelvic floor is not an isolated muscle

Traditional approaches have focused on isolated pelvic floor exercises (‘lift and squeeze’), but the pelvic floor does not function independently.

It works as part of a pressure system alongside:

  • The diaphragm (your primary breathing muscle)

  • The abdominal wall

  • The deep core and spinal stabilisers

Together, these structures regulate pressure inside your body every time you:

  • Breathe

  • Lift

  • Run

  • Cough

  • Or even just stand upright

When this system is functioning well, everything moves in coordination.

When it’s not, symptoms can begin to appear.

Can breathing influence pelvic floor function?

Research increasingly suggests that it can.

The diaphragm and pelvic floor move in coordination:

  • On inhalation, the diaphragm descends and the pelvic floor lengthens

  • On exhalation, both recoil and can contribute to support and control

Studies have demonstrated a clear relationship between breathing mechanics and pelvic floor activity, with further evidence showing that training the diaphragm and breathing patterns can improve pelvic floor strength and endurance.

In simple terms:
Your pelvic floor responds to how you breathe.

Breath is also one of the primary ways we influence the nervous system. If the body is in a constant state of tension or alert, the pelvic floor often reflects that, remaining tight, guarded, or unresponsive.

The modern problem: dysfunctional breathing patterns

Many women that I work with present with breathing patterns that are:

  • Chest-dominant

  • Restricted through the ribcage

  • Accompanied by abdominal bracing

Layer onto this:

  • Stress

  • Pregnancy and postnatal recovery

  • The intensity of caring for young children

  • Sedentary lifestyles

  • Common gym cues like ‘brace your core’

    and the result is often a system that is rigid, pressurised, and poorly coordinated.

This can contribute to:

  • Excessive downward pressure on the pelvic floor

  • A pelvic floor that is overactive, tense, or unable to fully relax

Both are recognised contributors to dysfunction.

Our holding patterns are often habitual. Over time, we lose the ability to feel and release tension, particularly in areas like the pelvis.

It’s about more than strength

A key shift in both research and clinical practice is this:

Pelvic floor dysfunction is not always a strength problem.

It is often a coordination problem.

This may include:

  • Altered timing between diaphragm and pelvic floor

  • Reduced ability to lengthen and relax

  • Inefficient pressure management

While pelvic floor strengthening remains important, evidence suggests that breathing interventions can enhance outcomes when combined with targeted training.

Equally, improving awareness - being able to sense what the pelvic floor is doing, rather than just contracting it on command - can be a missing piece for many women.

A more effective approach: strength + breath + system health

In practice, the most effective approach is integrated, and includes:

1. Whole-body strength training

Building strength across the entire body improves load tolerance, posture, and pressure management. The pelvic floor does not work in isolation during real-life movement, so training shouldn’t either.

2. Breathing and diaphragm control

Restoring more efficient breathing mechanics helps re-establish coordination within the system and reduces unnecessary strain on the pelvic floor.

3. Fascia and tension management

Restrictions through the diaphragm, ribcage, abdomen, or hips can all influence how pressure is distributed.

Addressing this may involve:

  • Mobility work

  • Soft tissue or fascial release

  • Reducing chronic gripping or bracing patterns

But also, importantly:

  • Relearning how to feel and release tension

  • Developing awareness of the pelvic area without immediately trying to ‘fix’ it

This is where more holistic frameworks add value - reminding us that function improves not just through effort, but through restoring variability, responsiveness, and awareness.

What this means in practice

Moving beyond ‘just do your Kegels’, we need to ask:

  • Can you breathe into your ribcage, back, and lower abdomen?

  • Can your pelvic floor respond naturally to that breath?

  • Can you fully relax, as well as contract?

  • Are you managing pressure effectively when you lift, run, or train?

  • Can you actually feel what’s happening in your pelvic floor?

These questions are often where meaningful progress begins.

The bottom line

Pregnancy, hormones, and muscle strength all play a role in pelvic floor health.

But breathing mechanics, movement patterns, and overall system function are often overlooked.

Improving how you breathe will not fix everything in isolation.

However, when combined with:

  • Appropriate strength training

  • Improved coordination

  • Reducing unnecessary tension

  • Greater body awareness

it can make a significant difference to how your pelvic floor functions, and feels.

Your pelvic floor does not work in isolation.

Your training shouldn’t either.

References

  • Bø, K. et al. (2023). Can you breathe yourself to a better pelvic floor? A systematic review

  • Kocjan, J. et al. (2020). The role of the pelvic floor in respiration: A systematic review

  • Randomised trial (2019). Diaphragm and abdominal training effects on pelvic floor strength

  • Recent 2024 study on diaphragm–abdominal–pelvic floor synergy in women with PFD


Katie Brydges
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