Breathing, (S)Training and the Pelvic Floor—A Basic Concept

Abstract

Background: The current scientific literature is inconsistent regarding the potential beneficial or deleterious effects of high-intensity physical activities on the pelvic floor (PF) in women. So far, it has not been established with certainty whether disparate breathing mechanisms may exert short- or long-term influence on the PF function in this context, although based on the established physiological interrelationship of breathing with PF activation, this seems plausible. Objective: To propose a basic concept of the influence of different breathing patterns on the PF during strenuous physical efforts. Methodical approaches: Review of the recent literature, basic knowledge of classical western medicine regarding the principles of muscle physiology and the biomechanics of breathing, additional schematic illustrations, and magnetic resonance imaging (MRI) data corroborate the proposed concept and exemplify the consequences of strenuous efforts on the PF in relation to respective breathing phases. Conclusion: The pelvic floor muscles (PFMs) physiologically act as expiratory muscles in synergy with the anterolateral abdominal muscles, contracting during expiration and relaxing during inspiration. Obviously, a strenuous physical effort requires an expiratory motor synergy with the PFM and abdominal muscles in a co-contracted status to train the PFM and protect the PF against high intra-abdominal pressure (IAP). Holding breath in an inspiratory pattern during exertion stresses the PF because the high IAP impinges on the relaxed, hence insufficiently protected, PFMs. It seems conceivable that such disadvantageous breathing, if performed regularly and repeatedly, may ultimately cause PF dysfunction. At any rate, future research needs to take into account the respective breathing cycles during measurements and interventions addressing PFM function.

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence

“…The thickness change of TrA muscle was greater in healthy individuals compared to SUI patients in deep expiration and coughing. IAP during expiratory efforts requires the proper function of all abdominal muscles [6]. Anatomically, TrA muscle wraps around the abdominal cavity, and the fibers are placed horizontally.…”

“…Nevertheless, a weak association has been reported between PFM strength and urinary continence during tasks that increase intra-abdominal pressure (IAP) [4,5]. The PFMs do not act in isolation; instead, they are activated in synergy with other muscles surrounding the abdominal cavity during increased IAP [6].…”

Can you breathe yourself to a better pelvic floor? A systematic review

“…The rationale for suggesting breathing exercises into PFMT programs is the belief that there is a facial connections between the respiratory diaphragm and the pelvic floor. 7,8,12,21 Tim and Mazur-Bialy 50 claimed that PFM are linked by myofascial connections with the respiratory diaphragm, TrA, intercostal muscles, oblique abdominal muscles, and thoracolumbar fascia. This suggestion needs to be substantiated with evidence from basic cadaver and imaging studies of anatomy.…”

“…Due to its location at the lower part of the abdominal canister, it has been suggested that the PFM works in orchestra with abdominal muscles and the thoracic diaphragm 7,8 . Based on this some authors have suggested that “nonoptimal strategies for posture, movement, and/or breathing create failed load transfer which can lead to UI.” 9 Likewise, some authors claim that the PFM is important for breathing function, 7,10,11 and that holding the breath in an inspiratory pattern during exertion stresses the PFM and may cause pelvic floor dysfunction (PFD) 8 . In addition, it was suggested that “an expiratory motor pattern during body work‐outs and strenuous efforts is likely to protect and even train the cocontracted PFMs and lower abdominal muscles.” 8 Furthermore, Toprak et al 12 hypothesized that pelvic floor function can be improved by performing diaphragmatic breathing exercises, indirectly via what they claimed to be a facial connection between the diaphragm and PFM, and that incontinence could be reduced.…”

“…6 Due to its location at the lower part of the abdominal canister, it has been suggested that the PFM works in orchestra with abdominal muscles and the thoracic diaphragm. 7,8 Based on this some authors have suggested that "nonoptimal strategies for posture, movement, and/ or breathing create failed load transfer which can lead to UI." 9 Likewise, some authors claim that the PFM is important for breathing function, 7,10,11 and that holding the breath in an inspiratory pattern during exertion stresses the PFM and may cause pelvic floor dysfunction (PFD).…”