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  • Writer's pictureDr. Rebecca Alexander, PT, DPT, E-RYT

The Link Between the Pelvic Floor and Diaphragmatic Breath

Updated: Dec 2, 2020

By Dr. Rebecca Alexander, PT, DPT, E-RYT.

The relationship between the diaphragm muscle and the musculature in the pelvic floor is not widely known, yet the coordination of these areas serves an important role.

The pelvic floor is composed of three separate layers of muscles that sit like a bowl inside of the pelvis and are surrounded by connective tissue (fascia). These muscles assist in supporting all bowel, bladder, and sexual functions. The pelvis is also home to vital organs including reproductive viscera, bladder, urethra, prostate, and rectum. Function or dysfunction in this region of the body depends upon the health of our pelvic floor muscles- and their function relies on how we breathe.

Wondering how? Allow me to explain!:

When we inhale, air moves into the lungs at the same time that the diaphragm muscle- located at the bottom of the ribcage- begins to move downward. This helps to create more space inside of the ribcage for the lungs to expand. When we exhale the opposite happens: the lungs deflate, and the diaphragm muscle moves upward to its resting position. See the below image.

So how does this relate to the pelvic floor muscles, you might ask? Take a deep breath, then keep reading.

The pelvic floor sits parallel to the diaphragm muscle and below it, so when you take a breath in (picture on left) your pelvic floor moves in the same direction: downward. On the exhale? You guessed it: upward. This relationship serves to impact how we perform other things besides breathing at rest. For example, it impacts how we cough, jump, run, sneeze, or stand from a chair. When there are big pressure changes that happen and the diaphragm muscle is involved (say, when you cough)- the pelvic floor should move in the same direction as the diaphragm.

Often for reasons unknown, our pelvic floor muscles don’t coordinate with the diaphragm muscle. They may lower downward on an exhalation, a jump, or a cough and this can push a small (or large) amount of bowel or bladder out. This is called “stress incontinence”. The incontinence occurs because of a change in pressure in the abdomen, and the muscles aren’t coordinated when the pressure change is happening.

The pelvic floor muscles may also play a role in urinary frequency or urgency, constipation, pelvic pain, tailbone pain, hip pain and/or prolapse. If any of the above sounds familiar, know that you are not alone! Also: I want you to know that there are specialists who work with patients to treat symptoms just like yours.

Just because something is common doesn’t mean it is “normal”, nor does it mean it is something that can’t be improved! Too often incontinence gets normalized or laughed off, we are told kegels are the only solution, or we feel that after a certain age or stage of life that intimacy with a partner may not be feasible.

Pelvic floor rehabilitation is a specialty practice area of physical therapy that focuses on the musculature that sits inside of the pelvis. We evaluate patients as a whole, incorporating lifestyle, diet, movement, and functions into our assessments. We strategize to build a comprehensive plan, partnering with our patients to meet goals.

Often, this treatment begins with using our breath, and incorporating the diaphragm muscle. The utilization of healthy diaphragmatic breath coordinated with movement of the pelvic floor is a key component to maintaining health. Our pelvic floor is the base of our core and trunk, and it assists with stability during walking, running, sitting, squatting- any movement!

If you want to start incorporating your diaphragmatic/pelvic floor breath into a daily routine, here are some tips I use with patients:

● Start by lying on your back

● Place your hands on the abdomen, make your hands rise and fall

● On the inhale: abdomen lifts / On the exhale: abdomen lowers

On the in breath: peace

On the out breath: love

Rebecca Alexander is a physical therapist, artist, and yoga instructor. She received her Doctorate in Physical Therapy from SUNY Upstate, where she now practices full time as a clinician and specialist in the Pelvic Rehabilitation program. Dr. Alexander also has post-doctoral specialty in pelvic floor rehabilitation and yoga for pelvic health.

For more information please visit or contact

Instagram: @drrebeccadptryt

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