Diaphragmatic Breathing for Pelvic Health: A Somatic Pelvic PT’s Guide
Authored by Dr. Karah Charette, PT, DPT, RYT
Are you confused about what true diaphragmatic breathing is?
Do you want to understand the difference between diaphragmatic breathing and belly breathing?
Do you want to know why diaphragmatic breathing matters for pelvic health, the core, and the nervous system?
You are in the right place! At Bodyful, we highly value diaphragmatic breathing as a foundation for pelvic health and movement integration. Keep reading to learn why!
Why Diaphragmatic Breathing Matters for Pelvic Health
The body has many diaphragms. The pelvic floor is actually a diaphragm and is sometimes referred to as the pelvic diaphragm. When talking about breathing, the diaphragm underneath your ribcage is called the respiratory diaphragm.
Both of these diaphragms have a relationship to each other. They form the relative top and bottom of a closed pressure system that is actually our true core. Forget the “six pack abs” ideas around core strength. Your core is meant to absorb shock and manage pressure to offload your spine and prevent injury or compression.
If you can understand the respiratory diaphragm is part of this closed pressure system, you may begin to understand that if there is a pressure change in that system, all of the other muscles (including the pelvic floor) will respond.
How do we create a pressure change? Through true diaphragmatic breathing patterns. Diaphragmatic breathing is not belly breathing. Though we still want the belly to gently rise and expand during our inhales, it should not be the sole point of initiation or focus.
Our respiratory diaphragm is underneath our ribcage, not in our belly or abdomen. In order to get this muscle to truly expand and engage with breathing, one of the better cues and images is to let your ribcage expand. If possible, focusing on letting the ribcage expand to the sides and even the back of your body is even better as this is where a majority of the fibers of the respiratory diaphragm live.
If you are able to begin training in this practice, what happens is that when you inhale the diaphragm expands and relatively goes down. You can almost imagine what it was like to play with those parachutes in gym class. When the parachute expanded, it also moved lower to the ground. This is important because when we inhale we want our lungs to expand. The respiratory diaphragm is below the lungs and so when it expands and goes down, it creates more space for the lungs to expand and take in air.
When you exhale, it is like that same parachute is now slackening and coming together. In this case, the diaphragm is elastic, like a rubber band, and it requires minimal effort to recoil and return back to its original resting place. This place is where the diaphragm is shortened and sitting a little higher up under the ribcage.
Perhaps you take a moment to pause right now. Place your hands on your ribcage and feel this for yourself. What do you notice?
If you can begin to feel or imagine this, you are on your way to true diaphragmatic breathing. However, there might still be the question of how this connects to the pelvic floor? If you can remember that the respiratory diaphragm is the top of this closed system and the pelvic floor is the bottom, let’s now explore what happens when the respiratory diaphragm expands.
When the respiratory diaphragm expands and goes down, it creates a pressure change in this closed system. As pressure increases because the diaphragm has moved down, the pelvic floor must respond by also expanding and moving relatively downwards to accommodate the change. Therefore, a healthy pelvic floor will begin to move just as the diaphragm does, with gentle expansion on the inhale and passive recoil on the exhale.
This is how you begin to regulate your pelvic floor through diaphragmatic breathing patterns. It is not about always relaxing or always tightening your pelvic floor, but rather returning the freedom of movement and range of motion with breathing. This prevents the muscles from getting too stiff and helps promote blood flow and even relative nerve glides to the nerves within the pelvic floor.
Diaphragmatic breathing can provide substantial change, health, and regulation to the pelvic floor when taught and assessed by a trained pelvic floor physical therapist.
How Somatic Pelvic Floor Therapists Approach Diaphragmatic Breathing
At Bodyful, our pelvic floor physical therapists value a somatic approach to teaching and embodiment. We often start with imagery and tactile feedback in order to help you not just understand this concept cognitively, but also to help you feel it in your body.
Once you have begun to explore connecting to this new movement, we might begin to facilitate integration into more functional and meaningful movements for you. Diaphragmatic breathing can be a meditative practice, and it can also be used to support your core and trunk when doing functional movements that might be painful for you. Learning how to integrate diaphragmatic breathing into posture and dynamic movements is essential in allowing this practice to create more sustainable results.
As somatic movement therapists, we value going slow, creating space for being in the question, and allowing you to have your own individual experience. Everyone experiences their body differently, and that is part of the joy of finding out what this practice means to you. Let compassionate curiosity guide the way.
Step‑by‑Step Diaphragmatic Breathing Practice (Somatic Pelvic PT Version)
Step 1: Ground and find safety: See if you can find a quiet place where you will be undisturbed for at least 5 minutes. Allow yourself to land in a position that feels supported and restful for you.
Step 2: Place your hands on your ribcage: Find the sides of your ribcage and gently place your hands there. Alternatively, you could use a strap around the ribcage.
Step 3: Inhale slowly through the nose: As you inhale, gently feel your ribcage expand out to the sides. Allow your belly to still ride the wave of the breath and gently expand as well. Notice if you can imagine or feel your pelvic floor expand gently with this breath.
Step 4: Exhale through the nose or mouth gently: Try not to use a forceful exhale, let it be quiet. Feel into the quality of passive recoil of your respiratory diaphragm and your pelvic floor as you exhale and let those structures gently draw in.
Step 5: Repeat 5–10 breaths: Try to repeat this for a few rounds so you can teach your nervous system this new pattern for breathing and being.
Step 6: Add movement or posture variation: If you feel ready or curious, perhaps begin to try this breathing as you gently move or lift a limb. You can even try this when moving from sit to stand, or while walking. You do not need to breathe this way all the time, you just want to show your body a new and helpful option.
10 Benefits of Diaphragmatic Breathing
Decreased pelvic floor tension or symptoms: This type of breathing can help to regulate and decrease tightness in the pelvic floor, which can also decrease pelvic symptoms such as pelvic pain or pelvic pressure.
Improved core stabilization: You may notice your core begins to feel stronger or more coordinated as your respiratory diaphragm is part of your core. Remember a tight muscle is not a strong muscle.
Less breath-holding patterns: If you are someone who chronically holds their breath or tightens their stomach, especially when stressed, this practice may begin to interrupt those unconscious holding patterns.
Nervous system regulation: There is an important nerve called the vagus nerve that when stimulated with safe physiological feedback can help regulate our nervous system. It runs through the respiratory diaphragm and when you do this type of breathing you can actually mechanically stimulate this nerve which helps activate the parasympathetic nervous system. This in combination with exhales that are longer than your inhales help build the resilience and adaptability to move into more of a rest and digest state when in pain or stress. We now know that increased activation of the fight fight system can increase pain patterns due to tension in fascia and increased cortisol levels. Regulating your nervous system is essential in pain and symptom management.
Ease of movement: You might begin to notice movement transitions become easier with the support of this breathing. Play with this breathing practice during movements you might normally label as “hard” or “painful” and see what you experience.
Improved movement of lymph: Underneath the respiratory diaphragm sits a major lymph duct called the cisterna chyli. When the diaphragm moves efficiently with breathing, it can act like a pump to help mechanically move lymph throughout the body. This is helpful as lymph plays a role in our immune system and if it is not flowing properly can contribute to congestion in tissues and lack of blood flow to muscles and nerves.
Improved blood flow: For the same reasons above, the diaphragm can also act as a pump for proper blood flow which is essential for all our biological processes.
Decreased acid reflux: The esophagus runs through the respiratory diaphragm. When the diaphragm is tight and less mobile, it can often put the esophagus in a relative “chokehold” and contribute to mechanical causes of acid reflex or GERD. Decreasing the tension on this structure through this breathing can decrease GERD symptoms.
Improved digestion and decreased bloating: The respiratory diaphragm can also act like a pump for the digestive system. It can help with the mechanical pumping that is necessary for food to move through the digestive tract. It also helps by stimulating the vagus nerve which aids in digestion. Lastly, it can decrease bloating by improving mobility of the diaphragm which can promote decreased laxity in the abdominal wall. This is called abdomino-phrenic dysynergia and you can read more about this dysfunction and how to address it here.
Decreased back pain: Your respiratory diaphragm is meant to be a primary respiratory muscle. However it has been shown in research that people with chronic back pain develop holding patterns at the diaphragm where it loses its movement and remains stiff and tight. When the respiratory diaphragm fascia is worked with (which we as pelvic floor therapists and visceral fascial physical therapists do per our training in this work) in addition to proper breathing mechanics, the core can begin to function properly again and back pain patterns decrease.
The respiratory diaphragm does so much- it is incredible and more than “just breathing”!
When to Use Diaphragmatic Breathing Practices
Before or after pelvic floor exercises and/or manual therapy techniques.
During labor prep, birth, and in postpartum recovery. Diaphragmatic breathing can support the nervous system and pelvic floor muscles during labor which can help prevent tearing.
When feeling pelvic tension or stress.
As a daily “somatic check‑in” practice to continue to regulate your nervous system and develop new neural pathways for this motor pattern.
Work With a Pelvic Floor Expert in Oakland!
Want to have your breathing patterns assessed and ensure you are doing correct diaphragmatic breathing? Click here to explore our services including skilled pelvic floor physical therapy assessments if you have symptoms and need a diagnosis and plan of care. If you are more interested in education and awareness, you can book a somatic wellness session with us! We can even work with you over telehealth if you want to learn more but you are not in Oakland or the Bay Area.
Bodyful Physical Therapy and Wellness is a private practice that specializes in somatic approaches to pelvic health physical therapy in Oakland, CA.
