Diaphragmatic breathing and the pelvic floor

Diaphragmatic Breathing and Pelvic Floor Health Transcript

Nina: Hello, welcome to Women Living Better’s Interviews with Experts series. Today we’re talking about diaphragmatic breathing and why doing it correctly can have benefits for your pelvic floor.

So, the backstory is that at some point in my late thirties, I learned that I wasn’t breathing correctly. Instead of my belly pushing out when I inhaled or took a breath, it moved inward. So I was a chest breather, not a belly breather.

But from that point forward, I thought I had it figured out until my late forties when I learned I was still not fully belly breathing, and I discovered this in pelvic floor therapy.

So today we’re talking to the person who taught me that I had more to learn here. She also taught me why working on my breathing was important for my pelvic floor health.

I’m thrilled to discuss diaphragmatic breathing with expert Kathy Kates. Kathy is a nurse practitioner, a pelvic floor therapist and founder of the Institute for Pelvic Health, an organization dedicated to educating healthcare providers about the pelvic floor.

Welcome, Kathy. Thank you so much for discussing this topic with me. As you know, it was such an aha moment for me, and I think I immediately said, oh my gosh, we have to talk about this for the Women Living Better community. And I know you said yes right away, and it’s taken some time, but here we are. So I’m very grateful.

Kathy Kates: Well, thank you for having me, Nina, and thank you for all that you do to put this beautiful resource out into the world, this beautiful evidence-based resource out into the world for people on the path to menopause. I know I recommend your site multiple times a day to my patients and feel so confident because it’s accurate, sound evidence-based information. And I so appreciate your passion and dedication to it. So thank you.

Nina: Thank you, thank you. So let’s jump in. Can you explain why, I’m going to call it true belly breathing, but it’s not really belly breathing. Can you explain why diaphragmatic breathing is so important to a healthy pelvic floor?

Kathy Kates: Absolutely. Because your diaphragm, which is your breathing muscle, is here, right? If you put your fingers on your rib cage where they come together and you can kind of push in this part where they come together is where your diaphragm starts. So it’s here. Every time we breathe it’s counterintuitive, and the reason I think, Nina, that you thought of it differently is because we think we breathe in, you think you breathe in, everything should go up. But it’s actually the opposite. When we breathe in, the diaphragm, when it’s functioning properly, goes down. So it’s counterintuitive and incredibly important.

And in my world as a pelvic floor therapist, it’s even more important because of this relationship. So my upper hand is the diaphragm. My lower hand is your pelvic floor. So every time when we take a breath in and the diaphragm goes down, the pelvic floor goes down, the pelvic floor relaxes, the pelvic floor muscles lengthen, whatever language you want to use. But it’s this mechanism that you breathe in and everything drops, and then when you exhale, it just gently lifts back up. So diaphragmatic breathing is the hallmark to pelvic floor therapy.

Nina: Yep, that’s what I learned. Can you, I was just so there was such, as I said, an aha moment. I looked and looked online and I called Kathy and I said, can you demonstrate diaphragmatic breathing because it seems like it would be so intuitive. Well, we talked about how it’s not actually intuitive. It wasn’t for me. Can you demo and maybe give a few different cues? I know everybody sort of cues into this differently of how you teach diaphragmatic breathing.

Kathy Kates: Absolutely. So if you’re comfortable putting a hand on your belly and on your upper chest, that’s a beautiful way to start. If you’re not comfortable with that, you can take a tissue box, a book, a roll of toilet paper, anything. You just need something to focus on.

So that being said, you can do it seated. You can do it lying down. So one hand on the belly, one hand on the upper chest, and then take a breath in and notice which hand moves away from you more. Right? So take a minute, one hand on the belly, one hand on the upper chest, breathe in, and then notice, is it your bottom hand that goes out more? Or do you feel like it’s like your upper chest is moving your top hand forward? That’s it. So whatever one you notice.

So say I’m looking at my person and I see a lot of the upper hand is really moving a lot, I’ll say to them, okay, for your case, keep your hand right there. And how little can that hand move? Because how little can that hand move means that more of the breath will be down here.

For some people, it’s much easier. They connect right away and they’re like, oh, you want my bottom hand to go out? Oh, okay. And they just do it. So seated is one way, but then we can also do it lying down.

So it’s the same thing I’ll demonstrate with a block so you can see it, right? So you’ll have maybe a block on the upper chest and maybe your hand down here, take a breath in, then notice which one moves more. So I practice this all the time, so mine will move more. So I breathe in, you can see the block goes up. And you’ll see very little movement in my upper chest. If I breathe in, it’s all down here and I breathe out.

I’ve had a lot of years of practice, so it takes time, but you just have to figure out the right thing that works for you. There’s no right or wrong, no right or wrong. But just remember we got to get the diaphragm going down and coming back up.

You’ve heard of a frozen shoulder, right? Your shoulder gets frozen and then you can’t move. So many of us have frozen diaphragms, and when your diaphragm is frozen and you’re getting no motion here, that means that you’re getting whatever your pelvic floor is doing, it’s stuck because they have to go together.

Nina: Okay. That’s excellent. And then I put this per your suggestion on the website, but there’s also a way through an internal exam that you can really, if you want to describe that.

Kathy Kates: Yes, absolutely. You’re

Nina: You could do it with a practitioner, but you could do it yourself too, right?

Kathy Kates: Absolutely. So if you’re with your therapist, that’s one thing. They will put a finger. Here’s the vaginal or genital opening. Here are your pelvic floor muscles. You put a finger inside, so I’m approximating. But then, so this is the therapist’s finger. These are your muscles. You take a breath in and the therapist wants to feel that space is created around their finger. And then when you exhale, you just come back to where you started. So if you’re with a pelvic floor therapist, amazing. You ask them to do that, and it’s something that you have to practice. It doesn’t come naturally to a lot of people.

If you don’t have a pelvic floor therapist and you’re comfortable, you can try it at home. You can put a finger inside. I would recommend lying down and probably with the head of your bed elevated, put a bunch of pillows up because in order to get your finger inside, your upper body and your head have to be elevated, otherwise you’re going to hurt your shoulder. Because you’re going to be reaching around like this and it’s going to be very awkward.

So once that finger’s inside, take a breath in, you’ll probably do three breaths. Once you do three breaths, then start to notice, do I feel like I’m creating space around my finger? And then I’m coming back to where I started. 

And this motion is analogous to a bicep curl, like contracting and releasing.

And with the diaphragmatic breath, it’s this part, we want to release the pelvic floor muscles, and that is key to floor therapy. 

It’s also so good for any other tight muscles you have, because when we tight muscles, our muscles are lacking some oxygen as well. So it’s beneficial for your musculoskeletal system, for your nervous system, because we know diaphragmatic breathing gets us more into the parasympathetic or rest and digest state and out of the sympathetic or the fight or flight state. So it has so many benefits and it’s foundational for your pelvic health.

Nina:  Excellent. I’m a big fan. And I echo your, it takes practice. It does take practice. You think that, oh, okay, now I get it, but I’m still…

Kathy Kates: It’s hard. It’s hard work.

Nina: I’m still doing my 10 per day, Kathy. I’m still doing my 10.

Kathy Kates: Oh, good for you. Good for you. Nina.

Nina:  Thank you so, so much. I think this is going to be really, really helpful. Any other things before we sign off about diaphragmatic breathing?

Kathy Kates:  If you do one thing, do the diaphragmatic breathing, one thing,

Nina:   I don’t know if it’s just was my homework or I mean, is 10 a day, five a day? What would your homework recommendation be?

Kathy Kates: Do? You have to start with a number that you can do.

Nina:  Okay.

Kathy Kates: So start with 3. And if you can do 3 every day for three weeks, then you can do 5. If you can do 5. You have to set yourself up to succeed. Sometimes 10 is too many to start.

Nina:  Make it doable. Make it doable. Hey, thank you so, so much.

Kathy Kates:  You’re welcome.