Pelvic Floor PT/OT Diaphragm and Pelvic Floor Connection

Authors: Madelyn Levasseur MS, OTR/L

The relationship between the pelvic floor and the diaphragm is often important when considering conditions like urinary incontinence, constipation, pelvic organ prolapse, and diastasis recti. When thinking about the abdomen like a canister, the pelvic floor is at the bottom of the canister and supports the abdominal contents and pelvic organs (rectum, uterus, and bladder) from the bottom. The diaphragm resides at the top of the canister and contracts / relaxes during breathing throughout the day. The muscles of the core and back make up the walls of the canister.

When these muscles are all coordinated and strong, they can contribute to continence and ability to participate in daily activities without urinary leakage, pelvic floor pain, or pressure management challenges. Understanding the optimal functioning of these muscles is essential to addressing pelvic floor symptoms.  

When a person takes a deep breath, the diaphragm contracts and moves down towards the pelvic floor to open space within the lungs so they can expand and fill with oxygen. This is a great opportunity for the pelvic floor to expand, relax, and lengthen in response. Child’s pose or laying on your stomach with a pillow supporting your abdomen are two positions that typically make it easier to feel this relationship between inhalation and pelvic floor lengthening / relaxation. Practicing this connection is a great way to make a connection between your brain and body that the muscles in your pelvic floor do more than just contract or “Kegel” and can be a great way to start to relax them. 

During the exhale, when the diaphragm relaxes and moves back up into the rib cage, the pelvic floor naturally lifts back up. This is a great opportunity to work on developing a pelvic floor muscle squeeze and lift in a way that is coordinated with your diaphragm. When you cough, sneeze, or laugh the pelvic floor should contract to support continence and if that is not happening, urinary leakage can occur. 

Because of how these muscles all interact and coordinate, it can be difficult to tell if your symptoms are being caused by muscle weakness, muscle tension, difficulty with coordination, or a combination of these factors. That is when an assessment by a pelvic floor therapist can be helpful to get you started on the right track in addressing your symptoms.