The ‘cylinder’ that houses the abdominal and pelvic organs has a top (diaphragm) and a bottom (pelvic floor) as well as (ideally) strong abdominal and spinal/trunk muscles at the front, sides and back, that together create stability for the spine and limbs.
Imbalance in any aspect of this cylinder influences all other aspect – for example a poor breathing pattern (upper chest breathing for example) leads to inefficient diaphragm function and tone, affecting the pelvic floor, and potentially resulting in back pain, sacroiliac dysfunction and problems such as incontinence.
Similarly excessive tone in any aspect of the cylinder – such as the pelvic floor – will have repercussions on the other parts and functions.

Regular visitors to this site will know that I frequently tend to return to the subject of better breathing, as a key to recovery from many health problems (for more on this topic see my co-authored book Multidisciplinary Approaches to Breathing Pattern Disorders).

New visitors might also wish to search this site for postings on the subject, as they are numerous, and hopefully enlightening, on what I see as a fundamental and much neglected topic.

Today’s return to the subject of breathing rehabilitation was triggered by reading a newly published research article by Taiwanese experts, in both physical therapy and gynaecology, led by Hsiu-Chuan Hung and colleagues.
The title of the report, which appeared in 2010 in the prestigious journal Manual Therapy is:
An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function

Stress urinary incontinence occurs in over 40% of women – many in their 20s and 30s – and a significant number of men).

Hodges (2007) has shown that there is a connection between respiration and pelvic floor function, as well as to sacroiliac joint problems, particularly in women.

If pelvic floor muscles are dysfunctional, spinal support is likely to be compromised, increasing external abdominal oblique muscle activity, which can overwhelm pelvic floor activity, and result in incontinence (Smith 2006)

This problem is extremely prevalent amongst athletes, gymnasts, dancers and individuals who train excessively to ‘tone’ themselves, but who neglect to ensure that their breathing patterns remain balanced and diaphragmatic.
For example researchers have reported that 41% of elite female athletes experience stress urinary incontinenc
e (Bo & Borgen 2001)

The summary/abstract of the report I am commenting on in today”s post, gives a clear indication that urinary incontinence is over 90% curable/significantly improvable, simply through retraining of the diaphragm (i.e. better breathing) – together with enhanced abdominal and pelvic floor muscle coordination

“This study was a randomized controlled trial to investigate the effect of treating women with stress or mixed urinary incontinence (SUI or MUI) by diaphragmatic, deep abdominal and pelvic floor muscle (PFM) retraining. Seventy women were randomly allocated to the training (35) or control group (35). Women in the training group received 8 individual clinical visits and followed a specific exercise program. Women in the control group performed self-monitored PFM exercises at home. The primary outcome measure was self-reported improvement. Secondary outcome measures were 20-min pad test, 3-day voiding diary, maximal vaginal squeeze pressure, holding time and quality of life. After a 4-month intervention period, more participants in the training group reported that they were cured or improved
The cure/improved rate was above 90%.
Both amount of leakage and number of leaks were significantly lower in the training group

More aspects of quality of life improved significantly in the training group than in the control group. Maximal vaginal squeeze pressure, however, decreased slightly in both groups. Coordinated retraining diaphragmatic, deep abdominal and PFM function could improve symptoms and quality of life. It may be an alternative management for women with SUI or MUI.

There is a paradox in this report since, in previous posts, I have highlighted the risks of excessive toning of these very muscles (abdominal/pelvic floor) – something that can lead to pelvic pain as well as symptoms such as stress incontinence (see posting in February 2008)
The difference between ‘toning’ and achieving ‘coordination’ as reported in the study above, is enormous.
One approach (toning) may lead to pelvic floor rigidity; the other approach (coordination and breathing training) should lead to greater flexibility as well as control – and apparently does so in over 90% of individuals !

  • Bo K Borgen J 2001 Prevalence of stress and urge urinary incontinence in elite athletes Med Sci Sports Exerc 33:1797-1802
  • Hsieu-Chuan Hung et al 2010 An alternative intervention for urinary incontinence. Manual Therapy 15:273-279
  • Hodges P 2007 Postural and respiratory functions of the pelvic floor muscles Neurourology and Urodynamics 26(3):362-371
  • Smith M Russell A Hodges P 2006 Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Australian Journal of Physiotherapy 21(52):11-16