Urinary Incontinence and Breath.

By Vanessa Harris, PT, DPT. Employee of CPR Physical Therapy + Performance

The Importance of How We Breathe.

          What if you could decrease urinary leakage just by changing the way you breathe? We take an average of 12-20 breaths per minute or around 20,000 breaths each day; however, the impact that breath can have on our bodies is often overlooked. Many of us have gotten into the bad habit of upper chest breathing or even breath holding patterns with exercise and daily activities. These bad habits can contribute to stress, increased heart rate, increased blood pressure, and even contribute to pelvic floor dysfunction. Pelvic floor dysfunction can present in many ways including: incontinence, increased urinary urgency and frequency, pelvic pain, and pelvic organ prolapse. The pelvic floor is a layer of muscles at the bottom of the pelvis that help support bowel, bladder, and reproductive organs. This group of muscles is what helps us with bowel and bladder control and helps to prevent incontinence. The pelvic floor also assists with important pelvic and core stabilization throughout normal daily activities and exercise. There is growing research supporting the interconnection between the pelvic floor and the way we breathe. The research has demonstrated that breath holding with certain movements contributes to intraabdominal pressure and downward pressure on the pelvic floor. Shallow breathing can contribute to a tense, stagnant pelvic floor that is not promoting normal ability to contract and relax these muscles. Both issues can be common contributors to urinary incontinence and pelvic organ prolapse.

So what can we do about it? How should we breathe?

      The alternative to shallow chest breathing is called diaphragmatic breathing. The diaphragm is a dome shaped muscle that attaches to the ribs and separates the thoracic cavity from the abdominal cavity. The primary function of the diaphragm is to assist with breathing. When the diaphragm contracts, it moves downward, allowing air to enter the lungs. When the diaphragm relaxes, it moves upward, helping to force air out of the lungs. By taking slow, deep breaths that engage the diaphragm and expand the ribcage we can have a positive impact on other body systems. Learning how to take deeper breaths and use our diaphragm to breathe we can start to improve core and pelvic floor function. Diaphragmatic breathing has been shown to help with reducing anxiety, relaxing the pelvic floor musculature, and decreasing urge incontinence. Urge incontinence is defined as “a type of urinary incontinence where you experience a sudden, intense urge to urinate, often followed by involuntary leakage of urine, meaning you can't delay going to the bathroom and may not make it in time. This is due to the strong bladder muscle contractions; it's often associated with an overactive bladder condition where the bladder muscle contracts too frequently.” In a research study done in 2022 they divided participants into two groups. One group was instructed in how to perform pelvic floor strengthening exercises only, while the other group was instructed in pelvic floor strengthening and diaphragmatic breathing. Both groups completed questions and tests reporting symptoms of urinary urgency and incontinence both before and after 6 weeks of treatment. While both groups showed improvement in decreased incontinence only the diaphragmatic breathing group showed improvement with less urgency and urge incontinence symptoms. The authors concluded that diaphragmatic breathing exercises were more effective than just performing pelvic floor strengthening exercises alone in treatment of urge incontinence.

How to get started with Diaphragmatic Breathing

     If you think that dysfunctional breath patterns could be contributing to pelvic floor dysfunction or incontinence symptoms for you or are just interested in pursuing a better breath pattern, here are some cues to get started practicing diaphragmatic breathing:

     By optimizing the way you breathe you can help promote a healthy relationship between your diaphragm and pelvic floor to better regulate abdominal pressure and normalize the pelvic floor musculature’s ability to contract and relax to avoid increased irritation, urgency, and leakage from the bladder.

Additional Treatment Options

     If you feel like you want some additional help or assessment of breath patterns you may benefit from pelvic floor physical therapy. In pelvic floor therapy at CPR we assess and teach breathing patterns and how to coordinate breath for improved pelvic floor function. We also teach urge suppression techniques including diaphragmatic breathing to help retrain bladder habits to eliminate incontinence on the way to the bathroom and evaluate and treat other pelvic floor dysfunction.

References:

Toprak N, Sen S, Varhan B. The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study. J Bodyw Mov Ther. 2022;29:146-153. doi:10.1016/j.jbmt.2021.10.002

Cozean N. Diaphragmatic breathing for pelvic health. Pelvic Sanity. Published December 26, 2021. https://www.pelvicsanity.com/post/diaphragmatic-breathing-for-pelvic-health

National Institute on Aging (U.S.). Urinary Incontinence in Older Adults (https://www.nia.nih.gov/health/bladder-health-and-incontinence/urinary-incontinence-older-adults). Last reviewed 1/24/2022. Accessed 2/10/2025. Physiopedia. Pelvic floor Dysfunction. (http://physiopedia.com/pelvicfloordysfunction). Accessed 3/5/25.