The Body in Conversation: Part 6 -The Pressure Conversation

Does pressure just move in one direction in the body?

In this blog we look at the relationship of pressure between the thoracic diaphragm and the pelvic ‘floor’.

If we talk about the diaphragm forming the roof of the abdominal cavity, then there is an obvious question we need to ask next.

What happens underneath it when it moves?

Because every time the diaphragm contracts and changes shape, the space inside your torso changes too.

And when that space changes shape, the pressure changes.

This is where conversations we usually read or hear about the diaphragm often become very simplistic and sound a little like this:

The diaphragm goes down.

The pelvic floor goes down.

The diaphragm comes up.

The pelvic floor comes up.

A nice little piston.

Often with a visual of a cafetière, where the plunger simply moves up and down.

Except, once again, this is not the full picture.

The body is way more interesting than that.

Pressure does not simply shoot vertically downwards.

The abdominal cavity is, like us, three-dimensional. The abdominal wall wraps around the front and sides of us, the spine forms the support behind, the pelvic floor sits below as the floor, in simple terms, and the thoracic diaphragm forms the roof.

And all of these structures are moving, adapting and responding to each other all the time.

So rather than imagining pressure as something being pushed straight down onto the pelvic floor, I think it is much more useful to think about pressure being distributed throughout a changing container.

And that container is reflexive, mobile and alive.

Pressure is not the enemy

If you have pelvic floor symptoms, you may already have been told to avoid pressure.

Don't lift heavy things.

Don't hold your breath.

Don't run.

Don't jump.

Don't strain.

Don't cough badly.

Don't do anything that increases intra-abdominal pressure.

Except there is a slight problem with all of that. You need pressure.

You use pressure to cough.

To sneeze.

To laugh.

To poo.

To lift.

To stand up.

To run.

To jump.

To throw.

To shout.

To blow up a balloon.

To get off the floor.

Pressure is not inherently bad. It is part of how the body creates stiffness, transmits force and manages movement.

The better question is not:

How do I avoid pressure?

It is:

How does my body respond to pressure?

And does it have enough options to distribute that pressure well?

What happens when the diaphragm descends?

On an inhale, the diaphragm contracts and changes shape.

Its domes flatten to some degree and the central tendon moves downwards.

That increases the volume of the thoracic cavity and helps draw air into the lungs.

But because the diaphragm also forms the roof of the abdominal cavity, its movement changes the pressure relationship below it too.

The abdominal contents do not disappear.

They have to move somewhere.

So the abdominal wall changes shape.

The lower ribs move, expanding and changing shape.

The spine and pelvis participate.

And the pelvic floor responds.

That does not mean every inhale should make your pelvic floor dramatically drop.

And it definitely does not mean that if you cannot feel your pelvic floor descend, you are breathing incorrectly.

The response is influenced by posture, movement, speed, load, tension, habit, continence demands and what you are actually doing at the time.

Breathing while lying on the floor is not the same task as breathing while sprinting up a hill carrying shopping.

The system adapts.

The pelvic floor is not a trapdoor

This is where I think pelvic floor teaching has sometimes let people down.

The pelvic floor is often described as though it is sitting underneath the body like a little hammock waiting to catch everything above it.

Or worse, like a trapdoor that pressure is constantly threatening to force open.

That image can create fear very quickly.

Your pelvic floor isn’t a floor… it is more of a cone or hammock shape it is muscular, fascial, neural and responsive. And is a collection of many muscles, not just one band.

It changes shape.

It lengthens.

It shortens.

It stiffens.

It relaxes.

It responds to changes in breathing, movement, impact, continence, bowel function, sexual function and load.

It is not simply sitting there hoping the rest of the body behaves itself.

And it most definitely is not working alone.

The abdominal wall is part of the conversation too

If pressure changes inside the abdominal cavity, then the abdominal wall has to respond.

Again, this is not simply about "switching your core on".

The abdominal wall is not an actual corset that should be permanently tightened.

It needs to move.

It is designed to move.

On an inhale, parts of the abdominal wall lengthen and expand as the abdominal contents are displaced.

On an exhale, there is generally recoil and a change in abdominal wall tension.

But this will vary depending on what you are doing.

If you are lying quietly, the response can be soft.

If you are lifting something heavy, the whole system may become much stiffer.

If you are coughing, the pressure event is fast and forceful.

If you are running, the abdominal wall is responding to breath, rotation, impact and limb movement all at once.

So the abdominal wall is not just a passive bag around the organs.

It is part of the pressure-management system.

Your body does not manage pressure in one direction

This is one of the things I would really like people to take away from this part of the series.

Pressure does not only go down, down, down.

The body is not a tube with the diaphragm at the top and the pelvic floor at the bottom.

Pressure is distributed in multiple directions.

Into the abdominal wall.

Towards the back.

Across the ribs.

Through the pelvic floor.

And the shape of the container influences where that pressure is felt and how it is managed.

This is why the relationship between the ribs and pelvis matters.

They are connected, in part, through the spine, so the position and movement options available through the spine matter too.

Therefore:

Abdominal wall function matters.

Pelvic floor function matters.

Rib movement matters.

Spinal movement matters.

And breathing matters.

Not because there is one perfect alignment that makes pressure disappear.

There isn't.

And we don't actually want pressure to disappear. It contributes to trunk stiffness and spinal support when we need it.

What matters is that changing the shape and stiffness of the container changes how force and pressure are distributed within it.

What happens when we brace?

Bracing is another word that gets turned into either a hero or a villain.

Sometimes we do need to brace.

If I am lifting something heavy, I want my trunk to become appropriately stiff, but i still need to be ale to breathe!

If I am about to be tackled playing sport, I do not want a completely floppy abdominal wall.

If I am coughing, the system has to manage the pressure very quickly, expanding and recoiling.

The problem is not bracing itself.

The problem is when we only have one strategy.

If your answer to everything is:

Grip the tummy.

Clench the pelvic floor.

Tuck the bottom.

Hold the breath.

Then the system has fewer options.

Pressure is still being created.

But you may have inadvertently reduced the ability of the ribs, abdomen, spine and pelvic floor to adapt around it.

And that can become particularly interesting in people who describe heaviness, urgency, incomplete emptying, constipation or pelvic pain.

Sometimes the issue is not that they need more strength.

Sometimes they just need more movement options.

And symptoms themselves give us information.

Heaviness, leaking, bulging, pain or breath-holding do not automatically mean that pressure itself is damaging you.

They are clues about how your system is currently managing that particular task.

Holding your breath changes the equation

Try this.

Sit comfortably.

Take an ordinary breath in and out.

Now hold your breath and gently press your hands together.

Notice what happens in your trunk.

You may feel the abdominal wall stiffen.

You may feel pressure internally.

You may notice the ribs becoming more fixed.

Now let the breath go and repeat the same hand press while breathing regularly.

It feels different, doesn't it?

Neither strategy is automatically wrong.

A breath hold can be useful during some high-force tasks.

But if you hold your breath every time you bend over, pick up a bag, stand from a chair or lift your child, you are repeatedly choosing the same pressure strategy.

It may work perfectly well for a while.

But your body may eventually tell you that it would quite like another option.

Coughing is a brilliant example

A cough is basically a very fast pressure event. Travelling at speeds of 50-100 miles an hour.

There are three broad phases.

1. The inhalation phase:
Sensors in the airways detect an irritant such as dust or mucus and send information to the brain. You take a quick breath in, increasing the volume of air in the lungs.

2. The compression phase:
The glottis closes and the muscles involved in expiration contract, creating a rapid increase in pressure inside the chest and abdomen.

3. The expiration phase:
The glottis opens and that pressurised air is expelled rapidly, helping shift whatever irritated the airway.

And all of that happens very quickly.

This is why telling someone who leaks when they cough to simply "squeeze their pelvic floor harder" can be way off beat, and counterproductive because the pelvic floor needs to adapt to support and to absorb. So, depending on the body and it’s journey through life.

They may need strength.

But they may also need timing.

Coordination.

Perhaps a different rib strategy.

Maybe better abdominal wall contribution.

Less background gripping.

Or simply practice dealing with fast changes in pressure.

Again, the pelvic floor is part of the conversation.

Not the entire conversation.

What about lifting?

Lifting is another area where people can become terrified of pressure. And yes, lifting can significantly increase intra-abdominal pressure.

That is not necessarily a problem.

Intra-abdominal pressure absolutely does contribute to trunk and spinal stability and help us to transmit force.

The question ought to be whether the person can manage that load at this stage in their life- what they lift and how heavy it is can change because someone recovering after childbirth will need a different strategy from;

Someone with a symptomatic prolapse.

Someone with a hernia.

Someone who has been sedentary for ten years.

Someone who deadlifts twice their bodyweight.

These are not the same person.

So the answer cannot simply be:

"Pressure is bad."

Nor can it be:

"Pressure doesn't matter."

Context matters.

So does their current capacity, the symptoms they have and the load they can manage at this point in time.

And how that person breathes and moves matters too.

The problem with "exhale on effort"

You may have heard the advice:

"Always breathe out on the effort."

It can be really useful.

Especially for someone who habitually holds their breath and bears down.

But it is not a law of human movement.

Sometimes we inhale during effort.

Sometimes we hold our breath.

Sometimes the breathing pattern changes according to the task.

And if you have to lift something heavy and then carry it, what do you do after you exhale?

You still have load...

If I am helping someone relearn pressure management, exhaling on effort can be a fantastic way of giving them another strategy.

But I do not want them to leave believing that every time they stand up for the rest of their lives they have to remember to breathe out correctly.

The aim is not perfect breath choreography.

The aim is adaptability.

The pelvic floor and diaphragm do move together, but...

This is where we need nuance and common sense.

Research using ultrasound and other forms of imaging has shown that breathing and pelvic floor movement are definitely related.

During relaxed breathing, a pattern commonly observed is that the pelvic floor descends during inspiration and rises during expiration.

But it is not a rigid mechanical law.

Change the task and the relationship can change.

Increase load.

Change posture.

Add continence demands.

Run.

Jump.

Cough.

Lift.

Hold your breath.

And the nervous system may organise the system quite differently.

So yes, diaphragm and pelvic floor movement are related.

But "inhale equals pelvic floor down, exhale equals pelvic floor up" is a useful starting model.

Not the whole story.

Pressure follows the task

This is probably the phrase I would keep coming back to.

Pressure follows the task.

Quiet breathing requires one strategy.

Running requires another.

A bowel movement requires another.

A heavy deadlift requires another.

Laughing requires another.

Sex requires another.

Birth requires another.

Your body should not have one fixed pressure-management strategy for all of them.

And when symptoms appear, one of the questions we can ask is:

Has the body lost options?

Not:

What muscle is broken?

Not:

What should we tighten?

Not:

What should we avoid forever?

But:

What does the system need in order to do this task more comfortably?

Try this: sit to stand three ways

Sit towards the front of a chair with your feet comfortably underneath you.

Stand up normally.

Don't change anything.

Just notice what you do.

Sit down again.

Now stand up while deliberately holding your breath.

Notice what changes.

Do you grip your abdomen?

Do you feel more pressure?

Does your chest stiffen?

Sit down again.

This time, breathe out gently as you stand.

Do not squeeze your pelvic floor.

Do not pull your tummy in.

Just breathe out and stand.

Notice the difference.

Then do it again however feels most natural.

The point is not to decide which one is "correct".

The point is to feel that the same task can be organised in different ways.

You have options.

Try this: feel the container

Lie on your back with your knees bent.

Place one hand around the side of your lower ribs and the other across your lower abdomen.

Take an easy breath in.

Can you sense movement in more than one direction?

Can the ribs widen?

Can the abdominal wall respond?

Can the back of your body feel involved too?

Now breathe out.

Feel the shape change again.

Do not squeeze anything at all.

Do not try to make the pelvic floor move.

Just notice the container changing.

Then stand up and try the same thing.

The experience will probably be different.

That is the point.

Breathing does not happen in one fixed shape.

There is a connection

The diaphragm and pelvic floor are connected through pressure, movement and shared function.

But that does not mean the diaphragm pushes directly down onto the pelvic floor like a piston.

It does not mean every pelvic floor problem begins with breathing.

It does not mean you can cure prolapse by breathing perfectly, but I have had many clients who massively reduced their symptoms by observing their breath and making changes to the way they used breath to change their relationship with pressure.

And it does not mean intra-abdominal pressure is something we should spend our lives trying to avoid. Because we need it!

There is a real connection between your diaphragms what occurs in your thoracic diaphragm has an impact on your pelvic floor diaphragm.

When I work with clients, we look at that connection, where the conversation may have become less adaptable and what that might mean for their body.

Like detectives.

That is the relationship I am interested in digging into.

Not simply asking, "Is your pelvic floor strong enough?"

But asking:

What else is happening here?

What is the rest of the body doing?

What happens when we change the task?

And does that change the symptom?

You may not leak when you walk, but you do when you start to run or halfway through a run or only when you run downhill or walk up stairs- this is not random. It is such important information

Pressure is information

I think this may be the shift I would like you to take away from this blog.

Well, one of them.

Pressure is not simply a force threatening the pelvic floor, it is actually no threat at all, It is vital information. It tells us something about the task the body is trying to perform and it constantly changes depending on breathing, movement, load and position.

And a healthy system is not a pressure-free system.

It is a system with loads of options available to it. A system that can summon softness when it is needed and stiffen when required. That is able to expand and recoil, absorb ground force and create force to propel you through life in a functional way and be able to change strategy depending on what life is asking it to do.

Which brings us to another part of the body that gets talked about in almost as simplistic a way as the pelvic floor.

The abdominals and some of the phrases that make my body and mind shudder:

"Switch your core on."

"Pull your belly button to your spine."

"Brace."

"Don't let your tummy bulge."

But what is the abdominal wall actually doing while we breathe, move and manage pressure?

And what happens when we stop treating it like a corset?

That is where we are going next.

If you are starting to think

“my body needs more connection” - let’s do it - click the button below - to book a chat with me!