Breath Holds, Vacuums & the Pelvic Floor
woma holding a baloon to represent pelvic floor pressure management
Why Hypopressives Are Not Valsalva, and Why That Matters for Leaks, Prolapse and Pelvic Floor Control
Breath holds show up everywhere — in yoga, Pilates, strength training, rehab and daily life.
But for the pelvic floor, not all breath holds are equal.
Many people are told to “hold their breath and brace”, others are told to “pull the belly in”, and some are taught to “lift the pelvic floor while holding the breath”. When symptoms persist — leaking, heaviness, pressure, pain — the assumption is often that the pelvic floor is weak or failing.
In reality, it’s usually a pressure management problem, not a motivation problem.
To understand why Hypopressives can help — and where they don’t replace other training — we need to untangle three commonly confused strategies:
the Valsalva manoeuvre
Uddiyana Bandha
Hypopressive apnoea
The Valsalva Manoeuvre: Useful, Powerful, and Often Misapplied
A Valsalva manoeuvre is a breath hold against a closed airway with active bracing.
You see it when:
lifting very heavy weights
straining on the toilet
pushing through effort
Internally, this involves:
closure of the glottis
a stiffened rib cage
an abdominal wall that pushes outward
rising intra-abdominal pressure directed downward
For short bursts of maximal force, this strategy can be appropriate.
But for people with pelvic floor dysfunction, prolapse symptoms, or leaking, it often creates the very thing they’re trying to avoid: downward pressure onto the pelvic organs and pelvic floor.
The pelvic floor isn’t “lazy” here, it’s being asked to fight pressure repeatedly.
Valsalva isn’t necessarily or always wrong. It’s just compressive, not decompressive.
Uddiyana Bandha: A Vacuum That Uses Effort
Uddiyana Bandha is often described as a “stomach vacuum”, which makes it sound similar to Hypopressives, but the internal strategy is very different.
Uddiyana involves:
a full exhale
holding the breath out
actively drawing the abdominal wall in and up
often with spinal flexion
This is a strong muscular action.
For some people, it creates an internal lift.
For others — especially those with a history of gripping or guarding — it can lead to:
abdominal bracing
pelvic floor gripping
neck and throat tension
Uddiyana is doing something to the body.
Hypopressives are about changing conditions so the body responds differently.
Hypopressive Apnoea: A Shift in Pressure, Not a Push
Hypopressives are not about pulling in, holding harder, or sealing tighter.
They work by altering pressure relationships inside the body.
In a Hypopressive apnoea:
you exhale gently
pause the breath
expand the rib cage without inhaling
the diaphragm ascends
abdominal contents respond upward
As pressure drops inside the abdominal cavity:
the pelvic floor lengthens first
then responds with a reflexive lift
This lift isn’t forced.
It’s a response to space.
For many people, this is the first time the pelvic floor experiences:
length
recoil
coordination with breath and posture
Rather than being asked to “hold everything up”.
Why Neck and Throat Tension Change the Outcome
The throat and neck sit right at the top of the pressure system.
If they grip during apnoea, the vacuum often gets stuck high, rather than distributing through the rib cage and diaphragm.
Common signs include:
strong suction in the throat
tight jaw or scalenes
a feeling of being “stuck” rather than lifted
When this happens:
rib expansion reduces
diaphragm movement is limited
the pelvic floor response becomes weaker or inconsistent
The aim isn’t a heroic seal at the throat.
It’s a quiet airway, so pressure can reorganise lower down.
The Swallow: A Tool, Not a Requirement
Swallowing is often misunderstood in Hypopressives.
It is not mandatory, and for many people, cueing a swallow at the wrong time pushes them straight into a Valsalva-like strategy.
When swallowing doesn’t help
at the start of apnoea if it creates bracing
if it tightens the neck or jaw
if pressure feels like it pushes down
When a swallow can help
A small, gentle swallow during apnoea can help only if:
suction feels stuck high in the throat
the neck starts taking over
the vacuum won’t “drop” lower
Done well, it softens an over-sealed glottis and lets pressure redistribute.
Done poorly, it adds tension.
How to Do the Helpful Swallow
Exhale gently
Pause the breath
Expand ribs without inhaling
Keep jaw, tongue and collarbones soft
Take a tiny, quiet swallow
Return immediately to rib expansion
If swallowing makes things harder — skip it.
“My Lower Abs Don’t Move” — What That’s Really Telling You
When people say their lower abdominal wall doesn’t move during apnoea, it’s rarely about weakness.
More often it means:
the diaphragm isn’t truly ascending
the rib cage isn’t expanding effectively
the nervous system is still guarding
The abdominal wall responds to permission, not command.
A simple reset
Before pushing deeper into apnoea, restoring ease often brings movement back naturally.
Lower Abdominal Permission Drill
Lie on your back, knees bent
One hand on ribs, one on lower belly
Gentle rib-led inhale
Long, slow exhale
Pause → ribs widen → belly softens
“Nothing pulls. Nothing pushes. The belly responds.”
Breathlessness After Hypopressives — Is That Normal?
Feeling slightly breathless afterwards is common early on.
It can reflect:
low CO₂ tolerance
unfamiliar breath pauses
a nervous system learning something new
This isn’t a sign to push harder.
Shorter apnoeas, longer rest breaths, and prioritising ease usually resolve it quickly.
Hypopressives should feel regulating, not depleting.
A Crucial Piece: The Urethra
Leaking isn’t just about a “weak pelvic floor”.
The urethra relies on three things:
Support
Closure
Timing
Hypopressives help with:
reducing downward pressure
improving reflexive timing
improving starting position
But they do not directly train forceful urethral closure.
That’s not a flaw — it’s simply not their job.
Where Pelvic Floor Muscle Training (PFMT) Comes In
PFMT trains what Hypopressives don’t:
urethral and vaginal closure
resting tone (hypopressives do this too)
endurance under load
Muscles like:
pubococcygeus
bulbospongiosus
anal sphincter / puborectalis
need direct, voluntary training to build closure strength.
This is especially important for stress urinary incontinence. Or with a hiatus that hasn’t closed effectively after childbirth.
PFMT Exercises That Complement Hypopressives
Pubococcygeus – “Curtains Closing”
Gentle vaginal closure
Visualise your labia as two soft curtains and gently draw them in or close them - with 30% effort
3–5 second hold
Full release
Bulbospongiosus
Gentle narrowing of vaginal opening
visualise your finger being inside your vagina and gently squeeze it
Focus on release
Anal Sphincter / Puborectalis
Gentle anal closure
visualise your anus as if it is a drawstring on a bag - gently draw the edges together and then release
Avoid glute gripping
Urethra
Gentle
Draw your urethra up like your want to gently flatten it on your vulva - 30%
avoid using your glutes, you should feel your lower abs kick in once your start the movement
then release
How Hypopressives and PFMT Work Best Together
Hypopressives:
create space
improve timing
reduce unnecessary pressure
improves resting tone
PFMT:
builds strength
improves closure
increases confidence under load
One without the other is incomplete healing for many
Together, they train coordination and containment.
SYNOPSIS: Why We Use TRE®, Hypopressives and PFMT — In That Order
Healing and training the pelvic floor is not about choosing one method.
It’s about sequence.
Just as a personal trainer wouldn’t load strength onto a stiff, guarded body, we don’t ask the pelvic floor to “work harder” before it knows how to release, move, coordinate and recover.
TRE® helps reduce chronic tension and trauma-driven guarding, restoring a baseline sense of safety in the nervous system.
Hypopressives then restore posture, breath timing, pressure management and fascial expandability thus allowing an internal lift through passive recoil, organ repositioning and reflexive pelvic floor response. This is mobility and coordination training for the pelvic floor, supported by intermittent hypoxia and cellular adaptation.
Only then do we layer in Pelvic Floor Muscle Training (PFMT) — the strength work that builds urethral and vaginal closure, resting tone and endurance.
Just as strength training without mobility creates stiff, non-functional “gym strong” bodies, pelvic floor strength without mobility and coordination fails to solve pressure problems.
TRE calms and regulates the nervous system.
Hypopressives restore movement, function, nervous system health and timing.
PFMT adds strength to function especially where closure is required.
This isn’t about squeezing harder.
It’s about building a system that knows when to yield, when to respond, and when to hold
If you would love to learn more and train your body this way I have a 12 week course coming up in February to teach you these tools. So healing becomes something you can do.
