Breathing is something most of us do thousands of times a day without ever being taught how to do it well. It happens automatically, it’s what keeps us alive and yet the way we breathe, particularly when we are stressed, has a physical effect that travels further into the body than most people realise.
According to Dr Sandra Elmer, Urologist and Women’s Pelvic Specialist and part of the endota Wellbeing Conversation, the connection between breathwork and the pelvic floor is often overlooked. While breathing isn’t the only factor, it can play a supportive role in helping to ease pelvic floor tension.
your diaphragm and pelvic floor are a team
You might not know this, but your diaphragm and pelvic floor are working together with every breath you take. Along with the deep abdominal muscles, they form a coordinated pressure management system within the core, moving in a rhythm that most of us are entirely unaware of.¹
The pelvic floor runs between the pubic bone at the front and the tailbone at the back, supporting all the pelvic organs: the urethra and bladder at the front, the vagina in the middle and the rectum at the back. “They’re all under the control of the autonomic nervous system,” Dr Elmer explains. In a well-functioning system, when you inhale, the diaphragm descends and the pelvic floor gently follows, lengthening and releasing. On the exhale, both structures naturally recoil, the pelvic floor lifting as the diaphragm rises. This gentle, rhythmic movement is part of how the pelvic floor maintains its health, keeping it supple and responsive rather than held.²
what happens when we breathe under stress
Think about the last time you were really stressed. Your breath probably got shorter, tighter, sitting up in the chest rather than moving through the body. That shift feels minor in the moment but when it becomes a habit, it has consequences that reach further than most people realise. Stressed breathing bypasses the diaphragm almost entirely, which means the pelvic floor never receives the gentle signal to release that a full breath provides.³
Dr Elmer notes that the pelvic floor is directly connected to the autonomic nervous system. “The diaphragm, the abdominal muscles and the pelvic floor, when working together in harmony, keep a nice relaxed breathing pattern,” she explains. “But when you’re very stressed and the breathing becomes shorter or shallower, not only can you feel that in your diaphragm or your abdominal muscle, but it can also throw your pelvic floor muscles out too.”
Over time, this can contribute to what Dr Elmer calls out as hypertonic pelvic floor muscle dysfunction, a state of chronic tension in the pelvic floor that can present as pain, urinary urgency or discomfort with intercourse.⁵ This is covered in more depth in How Stress Affects Your Pelvic Floor, but the important point here is that shallow breathing during times of stress, can contribute to tightening or dysfunction of the pelvic floor.
Many women have never been taught to connect breath to body in this way. The diaphragmatic breathing pelvic floor relationship is not something most of us encounter until something prompts us to go looking. The good news is that once you know it, it becomes a tool you have access to at any time.
Many women have never been taught to connect breath to body in this way...The good news is that once you know it, it becomes a tool you have access to at any time.
how breathwork helps release pelvic floor tension
If you’ve ever noticed that a long, slow breath out can make your whole body feel slightly less braced, you’ve already experienced what this section is about. That release isn’t imagined. Slow, deep diaphragmatic breathing sends a signal of safety to the autonomic nervous system, gently shifting the body from the sympathetic state of fight-or-flight into the parasympathetic state of rest and repair.⁴
Research shows that slow, focused breathing can measurably reduce the level of resting tension in the pelvic floor muscles specifically.⁵ Cortisol, the body’s primary stress hormone, also decreases with regular breathwork, which reduces the systemic stress load that contributes to pelvic floor tension in the first place.⁶
Dr Elmer is direct about the value of this approach. “Deep breathing, meditation, relaxation and gentle stretching” are among the simple techniques she recommends for women looking to calm their pelvic floor. “And if you’re really struggling or need some extra support, please find a specialist pelvic floor physiotherapist because they’re really good at teaching you ways that you can relax your pelvic floor.”
This is not about force or control. It is about creating the conditions for the body to restore itself and breathing exercises for pelvic pain and tension offer one of the gentlest entry points available.
a simple breath practice to try
The following is a starting point for anyone wanting to begin pelvic floor relaxation exercises at home. It requires no equipment and no prior experience, just a few minutes and a willingness to pay attention.
Find a comfortable position, lying down or sitting with your back gently supported. Let your hands rest on your lower belly. Close your eyes if that feels comfortable.
Take a slow breath in through your nose. Rather than lifting the chest, allow the belly to soften and rise beneath your hands. As you breathe in, see if you can notice a gentle, subtle dropping or releasing sensation in the pelvic floor. There is nothing to force here, just an invitation to notice.
As you breathe out, let the belly and pelvic floor rise naturally, without gripping or squeezing. The breath does the work, your job is simply to allow it.
Repeat this for five to ten slow, unhurried cycles. If the mind wanders, that’s fine. Simply return to the sensation of the belly rising and the breath moving through the body.
This practice is just a starting point. For women experiencing persistent pelvic floor symptoms, a pelvic floor physiotherapist can offer more targeted guidance and assess whether breathwork is the right approach for your specific situation. For those wanting to explore guided breathwork and relaxation as part of an ongoing self-care ritual, endota Retreat offers practices you can return to from home, at whatever pace feels right.
when breathwork alone isn’t enough
For many women, a consistent breathwork practice will bring noticeable relief over time. For others, particularly those dealing with more complex pelvic floor dysfunction, breathwork may act as a supportive tool rather than a complete solution.
Pelvic floor physiotherapists are specifically trained to assess breathing patterns, identify where tension is held and guide more targeted work. Dr Elmer is clear that this kind of specialist support is genuinely valuable. “Having a really good pelvic floor physiotherapist is worth their weight in gold,” she says.
Touch and bodywork can also play a meaningful role. The endota Organic Relax Massage is one example of a treatment that naturally deepens and slows the breath, supporting the shift into the parasympathetic state that breathwork for women is aiming toward. Used alongside a regular home practice, it can deepen the body’s ability to recognise and return to a state of ease.
frequently asked questions
How does breathing affect the pelvic floor?
The diaphragm and pelvic floor work as a coordinated system. On each inhale the diaphragm descends and the pelvic floor gently releases. On each exhale both naturally rise. When breathing is shallow or stress-driven, this rhythm breaks down and the pelvic floor can become stuck in a state of tension.2
Can breathwork help with pelvic pain?
It can, particularly for tension-related pelvic pain. Slow diaphragmatic breathing shifts the nervous system away from sympathetic drive, which can allow the pelvic floor to release the guarding response that contributes to pain.⁵ It’s a gentle starting point, and for persistent or complex pain, working with a pelvic floor physiotherapist is recommended.
What is diaphragmatic breathing and how do I know if I’m doing it right?
Diaphragmatic breathing means breathing in a way that allows the belly to rise on the inhale rather than the chest. Place one hand on your chest and one on your belly. If the hand on your belly rises first and more significantly than the one on your chest, you are likely breathing diaphragmatically. It can take practice, particularly if shallow chest breathing has become habitual.
How often should I practise breathwork for pelvic floor relaxation?
Even five to ten minutes daily can be meaningful. Consistency matters more than duration. Some women find it helpful to anchor the practice to an existing habit, such as before bed or after waking, so it becomes part of the natural rhythm of the day rather than something additional to fit in.
Is breathwork safe if I already have pelvic floor problems?
For most women, gentle diaphragmatic breathing is very safe and is often recommended as part of pelvic floor rehabilitation. If you have significant pelvic floor dysfunction or have recently had surgery or treatment, it is worth checking with your healthcare provider or pelvic floor physiotherapist before beginning any new practice.
Can I use breathwork alongside other treatments?
Yes, and it is often most effective that way. Breathwork complements pelvic floor physiotherapy, massage and other approaches by supporting the nervous system shift that makes other treatments more effective. Dr Elmer recommends it as part of a broader approach to pelvic wellbeing rather than as a standalone solution.
references
¹Hodges, P. W., & Gandevia, S. C. (2000). Activation of the human diaphragm during a repetitive postural task. Journal of Physiology, 522(1), 165–175. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00165.x
²Talasz, H., Kremser, C., Kofler, M., Kalchschmid, E., Lechleitner, M., & Rudisch, A. (2011). Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing: a dynamic MRI investigation in healthy females. International Urogynecology Journal, 22(1), 61–68. https://doi.org/10.1007/s00192-010-1240-z
³Perri, M. A., & Halford, E. (2004). Pain and faulty breathing: a pilot study. Journal of Bodywork and Movement Therapies, 8(4), 297–306. https://doi.org/10.1016/S1360-8592(03)00085-8
⁴Jerath, R., Edry, J. W., Barnes, V. A., & Jerath, V. (2006). Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Medical Hypotheses, 67(3), 566–571. https://doi.org/10.1016/j.mehy.2006.02.042
⁵Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012). Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings, 87(2), 187–193. https://doi.org/10.1016/j.mayocp.2011.09.004
⁶Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874
Dr Sandra Elmer is a urologist and women’s pelvic specialist. She is part of the endota Wellbeing Conversation, a group of experts who share evidence-based insights to help people better understand how their bodies and minds work.
