Pelvic Floor 101: Why Intra-Abdominal Pressure is the Key to Understanding Pelvic Floor Problems
To understand how pelvic floor problems develop, we need to talk about intra-abdominal pressure: this is the air pressure inside your lower trunk and abdominal cavity. When your deep core system is functioning optimally, it can manage this pressure efficiently.
However, when there’s dysfunction in your deep core, pressure management becomes problematic. Over time, poor pressure management can cause a cascade of issues throughout many body systems.
Let’s dive in and learn more about this delicate dance of pressure management and how it affects your pelvic health.
How Pressure Affects Your Pelvic Floor
Think back to the soda can analogy from our first Pelvic Floor 101 article:
Imagine a cylindrical container, like a soda can. Your diaphragm—the primary breathing muscle—forms the top of this container. The cylindrical sides are made up of your deepest abdominal muscle (the transverse abdominis) and your deep spinal muscles. Your pelvic floor muscles form the bottom of this container.
Normal pressure fluctuations occur with this internal canister during everyday activities. Day-to-day occurrences that rely on internal pressure include:
Breathing
Coughing, sneezing, and laughing
Lifting objects
Exercise
Bowel movements
A healthy deep core system manages these pressure changes smoothly. A well-functioning deep core also powers a piston-like action between the diaphragm and pelvic floor. This system is critical for many bodily functions, including your breath—let’s consider it more.
The Dynamic Piston System
When they’re working well, your diaphragm and pelvic floor function as a dynamic piston system, moving up and down together throughout the day. This system helps control normal breathing, a critical life function most people never even think about! Consider the following actions that drive your breath.
When you inhale (breathe in):
Your diaphragm drops down as your lungs fill with air.
This increases pressure within your abdominal cavity.
Your pelvic floor responds by lengthening downward to accommodate this pressure.
Your deep abdominal muscles also expand outward to relieve increased pressure.
When you exhale (breathe out):
Your diaphragm lifts up as air leaves your lungs.
This lifting relieves pressure inside the abdominal cavity.
Your pelvic floor lifts up in coordination with the diaphragm.
Your deep abs recoil inward as internal pressure decreases.
This coordinated movement happens automatically thousands of times per day, providing stability for your spine and pelvis while managing the pressure changes that occur with all manner of daily activities.
However, when dysfunction occurs, even normal pressure fluctuations can become problematic.
When pressure inside your "soda can" increases beyond what your system can handle, something has to give. Often, it's the bottom of the can—your pelvic floor—that bears the brunt of excessive pressure.
Next, let’s discover how problems with pressure management can manifest.
Problematic Pressure Management Patterns
The human body is incredibly adaptable. Typically, your body tries to compensate as best as it can for any deficits or imbalances. If it’s compensating well, you may not even realize that you have an issue…at least for a while.
However, as with any quick fix, these compensatory patterns can disrupt the delicate balance of your body’s pressure management system. Here are a few compensation patterns that people with pressure management problems develop, courtesy of pelvic health PT and educator, Diane Lee.
Shallow Breathing and Chest Gripping If you breathe primarily high in your chest (rather than allowing your diaphragm and belly ) it's like you’re squeezing around the upper third of your soda can. This pattern limits the normal piston action between your diaphragm and pelvic floor, increasing stress on your lower back, lower abdominals, and pelvic floor muscles.
People who chest-grip may notice a persistent "pooch" in the lower abdomen between their belly button and pubic bone.
Breath Holding and Bearing Down (Valsalva Maneuver)
The Valsalva maneuver occurs when you attempt to breathe out against a closed airway. It’s common when people strain during bowel movements or lift heavy objects. This is like compressing the soda can from the top down.
The Valsalva maneuver dramatically increases downward pressure on your pelvic floor. The occasional Valsalva maneuver isn’t a huge deal, but relying on this pattern regularly can put you on a fast track to pelvic floor dysfunction.
Abdominal Gripping
Many people habitually "suck in" their abdominals in a pattern of abdominal gripping. This pattern is like squeezing the soda can around its middle, increasing stress at the top (diaphragm portion) and bottom (pelvic floor portion) of the system.
Back Gripping
This is another compensation pattern that squeezes the soda can around the middle. Back grippers have excessive tightness in the muscles along their lower spines.
People with military or dance backgrounds often exhibit this pattern: they spend years training to “stand tall” and “stick the chest out”, to the point that they struggle to relax the long spinal muscles.
Because a back gripper’s spine is persistently arched, their abdominal muscles are constantly overstretched and weakened. This increases the burden on the other muscles of the deep core canister, including the pelvic floor.
The Consequences of Poor Pressure Management
When your deep core system can't effectively manage intra-abdominal pressure, you may experience a variety of troublesome symptoms. A few examples:
Bowel and bladder leaks: Excessive internal pressure can overwhelm your pelvic floor's ability to keep you continent.
Pelvic organ prolapse: Chronic downward pressure can cause pelvic organs such as the bladder to drop down from their normal positions.
Pelvic pain: Pelvic muscles and other tissues that are constantly under stress can become painful and dysfunctional.
Sexual dysfunction: Altered muscle tension and coordination can affect your ability to enjoy and feel satisfied with sex.
Back pain: Poor pressure management affects spinal stability and can contribute to back problems.
If this all feels like a lot of doom and gloom, don’t panic! While problems like these can develop due to poor pressure management, this doesn’t mean they have to. There’s plenty you can do to prevent compensation patterns from developing (and correct them if they do)!
At Cervu Health, we’re dedicated to help all people with vaginal anatomy manage their pelvic —and whole body—health. We understand the unique challenges facing female cancer survivors, and we’re building tools specifically tailored to those with pelvic floor problems.
We’re here to help, because survivors deserve better.
This article is intended for educational purposes only and should not replace professional medical advice. If you're experiencing pelvic floor symptoms, please consult with a qualified healthcare provider for proper evaluation and treatment.
About the Author
Caitlyn Tivy, PT, DPT, OCS
Dr. Caitlyn Tivy is a pelvic health physical therapist, clinical consultant, and medical writer. As Chief Clinical Officer of Cervu Health, she’s focused on helping Cervu users regain their health and wellbeing after cancer. Caitlyn believes that all survivors deserve compassionate, inclusive care and access to the most effective recovery tools. She specializes in smashing taboos, centering science, and making complex medical topics easy to understand.
