WHAT IS INTRAABDOMINAL PRESSURE? How can it affect core and pelvic issues like diastasis recti and prolapse?

Intraabdominal pressure is the way our body manages volume and pressure. It is a normal and naturally occurring management system. However, sometimes an excessive amount of pressure can put extra load and pressure on our core and pelvic floor resulting in issues like diastasi recti and prolapse.

First, let’s look at the science behind pressure. In a pressurised system when you decrease space, you increase pressure. And, when you increase space, you decrease pressure. Make sense? If not, think about a balloon. When a balloon is blown up it expands because the volume of space is increased, and as it expands there is less pressure. If you hold an inflated balloon in your fingertips and then let it go think about what happens. The balloon deflates due to the volume of space decreasing and the pressure increases which results in the balloon forcibly deflating.

In our bodies, volume and pressure drive breathing. There are 14.7 pounds per square inch of atmospheric pressure surrounding us and pressing on us at all times. To reduce the pressure we inhale, followed of course by the exhale (1).

How is breathing affecting our core and pelvic floor?

I define the core as everything that connects our thorax to our pelvis. Part of this is the intrinsic core which is like a container. It is comprised of the diaphragm (roof of the container), the pelvic floor (floor of the container), the transversus abdominus (the TVA which is a deep abdominal muscle - front of the container) and the multifidus (series of muscles that connect to the spine - back of container). All of these muscles need to coordinate with each other to provide a support system, and one way that they connect is through breathing. 

As we know, volume and pressure drive breathing. As you inhale the diaphragm descends and the pelvic floor expands, as you exhale the diaphragm and the pelvic floor recoil, and the TVA and the multifidus contract for support. Please note these are simplified explanations, and so much more goes on in our complex bodies, but to keep things light and accessible, and because I am not a biomechanist or anatomist, this will be the detail I will stay with! 

What happens when we have an excessive amount of intraabdominal pressure?

Now let’s think about placing an excessive amount of pressure on our system, and see how our system responds.

Make yourself cough and feel what happens to your belly - does it pop out, or do you feel more pressure in your pelvic floor? Or does the belly gently draw in?

Blow up a balloon - again does your belly bulge or do you feel pressure in your pelvic floor? 

Now, lie down on the ground with legs straight and lift both legs off the ground - this move is barely possible without feeling bulging in the abs. 

Think about lifting a really heavy weight - do you feel pressure pushing down or are you abs bulging out, or do you even potentially hold your breath as you lift the weight.

If you felt bulging or bearing down (pressure in pelvic floor) in these above movements or exercises then this can demonstrate an excessive amount of abdominal pressure, our system having to compensate in order to create space for this pressure. 

What is happening in our bodies for us to compensate and create extra pressure in our system?

Let’s think about how we breathe. Do you have mobility in your ribcage to create a three dimensional breath, or are your ribs locked down and have limited movement? If the later is the case then you would only be able to breathe into your belly all day, and when we use just our bellies all day to breathe we can created excessive pressure so we only push out into our abdominal wall, or push down to our pelvic floor.

What if we gripped our abdominals all day? So many of us hold excessive tension in our bellies. Again, if we are sucking in our lower abs or upper abs all day where would the pressure go? Likely down to our pelvic floor. And, what does our pelvic floor do to respond to this pressure, it will likely pull up and tighten its grip too.

 Our abdominals and pelvic floor are designed to withhold normal load and pressure, but not excessive pressure. We want strategies to effectively decrease pressure, not increase pressure.

What strategies can you use to rebalance your intraabdominal pressure?

We want our muscles to be reflexive and responsive. This means we need to allow our muscles to contract as well as to yield and relax too. Muscles cannot be strong if they don’t have the ability to contract and relax with control - think of a bicep curl. If your abdominal wall is constantly being held, or your pelvic floor is engaged all day, then when you breathe you can add tension to tension. 

The first step is awareness. Where do you hold too much tension in your body? Are you always holding your belly in, is your pelvic floor always drawn up in an active contraction, are you just breathing into your belly all day?

Also be aware of how you move throughout the day. Do you hold your body in the same way for the majority of the day? Or do you move in a variety of ways? And, why does this matter? Movement habits are super enlightening when it comes to core and pelvic health. If we are stuck in one way of moving we could be locking our pelvis in one place, or restricting movement in our ribcage making it impossible to fully expand. This has knock on affects to our breathing, our pelvic floor, and also our hips and shoulders too. What’s the answer? Move more!

 The second step is get in touch with me! For a full assessment on your movement habits, breathing, spinal mobility and core engagement, email me@shelleymccarten.com to book a private session, or come to one of my RYC™ courses!

And, as with all pelvic floor and core issues I always recommend to see a pelvic health physiotherapist. Jennifer Dutton at www.pph.nz and Pelvic Health Physio team at www.tiaki.net.nz are my recommendations!

For a taster - try this breathing assessment that I use on some of my clients.

  • Tighten your belly and then relax it fully. Keep the belly relaxed. Tighten your jaw and then relax it fully. Keep the jaw relaxed. Tighten your buttocks and then relax them fully. Keep the buttocks relaxed. Tighten your pelvic floor. And then relax it fully. Keep the pelvic floor relaxed. 

  • Take one hand to your belly and one hand to your sternum. Without letting the hand at your ribs to move, just breathe into the hand at your belly for three rounds of breath. Now, without letting the hand at your belly move, just breathe into the hand at your ribs for three rounds of breath. Now, with no judgment, notice which was more challenging. 

  • Next, gently and organically breathe into the 360 dimensions of the ribcage and allow your belly to respond to the volume change of the ribs by gently rising (no pushing, pulling and forcing). As you exhale, notice the volume decreasing in the body. Be curious about the way your body changes shape and volume as it breathes. Feel your inhalation as space and volume increases, diaphragm draws down, belly gently rises and pelvic floor lengthens. Feel your exhalation as space and volume decreases, diaphragm and pelvic floor recoils and belly gently falls back. Repeat as often as necessary!

REFERENCES:

(1) RYC™ Teacher Training Manual by Lauren Ohayon.