Pressure Management

What is Pressure Management?

Pressure management refers to the pressure in our body- specifically in our abdomen- and how it changes in response to activity. Pressure includes all movement exerted on the body including but not limited to bending, lifting, coughing, sneezing, and laughing. The superficial and deep core muscles in the abdomen work in coordination with the diaphragm and muscles in the spine to manage this pressure. Weakness in the back, core, or pelvic floor muscles can contribute to issues with pressure management. Impaired pressure management can lead to increased downward pressure, creating symptoms such as prolapse, constipation, urinary leakage, abdominal doming with exercise, or hemorrhoids.

Using Breath Work to Manage Abdominal Pressure

Breath work is key when it comes to managing pressure. Breathing in allows the chest cavity to fill up with air- as the ribs move out to the side and the abdomen moves outward, the diaphragm (belly breathing muscles) moves downward which increases pressure within the abdomen. The increased pressure stabilizes the spinal muscles, and a deep inhale also allows the pelvic floor muscles to relax. With exhalation, the exact opposite happens: the pelvic floor muscles activate up and in & the core muscles activate to pull the belly in to manage pressure. An easy reminder is to always exhale during the hard or active part of a movement. For example, when picking up a heavy case of water bottles, exhale when lifting. Managing pressure can be even more difficult during pregnancy due to the increased weight of the baby and abdominal stretching. Therefore, it can be effective to practice exhaling before performing a heavy activity when in the late stages of pregnancy, i.e. 28 weeks onward.

How to Properly Activate the Deep Core with Activity

The transverse abdominus (TA) is the deepest layer of your core muscles. There are several layers of core muscles in your belly, the outermost being the rectus abdominus (your 6 pack muscles) & obliques (think side crunches and Russian twists). The deep TA muscle helps to stabilize the spine with all movement- coughing, sneezing, bending, lifting, etc.

The TA can be activated in any position but is easiest to learn when laying down with the knees bent.

1. Place fingers on your low stomach. As you breathe in, you should feel your belly expand up into your hands and your ribs move out to the side as it fills with air.
2. As you breathe out, your stomach will naturally move down. While exhaling, pull your stomach in by trying to bring your belly button down towards your spine. The TA is split into 3 parts, so this can best be described as zipping up your belly as you would a jacket. Pull your belly in as if you were trying to put on a tight pair of pants. As you turn this muscle on, your belly should move inward and hollow rather than bulging up.
3. Practice this activation with your exercise routine, bending, or any of your regular daily activities.

Managing Pressure with Bladder and Bowel Habits

Impaired pressure management can cause or worsen bowel and bladder symptoms such as constipation, urinary leakage, or straining with bowel movements.

Below are some tips for managing pressure in the bathroom:

1. NO pushing or straining on the toilet! Both urination and bowel movements are meant to be passive, which means your pelvic floor muscles are not actively contributing. Pushing can increase pelvic floor tension, which can make it more difficult to fully empty the bladder and bowel.
2. Bulging & bearing down correctly with bowel movements- rather than holding your breath & pushing, use the principles of breath work to manage pressure in your abdomen to move stool out of the body. Bearing down should feel like opening up the pelvic floor. Inhale, exhale and contract the core muscles, and allow them to bulge out. Think belly big, belly hard! Bending forward slightly & utilizing a squatty potty to elevate the hips and knees will also help to create the best angle for having a bowel movement.
3. Reverse kegels! If you struggle with emptying the bowel and/or bladder fully, it may be due to pelvic floor tension. Remain on the toilet for an additional 1-3 mins as you practice deep breathing to loosen up the pelvic floor.

Activate the core and pelvic floor with coughing/sneezing/laughing: when able, perform a pelvic floor contraction & activate the TA to reduce leakage. Being upright also manages pressure as bending forward can increase abdominal pressure & place downward pressure onto the pelvic floor.

For more support, contact JAG PT today or schedule an appointment at our clinic nearest you!