Beyond the Pelvic Floor: Core & Respiratory Links

Looks at 3 different articles addressing the various components of the abdominal canister.

This study evaluated the efficacy of a hybrid telehealth physical therapy model targeting chronic constipation through respiratory muscle strengthening and breath coordination during defecation. Researchers also examined the relationship between respiratory muscle performance changes and patient-reported constipation outcomes, as well as changes in anxiety and depression.

Design: Pilot study using a quasi-experimental pre/post-test design with a historical control group.

Inclusion Criteria: Adults 18+ with two or more of the following:

Exclusion Criteria:

The intervention occurred over 8 weeks, with in-person visits at weeks 1 and 8 for data collection. Participants used "The Breather" respiratory device to strengthen inspiratory and expiratory muscles (2 sets of 10 reps at difficulty 5-7/10, twice daily). Researchers also instructed participants on 4 breathing techniques for defecation (snake sounds, blowing bubbles, resisted fist breath, straw breathing) and use of a toilet stool to optimize anorectal angle.

The historical control group (n=35) received traditional 60-minute 1-on-1 pelvic health PT including manual work, internal biofeedback, and rectal balloon training.

Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) collected at visits 1, 4, and 8. Functional outcomes used the Patient Assessment of Constipation Symptoms (PAC-SYM) and Hospital Anxiety and Depression Scale (HADS).

No significant difference in PAC-SYM scores between groups, suggesting respiratory muscle training may be a viable alternative for patients unable or unwilling to participate in internal treatment. Increases in MEP (but not MIP) correlated with improved constipation scores. The largest improvements occurred in the first 4 weeks. HADS changes approached but did not reach significance (p=0.052), warranting future research on respiratory training's effects on anxiety and depression.

_{Wood, A., Alappattu, M., Shane M.A.S., Yusufova, R., Kirk-Sanchez, N., Raya, M.A., Glynn, T., & Cahalin, L. (2025). Effects of an Accessible Hybrid Telehealth Respiratory Strengthening Program to Alleviate Chronic Constipation: A Pilot Study. Journal of Women's & Pelvic Health Physical Therapy, 49(3),120-131, https://doi.org/10.1097/JWH.0000000000000340}

Researchers compared the effects of pelvic floor muscle exercises (PFME) combined with standard diaphragm exercises versus PFME combined with 360° expanded diaphragm exercises on urinary symptoms, pelvic floor muscle (PFM) function, and respiratory function in women with stress urinary incontinence (SUI).

Design: Randomized controlled study

Inclusion Criteria: Women aged 18-64 diagnosed with SUI who were literate in Turkish with no cognitive impairments.

Exclusion Criteria: PFM training within the previous year, neurologic diseases, pelvic organ prolapse ≥stage 2, fecal incontinence, pregnancy, BMI ≥30, active UTI, respiratory diseases (COPD, asthma), history of hysterectomy, or lower extremity problems affecting the pelvis.

Participants were randomized into two groups (n=37 each) for an 8-week program with weekly 1-hour sessions (15 min patient education, 15 min diaphragm exercises, 20 min PFME). Participants also performed home exercises twice weekly.

Group 1: PFME + standard diaphragm exercises

Group 2: PFME + 360° expanded diaphragm exercises using sensor-based biofeedback devices (OhmTrack Sensor and Core360 Belt) to teach circumferential rib cage and abdominal expansion during inspiration.

Primary outcome was precontraction of PFM (initiation time of PFM contraction during Valsalva). Secondary outcomes included the Incontinence Severity Index (ISI), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), PFM function via EMG, and respiratory function (MIP and MEP).

Both groups demonstrated significant improvements in PFM function, incontinence severity (ISI and ICIQ-SF), and respiratory muscle strength (MIP and MEP) after 8 weeks (P<.05). The magnitude of change was similar between groups for these outcomes. Mean and maximum PFM contraction strength increased and time to initiate PFM contraction decreased in both groups.

The key between-group difference: the 360° expanded diaphragm group showed a significant reduction in time to initiate PFM contraction during the Valsalva maneuver (P=.010), while the standard diaphragm group showed no significant change. UI frequency decreased significantly in both groups, and both groups reported subjective improvement post-treatment.

_{Yakıt Yeşilyurt, S., Şahiner Pıçak, G., Başol Göksülük, M., Balıkoğlu, M., & Özengin, N. (2025). Investigating the Effectiveness of Pelvic Floor Muscle Training, Including Sensor-Based Diaphragm Exercises in Women With Stress Urinary Incontinence: A Randomized Controlled Study. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2025.06.019}

This study investigated differences in abdominal muscle thickness (transversus abdominis [TrA], internal oblique [IO], and external oblique [EO]) and lumbopelvic control among women with varying severities of stress urinary incontinence (SUI) compared to continent women. Researchers hypothesized that women with more severe SUI would demonstrate reduced abdominal muscle thickness and decreased lumbopelvic control.

Design: Cross-sectional study conducted between November 2020 and June 2021.

The study included 54 women: 21 with mild SUI, 12 with moderate SUI, and 21 healthy controls.

Inclusion Criteria: Women aged 30-60 with SUI diagnosed by a urogynecologist, leakage episodes >once/week (5-50g), BMI <30 kg/m², and no alcohol/drug addiction.

Exclusion Criteria: Pregnancy or planning pregnancy, pelvic/abdominal surgery within 6 months, concomitant SUI treatment, neurological/psychiatric disease, urinary tract infection, or inability to perform leg-lowering tests.

SUI severity was determined using an ultra-short perineal pad test: mild SUI was classified as <10g leakage, moderate SUI as 10-50g leakage.

Abdominal Muscle Thickness: TrA, IO, and EO thickness measured via ultrasound on the dominant abdominal side, midway between the 12th rib and iliac crest, at end-expiration.

Lumbopelvic Control: Assessed using one-leg-lowering and double-leg-lowering tests with pressure biofeedback. Participants maintained lumbar pressure at 50 mmHg while lowering legs; the hip extension angle at which pressure dropped was recorded, with larger angles indicating better control.

Abdominal Muscle Thickness: Healthy controls demonstrated significantly greater thickness in all three muscles compared to both SUI groups (p<0.01 for all): TrA (0.39 cm vs. 0.28 cm mild, 0.27 cm moderate), IO (0.93 cm vs. 0.75 cm mild, 0.77 cm moderate), and EO (0.71 cm vs. 0.52 cm mild, 0.57 cm moderate). No significant differences were found between mild and moderate SUI groups.

Lumbopelvic Control: Healthy controls showed significantly greater hip extension angles in the one-leg-lowering test (67.04°) compared to mild SUI (46.25°, p=0.04) and moderate SUI (34.31°, p<0.01). For the double-leg-lowering test, healthy controls (45.19°) showed significantly greater angles than moderate SUI (24.38°, p=0.04), but the difference with mild SUI (28.96°) did not reach significance (p=0.09).

These findings suggest that abdominal muscle morphological changes may occur early in SUI development, as both mild and moderate groups showed similar reductions compared to controls.

_{Hwang, U-J., Kwon, O-Y., & Kim, M. (2025). Comparison of Abdominal Muscle Thickness and Lumbopelvic Control Among Women With and Without Different Severity of Stress Urinary Incontinence. International Urogynecology Journal. https://doi.org/10.1007/s00192-025-06286-9}