Can Hypopressive Breathing Actually Improve Your Pelvic Floor Health?

Hypopressive exercise is a new name for an old technique. The yogi practice called uddiyana bandha was recast as hypopressive breathing or abdominal hypopressive technique (AHT) in the 1980s by Marcel Caufriez, a Belgian physical therapist working in Spain. Caufriez was looking for a way to help his postpartum patients with urinary incontinence and pelvic organ prolapse.

So what are hypopressives? You've likely seen photos or videos of someone doing this technique but didn't know what it was called, or how or why you would want to do it yourself. Abundant TikToks show exercise influencers doing something similar called the "vacuum method."

Four basic steps are required to perform the maneuver:

1) Sit with your back straight and inhale deeply, expanding your ribs.

2) Exhale completely.

3) Suck in as if you are inhaling, but don't actually take in any air. The negative pressure will cause the diaphragm to rise, lifting the abdomen in a vacuum.

4) Hold the position for four seconds and then breathe normally.

Does AHT actually work?

Research on hypopressive breathing is split. Some studies have found the practice to be helpful for women suffering from pelvic floor dysfunction. However, an editorial published in the British Journal of Sports Medicine called into question the effectiveness of the practice.

Still, anecdotal evidence indicates AHT has been helpful for some individuals. Kendyl Muz, a chiropractor in Coquitlam, British Columbia, and the mother of two young children, found hypopressive breathing made a huge improvement in her bladder prolapse.

"During my second pregnancy, I felt pressure in my vagina. I went to a pelvic floor physio and discovered I had a bladder prolapse," Muz said. "I had a feeling of pressure and heaviness daily and it was constantly on my mind. I was worried about lifting my children or carrying anything heavy for fear I would make it worse.

"I started doing the hypopressives daily and within a couple weeks, I noticed an improvement in my symptoms," Muz continued. "It also just felt good to do them. Between working with the pelvic floor physio and doing hypopressives, my symptoms have almost completely subsided. I still get occasional heaviness depending where I'm at in my cycle, but nothing like it was back then."

Hypopressives for prolapse

"Hypopressives are one of the first things that have come along that can improve prolapse and potentially even reverse it," said pelvic floor trainer Kim Vopni, aka the Vagina Coach. About half of American women have some degree of prolapse, though many don't know it because they don't have symptoms.

"If somebody has prolapse, I recommend starting with hypopressives," Vopni said, adding that AHT makes Kegels more effective. Repositioning the pelvic organs closer to their proper position before starting Kegel exercises allows the client to better perform Kegels, Vopni explained.

Claire, a British Columbia-based doctor and mother of a 3-year-old who asked to be identified by her first name, thought she had done everything right. As an active medical professional, she knew about the importance of a strong pelvic floor. During her pregnancy, she practiced pelvic floor exercises, and she met with a pelvic floor physiotherapist shortly after she gave birth.

"So you can imagine my surprise and disappointment when I diagnosed my own grade 3 prolapse at eight weeks postpartum...It was a very dark time," Claire said. "My physiotherapist suggested hypopressives to me when I was nine months postpartum. I was supposed to do it every other day, but after the first day I felt such relief, I started doing them daily. Now at three years postpartum, I still do them at times of my cycle when things feel heavier or after a harder workout."

AHT for incontinence

Urinary incontinence is prevalent, especially in women. Women have a wider pelvic base with an additional opening, and they have hormonal fluctuations from their menstrual cycles and menopause. They may get pregnant and give birth, often multiple times, leading to the unfortunate side effect of leaking urine when they laugh, cough, lift or run.

Vopni recommended the combination treatment of hypopressives and Kegels, starting with Kegels as an entry point and adding AHT. "The two together are incredibly powerful because they both have benefits," Vopni explained. "If every woman did both...incontinence, prolapse and suffering would drop significantly."

Are hypopressives right for you?

Before starting any new routine or treatment, it's always best to talk to your doctor about the risks and benefits. Your doctor can recommend whether or not AHT is a good option for your situation. Research on the effects of AHT is still ongoing and there is no medical consensus on whether the practice is beneficial.

Hypopressives are not recommended for people who are pregnant or menstruating, or those who have high blood pressure, ulcers or a hiatal hernia.