Estimated reading time: 8 minutes
In this article, we will as the question Are hypopressives beneficial for pelvic floor dysfunction? If you are suffering from pelvic floor dysfunction, you may well have heard of Hypopressives; a breathing technique that uses a stomach vacuum to tap into the relationship between the pelvic floor, core and breathing diaphragm. These stomach vacuums are the same as those practiced by yogis for millennia and utilized by bodybuilders since the seventies to enhance breathing, reduce waist size and improve aesthetics.
The idea that these stomach vacuums could be beneficial for treating pelvic floor dysfunctions was first suggested in the eighties when Belgian physiotherapist Marcel Caufriez began using hypopressive exercises to improve pelvic floor control in patients. With 1 in 3 women1 suffering pelvic floor dysfunction during her lifetime, finding conservative and easy to follow exercises to improve symptoms and quality of life is critical. So, let’s first explore the exercise before delving into its perceived benefits for those with pelvic floor dysfunction.
How to Perform a Hypopressive Exercise (Stomach Vacuum)
The hypopressive manoeuvre (also known as an apnea) involves emptying the lungs completely and immediately closing the airways to prevent air reentering the lungs. Following this, the abdominals are relaxed and the ribcage is expanded which creates a stomach vacuum causing the abdominals the be drawn upwards and inwards. The vacuum can also be seen on the back of the body and around the shoulder blades. Follow the steps below to perform the hypopressive manoeuvre which is shown in the animation.
Steps to Perform a Hypopressive Apnea
- Perform three breath cycles where you inhale and exhale.
- On the third exhalation, empty the lungs fully, this will include contraction of the abs to empty the reserve volume from the lungs.
- Close your airways to prevent air from reentering the lungs.
- Take your apnea. To do so, relax the abdominals and expand the ribcage out to the sides in the same motion used when breathing but without taking air in.
- Hold for a count of 4.
- Relax the ribcage and abdominals before taking your next inhalation.
Should You Replace Kegels With Hypopressives?
For those suffering from a Pelvic Organ Prolapse, the uplifting motion produced when performing an apnea can feel quite relieving on the prolapse, as is my experience with my own rectocele. Of course, feeling some immediate relief doesn’t necessarily mean that there are proven benefits. Marketing of hypopressive training is strong, and some campaigns even suggest using hypopressives as an alternative to Kegel exercises (Traditional Pelvic floor muscle training). In keeping with the usual approach on this website, we will explore the research to see if this makes sense, and to discover the proven benefits of practicing hypopressives.
Traditional pelvic floor muscle training (Kegels) as a treatment for incontinence and prolapse is backed by decades of research confirming the benefits. Hypopressives, on the other hand, have only been studied during the last decade. The first study2 into hypopressives compared a group performing Kegels with another performing hypopressives. The conclusion was that hypopressives were less effective than Kegels alone.
A subsequent study3 in 2012 had three groups; one performing hypopressives plus Kegels, a second performing Kegels alone and a control group. That study found that both groups performing exercises did better than controls, however; adding hypopressives to Kegels didn’t improve pelvic floor function and those who practiced only Kegels had superior pelvic floor endurance.
Another 2012 study4 directly compared a group performing Kegels with another performing hypopressives and found that both groups showed similar improvements.
Since those early studies, there have been numerous other studies, none of which have confirmed that you should ditch your pelvic floor exercises in favour of a hypopressive practice, however; through the course of these studies, the true benefit of hypopressives has been revealed.
A Program of Hypopressive Exercises Showed Positive Results in Post-partum Abdominal Diastasis
The Real Benefits of Hypopressive Exercise
If you are suffering from pelvic floor dysfunction, it is very likely that you also have some core weakness. This is where hypopressives can provide benefits. Whereas the early studies into hypopressives did not substantiate the suggestion that they should be used as an alternative to Kegels, they did reveal improvements in the strength of the transverse abdominis (TrA), one of the key core muscles.
A 2021 study6 exploring how the abdominal muscles change during hypopressives found that hypopresives significantly increase the thickness of the TrA and internal oblique during the exercise in comparison with the muscles at rest. With that said, you should’t rush to swap your core exercises with hypopressives. A 2020 study7 that looked at the pelvic floor and abdominal muscle response during hypopressives did note that the muscles showed increased activation during the exercises, but not sufficiently to create strength gains. They did, however, suggest it could have an endurance effect. Further studies would be needed to substantiate that hypothesis.
Why Practice Hypopressives?
So why bother practicing hypopressives if they aren’t going to heal your prolapse or cure your incontinence? I have three reasons why I personally practice hypopressives, and why I included them in some of the breathing modules of my Eight-phase training course.
One of the main reasons I like to practice hypopressives is because it relieves the symptoms of my rectocele. I generally only feel symptomatic if I allow myself to get constipated and have to strain to poop. When I get the heavy dragging feeling of the prolapse, I practice my hypopressives and it helps to reduce the symptoms. I also find inversions to be helpful with symptom relief.
One of the triggers for the symptoms of prolapse, which is also a cause of leakage during stress incontinence, is increased intraabdominal pressure. When you practice hypopressives, you tap into the relationship between the breathing diaphragm, the core and the pelvic floor. I find that my hypopressive practice helps me to feel and manage this relationship, which in turn helps me to balance my intraabdominal pressure.
The final reason I like to practice hypopressives is vanity! Whereas I have not actually taken measurements to show that my waist is reduced from the practice, nor did I find any any studies that confirm it does reduce waist size, I feel more trim. Maybe you’ve read the article by Carol Harmon that we posted back in 2019 where she showed her before and after photos. There is a visible difference in those images (and she clearly spent some time in the sun in the 48 hours between the photos!!), so I am not alone in feeling that it creates an aesthetic improvement.
Looking for Structured Training for Pelvic Floor Dysfunction
It’s time for a shameless plug! If you are looking for a structured program to overcome pelvic floor dysfunction, I have written an extensive book including my complete Eight-Phase training program which is available on Amazon. The Eight-Phase training is also available as a video course that gives you access to premium areas of the community including access to weekly Zoom Q&A sessions with me. If you would like to support me to continue producing content for pelvic health, you can also subscribe to my Patreon where you can get discounts for the course and other benefits.
- Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, Whitehead WE, Wu J, Brody DJ; Pelvic Floor Disorders Network. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008 Sep 17;300(11):1311-6. doi: 10.1001/jama.300.11.1311. PMID: 18799443; PMCID: PMC2918416.
- Stüpp L, Resende AP, Petricelli CD, Nakamura MU, Alexandre SM, Zanetti MR. Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography. Neurourol Urodyn. 2011 Nov;30(8):1518-21. doi: 10.1002/nau.21151. Epub 2011 Aug 8. PMID: 21826719.
- Resende AP, Stüpp L, Bernardes BT, Oliveira E, Castro RA, Girão MJ, Sartori MG. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse? Neurourol Urodyn. 2012 Jan;31(1):121-5. doi: 10.1002/nau.21149. Epub 2011 Oct 28. PMID: 22038880.
- Bernardes BT, Resende AP, Stüpp L, Oliveira E, Castro RA, Bella ZI, Girão MJ, Sartori MG. Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial. Sao Paulo Med J. 2012;130(1):5-9. doi: 10.1590/s1516-31802012000100002. PMID: 22344353.
- Ramírez-Jiménez M, Alburquerque-Sendín F, Garrido-Castro JL, Rodrigues-de-Souza D. Effects of hypopressive exercises on post-partum abdominal diastasis, trunk circumference, and mechanical properties of abdominopelvic tissues: a case series. Physiother Theory Pract. 2021 Nov 15:1-12. doi: 10.1080/09593985.2021.2004630. Epub ahead of print. PMID: 34779692.
- Da Cuña-Carrera I, Alonso-Calvete A, Soto-González M, Lantarón-Caeiro EM. How Do the Abdominal Muscles Change during Hypopressive Exercise? Medicina (Kaunas). 2021 Jul 9;57(7):702. doi: 10.3390/medicina57070702. PMID: 34356983; PMCID: PMC8305934.
- Navarro Brazález B, Sánchez Sánchez B, Prieto Gómez V, De La Villa Polo P, McLean L, Torres Lacomba M. Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction. Neurourol Urodyn. 2020 Feb;39(2):793-803. doi: 10.1002/nau.24284. Epub 2020 Jan 27. PMID: 31985114.