What is IAP?
IAP is the increased pressure that we create inside our abdomen during physical tasks that either helps push things up and out our nose/mouth (sneezing, coughing, laughing, etc) or down and out your rear end (bowel movements and passing gas). IAP is a necessary part of life; we use increased IAP to our benefit anytime we sneeze or blow our nose, have a bowel movement, cough or laugh, etc.
So, I want to be very clear that all IAP is NOT bad, as you do need it for everyday tasks! The problem becomes when people are increasing IAP as a substitution for lack of core strength, to give them extra “oomph” when lifting or carrying heavy things, or to help put more pressure on their bowels to eliminate their stool if they are constipated. As you can imagine, if you are chronically increasing the pressure inside your abdomen when you really shouldn’t be, this can definitely cause or contribute to your internal organs being pushed out of position.
In order to talk about when increasing IAP is and isn’t helpful, we’ll need to do a quick review of breathing mechanics.
Your pelvic floor and internal organs SHOULD move
With every breath you take, your body does an awesome and intricate dance between your diaphragm, abdominals, and pelvic floor. As you inhale, your diaphragm pushes downwards in order to help fill your lungs with air. This creates increased IAP, which then pushes the belly slightly outwards, and the internal organs and pelvic floor slightly downwards. Then as you exhale, the diaphragm relaxes and elevates as you expel air from your lungs. In turn, this helps pull the pelvic floor and internal organs upwards, and helps the abdominals relax or fall back towards your center. If you want to see this movement in action check out this breathing gif or this abdominal and pelvic floor movement gif.
This amazing coordination happens with every. single. breath. that you take! So hopefully this should help illustrate why we always coordinate brace/blink/rocket on the exhale. Coordinating your belly and pelvic floor with the exhale helps keep your IAP low, and naturally helps your body activate your abs and pelvic floor. You can also imagine why prolapse is linked to chronic lung conditions like asthma and COPD, or why you may have worsened prolapse (or incontinence!) with an illness that causes excessive coughing/sneezing.
This is also why we don’t want people to get in the habit of holding their breath with exercise or everyday activities. And it’s also why we don’t want someone to ONLY focus on engaging/strengthening their pelvic floor, and never focus on relaxing it. Your diaphragm gets really rigid when you hold your breath, and thus puts a lot of pressure on your internal organs below (illustrated in the second pic). It also doesn’t allow you to engage your abs or pelvic floor properly.
The same goes for an overactive pelvic floor—too much rigidity in the pelvic floor doesn’t allow for the natural movement your diaphragm and abdominals should have while breathing, and can cause you to take shorter, shallower breaths. This tension in turn may create more tension in your pelvic organs & fascia, and contribute to their descent. In this, and in most cases, motion is lotion!
How do I prevent IAP from becoming a problem?
In a word, EXHALE! When you exhale fully your IAP is at its lowest. This is due to the natural coordination between your pelvic floor, diaphragm, and abdominals as mentioned above. When the diaphragm elevates and empties your lungs fully of air, it encourages the pelvic floor and abdominals to draw inwards. This provides better support for your internal organs too.
This doesn’t mean that it’s always terrible to hold your breath, or you should be scared of taking a deep inhale that causes your belly to bulge a bit and pelvic floor to push downwards/outwards. As explained above, your pelvic floor and internal organs NEED to move. The fear that some people develop after a prolapse diagnosis that prevents them from never fully relaxing their abs and pelvic floor is just as bad as someone who never engages them. Life is all about balance!
So, get into the habit of exhaling with any tasks that might increase IAP. This would include lifting anything heavy (from that big bag of dog food to your 20 lb infant plus car seat), pushing/pulling anything heavy (heavy grocery carts, moving furniture, etc), light weight-lifting, etc. A special note here for moderate to heavy weights—sometimes this does require you to INCREASE your IAP in able to lift weights safely. If this applies to you, please make sure to work with a personal trainer or other certified fitness professional who can teach you safe techniques for heavier weight lifting.
What about deep abs and pelvic floor?
Yes, it’s even better if you can coordinate your deep abs (belly brace) and pelvic floor (Kegel) with the exhale during these everyday life tasks! But, the good news is there is a "cheat" if that’s too hard to coordinate (looking at you, the mom with 3 under 5 who has two toddlers asking her 5 million questions while she's lifting the baby out of the car). If you can at least coordinate the exhale during moments of increased IAP, the rest of your muscles will follow. The main point here is that you do not hold your breath with any of these activities.
It is also true that some people with prolapse will have INCREASED tension in their pelvic floors, not decreased tension. If you know that is you, then you can ease up on the blink/rocket with increased IAP. But, doing the brace would still be helpful!
Next article we’ll dive more into exercises for prolapse, so be sure to check that one out!