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Pelvic Floor Considerations in Covid-19

Source: Sircusa and Gray, 2020 (Journal of Women's Health Physiotherapy) -

Pelvic floor health hasn't been widely discussed in terms of treatment of individuals surviving Covid-19, however, it has been shown that Covid survivors often have a disability in the respiratory diaphragm. The effect on Covid-19 directly on pelvic floor function is unknown, but as the respiratory diaphragm has an impact on the ability of the pelvic floor to contract and relax, potential issues can be predicted.

During inhalation, the descent of the diaphragm causes expansion of the abdominal wall and the pelvic floor. With exhalation, the diaphragm recoils to its resting position and the abdominal wall and pelvic floor will gently contract. However, individuals with poor ribcage/diaphragm movement will likely have difficulty relaxing and lengthening their pelvic floor, which could lead to long-term implications on pelvic floor function.

Coughing and exertional shortness of breath commonly persists after recovery from Covid-19 even in the mild disease (Yu-Miao et al. 2020) and may consequently provoke pelvic floor symptoms. Populations that have increased incidence of chronic coughing also have a higher incidence of incontinence and pelvic organ prolapse. When an individual is short of breath the pelvic floor can become overused and may not be able to respond to the increase respiratory rate to prevent incontinence. Anxiety is also common in people with shortness of breath due to an up-regulation of the autonomic nervous system, and this has been associated with pelvic pain (Siqueira-Campos et al. 2019 and de Voogd et al. 2011).

Consequently, it is important that functional exercises with integrated pelvic floor focus as well as training accessory muscles that assist pelvic floor function are utilised in returning to movement and exercise. Restricted movement of the ribcage will have implications for diaphragm descent and as a result pelvic floor lengthening. Therefore, treating breathing mechanics including manual release of the diaphragm, rib mobility exercises, stretches and manual cueing of diaphragmatic breathing can also be coordination with pelvic floor muscles actions to improve coordination in the whole system.

If you have concerns over your breathing mechanics and pelvic floor function whether you've suffered with Covid-19 or not, please get in touch.


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