Bearing down, or controlled pelvic exertion, is the deliberate act of increasing intra-abdominal pressure to generate a downward force through the pelvic floor. This muscular action is a coordinated movement involving the diaphragm, the abdominal wall, and the muscles of the pelvic floor, not simply straining. Mastering this technique requires learning how to direct pressure downward in a controlled manner while simultaneously allowing the pelvic floor muscles to lengthen and release. Proper technique is important for maintaining the health and function of the pelvic organs, as uncontrolled pressure can lead to strain or injury over time.
The Context: Delivery vs. Elimination
The purpose for bearing down significantly alters the specific technique employed. During the second stage of labor, the urge to push is often triggered by involuntary uterine contractions, which provide a powerful downward force. Pushing for delivery involves coordinating the voluntary effort of the abdominal muscles with this uterine force to help guide the baby through the birth canal. Pelvic floor therapists frequently teach a technique called “open glottis” pushing, which involves exhaling or making sound while pushing to manage pressure and reduce the risk of injury.
In contrast, bearing down for a bowel movement is a purely voluntary action intended to assist the movement of stool through the lower digestive tract. This effort primarily focuses on relaxing the anal sphincter and the rest of the pelvic floor while gently increasing abdominal pressure. The goal is to move the contents out without excessive straining or clenching, which can put unnecessary stress on the tissues and organs.
Step-by-Step Guide to Controlled Pelvic Exertion
The foundation of controlled pelvic exertion is diaphragmatic breathing, which establishes the correct piston-like motion between the diaphragm and the pelvic floor. Begin by finding a comfortable position, such as sitting upright on the toilet or a supported squat, as gravity assists the downward movement. Proper posture allows the abdominal contents to descend naturally and places the pelvic floor in an optimal position for lengthening.
To initiate the movement, take a slow, deep inhale, allowing the abdomen and lower ribcage to expand fully. As the diaphragm moves downward, the pelvic floor muscles should naturally descend and lengthen, creating a sensation of gentle expansion or dropping at the base of the pelvis. This relaxation is an active lengthening, sometimes described as allowing the muscles to “bulge” slightly without tension.
The controlled downward push begins at the peak of the inhale, or during a slow, deliberate exhale. Use the core and diaphragm to apply a gentle, sustained downward pressure, feeling the force directed toward the anus or vaginal opening, rather than toward the head or chest. A common analogy is the feeling of a deep sigh or a gentle, sustained push.
This action should be smooth and controlled, lasting only a few seconds, and should not involve holding the breath. The focus is on coordination and relaxation of the pelvic floor, not maximum brute force. After a short push, allow the muscles to fully relax and return to their starting position before taking another preparatory breath. Repeating this gentle, coordinated push multiple times is far more effective and safer than one prolonged, forceful strain.
Avoiding Harmful Pushing Habits
The most common harmful habit during bearing down is the Valsalva maneuver, which involves taking a deep breath, closing the throat (glottis), and then straining forcefully against the closed airway. This technique dramatically increases intra-abdominal and intrathoracic pressure, which can lead to negative health outcomes. The rapid pressure spike can elevate blood pressure and may cause complications for individuals with pre-existing conditions like certain heart or eye disorders.
Uncontrolled straining directs excessive force into the delicate tissues of the pelvic floor and can contribute to dysfunction over time. Pushing too hard or for prolonged periods, especially when constipated, increases the likelihood of developing hemorrhoids. Consistent, incorrect bearing down is also a major risk factor for pelvic organ prolapse, a condition where one or more pelvic organs shift from their normal position.
A sign of incorrect technique is feeling the pressure rise into the face, leading to redness or visible straining in the neck and head. Instead of this forceful clenching, the sensation should remain low and centered in the abdomen and pelvis. If a person consistently struggles to achieve controlled exertion, experiences pain, or notices symptoms like pelvic heaviness or difficulty with elimination, seeking guidance from a pelvic floor physical therapist is advisable.