The Role of the Pelvic Floor in Respiration: A Multidisciplinary Literature Review

J Voice. 2020 Mar;34(2):243-249. doi: 10.1016/j.jvoice.2018.09.024. Epub 2018 Nov 14.


Objective: To conduct an interdisciplinary literature review on the function of the pelvic floor musculature during respiration and its role in phonation, particularly singing.

Study design: This is a literature review.

Methods: A literature review was conducted using three electronic databases: PubMed, Scopus, and Google Scholar. An index search was also performed for the NATS Journal/Journal of Singing utilizing the keywords from the original search, as these articles did not appear in the original search. Peer-reviewed articles from 1985 to 2017 were gathered on the respiratory musculature and/or support mechanisms for phonation (anatomy and physiology). Articles that pertained to the muscular function of the respiratory system in breathing and/or phonation were utilized in the review. Eighty-five articles were included in this review.

Results: Breathing and support strategies were variable and nonspecific in much of the singing voice literature. The voice science literature was a rich source of articles written about breathing and support for singing. Multiple studies looked at musculature utilized in respiration and breath support and subglottal pressure generation for muscular support. However, little or no mention was made specifically of the pelvic floor. The physical medicine literature includes the pelvic floor musculature as having an important role in respiration, as a key player in the generation of intra-abdominal pressure, and as a primary expiratory muscle.

Conclusions: The information gleaned from this literature review suggests that a cross-pollination between areas of science is needed, because quite obviously, the pelvic floor is a topic in physical medicine, but it is not (so much) in the voice literature. Reaching a consensus on how we describe the function of the respiratory musculature and specifically including the role of the pelvic floor in respiration and phonation deserves future attention. Further research looking specifically at the role of the pelvic floor in phonation is also warranted.

Keywords: Breath support; Forced expiration; Intra-abdominal pressure; Pelvic floor; Sub-glottal pressure; Thoracic diaphragm.

Publication types

  • Review

MeSH terms

  • Airway Resistance
  • Humans
  • Lung / diagnostic imaging
  • Lung / physiology*
  • Muscle Contraction*
  • Pelvic Floor / diagnostic imaging
  • Pelvic Floor / physiology*
  • Phonation*
  • Pressure
  • Respiration*
  • Singing
  • Voice Quality*