How Pelvic Floor Training Can Improve Lung Function in Elderly Post-Surgical Patients

Pelvic floor rehabilitation is often associated with urinary continence or pelvic support, but recent research highlights its broader role, including significant impacts on respiratory health. Studies now suggest that combining pelvic floor muscle (PFM) training with pulmonary rehabilitation can enhance lung function, particularly in elderly patients recovering from orthopedic surgery.

Pelvic Floor Muscle Training and Pulmonary Function
A 2025 randomized controlled trial investigated the effects of combining pelvic floor muscle training with pulmonary rehabilitation in elderly patients following surgery for intertrochanteric femur fractures (Ji et al., 2025). Fifty patients were randomly assigned to either pulmonary rehabilitation alone or pulmonary rehabilitation combined with PFM training. After four weeks, both groups showed improvements in forced vital capacity (FVC), peak expiratory flow (PEF), and the FEV1/FVC ratio, with the combined intervention group demonstrating significantly greater gains. Diaphragm excursion and thickening fraction were also improved, suggesting a synergistic relationship between the diaphragm and pelvic floor muscles that enhances respiratory mechanics.

Supporting Evidence
Additional studies support the connection between PFM function and respiratory performance. A recent study using sensor-based diaphragm exercises combined with PFM training in women with stress urinary incontinence demonstrated improvements in both pelvic floor function and respiratory parameters (Yakıt Yeşilyurt et al., 2025). Similarly, pelvic floor electrical stimulation has been shown to enhance diaphragm excursion and rib-cage movement during tidal and forceful breathing and coughing (Hwang et al., 2021). Foundational work also demonstrated that co-activation of abdominal and pelvic floor muscles contributes to improved expiratory function and intra-abdominal pressure regulation (Sapsford et al., 2001). Together, these studies highlight the physiological link between the pelvic floor, diaphragm, and respiratory system.

Why This Matters
For elderly patients recovering from hip fractures, optimizing lung function is critical to reducing postoperative complications such as pneumonia and supporting overall recovery. Integrating PFM training with pulmonary rehabilitation provides a novel and underutilized approach to enhance respiratory efficiency and accelerate functional recovery. Moreover, these findings expand the role of pelvic floor rehabilitation beyond traditional urogenital outcomes, emphasizing its value in multidisciplinary rehabilitation programs.

Takeaway
The pelvic floor contributes significantly to respiratory mechanics. Combining pelvic floor muscle training with pulmonary rehabilitation can improve lung function in elderly post-surgical patients and may support broader recovery goals. As research evolves, pelvic floor specialists have the potential to play a key role in integrated rehabilitation approaches.

Practical Next Step: Elevate your clinical expertise by enrolling in Breathing and the Diaphragm, scheduled for December 6. This course covers diaphragm anatomy, breathing mechanics, and how the diaphragm, abdominals, and pelvic floor interact to regulate intra‑abdominal pressure, support core stability, and influence posture. Lab sessions include assessment and treatment of dysfunctional breathing patterns, ribcage and thoracic-spine restrictions, and practical strategies for clinical integration. While broadly applicable to pelvic pain, incontinence, prolapse, and core/abdominal issues, these techniques can be adapted for elderly post-hip-fracture patients to optimize lung function and recovery.

References

• Yakıt Yeşilyurt S, Şahiner Pıçak G, Başol Göksülük M, Balıkoğlu M, Özengin N. Investigating the Effectiveness of Pelvic Floor Muscle Training, Including Sensor-Based Diaphragm Exercises in Women With Stress Urinary Incontinence: A Randomized Controlled Study. Arch Phys Med Rehabil. 2025 Jul 11:S0003-9993(25)00796-8. doi: 10.1016/j.apmr.2025.06.019. Epub ahead of print. PMID: 40653184. https://pubmed.ncbi.nlm.nih.gov/40653184/
• Ji D, Fu Y, Wu L, Tian C, Jin S. Effect of pelvic floor muscle combined with pulmonary rehabilitation training on lung function in elderly patients after surgery for intertrochanteric fractures of the femur: a randomized controlled trial. Eur J Med Res. 2025 May 14;30(1):381. doi: 10.1186/s40001-025-02610-7. PMID: 40369675; PMCID: PMC12076919. https://pubmed.ncbi.nlm.nih.gov/40369675/
• Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Effect of pelvic floor electrical stimulation on diaphragm excursion and rib cage movement during tidal and forceful breathing and coughing in women with stress urinary incontinence: A randomized controlled trial. Medicine (Baltimore). 2021 Jan 8;100(1):e24158. doi: 10.1097/MD.0000000000024158. PMID: 33429797; PMCID: PMC7793445. https://pubmed.ncbi.nlm.nih.gov/33429797/
• Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p. PMID: 11135380. https://pubmed.ncbi.nlm.nih.gov/11135380/