Could The Diaphragm and Ribcage Be The Driver In Your Constipated Kids?

In pediatric pelvic floor therapy, you’re often faced with complex cases. Children might struggle with constipation that won’t resolve or have ongoing pelvic pain despite good patient compliance. These cases can feel frustrating for you and for the families you serve.

You’re trained to look at muscle imbalances, postural misalignments, and behavioral habits. You educate about toilet routines and teach stability exercises. But what if something deeper is influencing all of these systems? What if you’re overlooking a key player in how the body coordinates movement, manages pressure, regulates emotion, and supports function?

Let’s turn your attention to the diaphragm.

While breathing may seem like a basic physiological process, its influence on neuromotor expression, intra-abdominal pressure, and pelvic floor function is profound—especially in the developing child. Understanding the role of the diaphragm and its integration with the rest of the core system can significantly shift how you evaluate and treat your young patients.

Have you ever wondered about the protruding abdomens that walk into your clinic? The really wide rib angles? Can you picture a “typical” constipated child in your head?

The concept of the “core” must extend beyond the abdominal wall and pelvic floor. The core is a system of interrelated structures that includes the diaphragm, vocal folds, ribcage, thoracic spine, abdominals, viscera, and the pelvic floor. These structures are all implicated in the loss of postural stability oftentimes associated with chronically constipated kids.

All these core components interact continuously. In the rush of treatment, it’s common to focus on one or two elements while unintentionally overlooking the rest. Disruption in one part of the system affects the others, leading to functional changes that extend far beyond the pelvis.

Breathing is not simply a ventilatory function—it is a critical contributor to neuromotor behavior. A dysfunction in the breathing mechanism can contribute to a cascade of symptoms, including impaired motor coordination, emotional dysregulation, and nociceptive sensitization.

The diaphragm plays a unique role in informing the central nervous system about postural needs. Diaphragmatic contraction sends proprioceptive input to the brain, which facilitates postural adjustments and motor output. In children, you may see inefficient breathing patterns can contribute to poor core engagement, altered balance strategies, and ineffective pelvic floor activation.

In essence, think of the diaphragm as a sensory and motor interface. If the information it provides is inaccurate due to mechanical restriction, fascial tightness, or postural imbalance, the resulting motor output will also be compromised.

Proper diaphragmatic function is essential for maintaining a balanced intra-abdominal pressure system. The diaphragm, abdominal wall, and pelvic floor work together to manage pressure during movement, speech, coughing, voiding, and defecation. If the diaphragm is restricted or poorly positioned, the burden of pressure regulation shifts disproportionately to the pelvic floor.

This shift has implications for many of the children you see. A child with a high, rigid rib cage may experience limited diaphragmatic descent, causing the pelvic floor to over-recruit as a compensatory mechanism.

Coordination between the diaphragm and pelvic floor is not voluntary—it is preprogrammed by the central nervous system. Therefore, a disruption in one part of the pressure system may present as musculoskeletal or be perceived as a behavioral issue that resists traditional intervention strategies.

Of note, children with “gut-brain” interaction disorders or vague, diffuse symptoms may have diaphragmatic restrictions at the root of their dysfunction. These connections highlight the importance of evaluating breathing and fascial mobility as part of a comprehensive pediatric pelvic floor assessment.

Core and postural training in pediatrics often misses the mark by not addressing respiratory mechanics. Think about how a child naturally develops. As they begin to assume against-gravity positions—crawling, sitting, standing—the diaphragm and pelvic floor align vertically. This alignment is critical for:

• Pressure modulation
• Lymphatic drainage
• Visceral mobility
• Neurologic function from the brain to the pelvic floor
• Pelvic floor engagement during functional tasks

Children with postural asymmetries, wide rib angles, or poor diaphragmatic control may lack the necessary internal pressure dynamics to support pelvic floor function. As a result, symptoms such as incontinence, constipation, and core instability may persist despite targeted interventions.

In many pediatric cases, respiratory mechanics are not prioritized in core training or postural interventions. You must be able to train the diaphragm to maintain both respiratory and biomechanical functions. Without this dual capacity, compensatory strategies develop—often manifesting as overuse of the accessory musculature or rib flaring. You will also see reduced pelvic floor efficiency.

As a pediatric pelvic floor therapist, you must broaden your perspective beyond the pelvis to include the entire core system—especially the diaphragm. Consider asking yourself the following during evaluation:

• What is the quality and pattern of the child’s breath?
• Does the rib cage move symmetrically?
• Can the diaphragm descend effectively?
• Are fascial restrictions contributing to limited mobility or altered pressure?
• Is the pelvic floor compensating for poor diaphragmatic control?

If the answers to these questions reveal inefficiencies, your intervention plan must address the diaphragm to restore functional coordination.

To support therapists in integrating these concepts into their clinical work, I’ve created an online mini course, “Development of Continence Through The Lens of The Diaphragm, Ribcage, and Pelvic Floor”.

This course offers practical strategies for:

• Assessing breath mechanics in pediatric patients
• Identifying patterns of compensation related to diaphragmatic restriction
• Addressing postural and fascial contributions to core dysfunction

Understanding the diaphragm’s role is foundational for pediatric pelvic floor therapy. By expanding your clinical lens to include this critical structure, you can offer more comprehensive and effective care for the children you serve.