What are Hypopressives?
Hypopressives—often taught under the Low Pressure Fitness methodology—are a series of postures and breathing techniques designed to reduce intra-abdominal pressure and create a gentle “vacuum effect” that triggers reflex activation of the deep core and pelvic floor.
Here’s what makes them different: instead of asking you to consciously squeeze your pelvic floor (like traditional Kegels), Hypopressives train your whole pressure system—diaphragm, rib cage, abdominals and pelvic floor—to work together more intelligently. Research published in the National Institutes of Health confirms this integrated approach.
Think of it as teaching your body a new language—one where your core and pelvic floor communicate seamlessly, without you having to micromanage every contraction.
Why Hypopressives matter for pelvic health
Most of us have been told to “do your Kegels” and “strengthen your core.” And whilst these aren’t bad pieces of advice, they miss a crucial element: how you generate and manage pressure often matters more than how hard you contract your muscles.
If you’re dealing with Diastasis Recti, incontinence, prolapse, back pain or a sense of core instability, traditional core work and everyday bracing can accidentally push down on the pelvic floor—especially if technique is off or tissues are already compromised.
Hypopressives flip this script entirely. They help you lift and support from the inside out, minimising downward pressure whilst strengthening the entire canister that supports your organs. This pressure-friendly approach is why Hypopressives are used globally by physiotherapists and movement specialists in pelvic floor rehabilitation programmes, and why they sit at the heart of re-centre’s method. Studies in Wiley Online Library support this approach for women with pelvic floor dysfunction.
How Hypopressives work (without the jargon)
The core idea
Hypopressives use three main ingredients:
1. Postural alignment: Standing, kneeling or sitting postures with axial length (tall spine), neutral pelvis and active shoulder girdle.
2. Specific rib breathing: Lateral and posterior expansion of the rib cage, teaching your diaphragm to move efficiently.
3. Apnoea / “vacuum” phase: After an exhale, you hold your breath and open the ribs without inhaling. This creates a gentle suction effect inside the torso.
During this apnoea phase, research presented at the International Continence Society shows something remarkable:
- Intra-abdominal pressure (IAP) does not spike; in fact, it can be lower than at rest in some positions
- Pelvic floor muscles (levator ani) activate up to ~50% of maximal voluntary contraction in some protocols—without you deliberately squeezing
This combination, lower or stable pressure, plus strong reflex activation, is exactly what we want for pelvic floor and core rehabilitation.
How this feels in your body
Most people first notice:
- A sense of “lifting” through the lower belly and pelvic floor
- More freedom around the rib cage and easier breathing outside of practice
- Better posture and a lighter, more supported feeling when standing and walking
Over time, these changes translate into practical shifts: fewer leaks, less heaviness, better core control and a more responsive pelvic floor in daily life.
What the research shows
There is growing, though still emerging, research on Hypopressives. The strongest evidence is currently in pelvic floor dysfunction, with promising but more limited data in other areas.
1. Urinary incontinence and pelvic floor dysfunction
A blinded randomised controlled trial involving 117 women tested hypopressive exercises in women with pelvic floor dysfunction and urinary incontinence over an 8-week programme. Published in Neurourology and Urodynamics, the study found:
Key findings after 8 weeks (2–3 sessions/week, ~20 minutes):
- Pelvic floor muscle strength (Modified Oxford scale) improved significantly in the Hypopressive group (F ≈ 89.5, p < 0.001)
- Symptom distress (PFDI-20) dropped significantly (better scores in genital prolapse, urinary and colorectal subscales)
- Impact on daily life (PFIQ-7) improved markedly (less effect on physical, emotional and social functioning)
- Urinary incontinence severity (ICIQ-SF) improved significantly compared with controls
Takeaway: Hypopressives can strengthen the pelvic floor and reduce incontinence and pelvic floor disorder symptoms in as little as 8 weeks.
2. Pelvic organ support and prolapse-related symptoms
In the same RCT, Hypopressives led to significant improvements in prolapse-related subscales and overall symptom burden. Research in PMC confirms these findings.
Imaging and ultrasound-based research suggests that Hypopressives can:
- Increase levator ani muscle cross-sectional area and thickness
- Reduce genital hiatus size (the opening at the centre of the pelvic floor)
- Elevate the position of pelvic organs (bladder, uterus, rectum) to some extent
Whilst pelvic floor muscle training (PFMT) often shows the largest muscle-size gains, Hypopressives appear to offer meaningful support improvements with lower pressure—which is particularly attractive for women with prolapse or prolapse risk. Studies published in PubMed support this approach.
3. Diastasis recti and abdominal wall function
For diastasis recti (the separation of the rectus abdominis at the linea alba):
A randomised controlled trial in postpartum women compared Hypopressive exercises with conventional abdominal exercises over 8 weeks. Both groups showed significant reductions in inter-rectus distance and pain; the Hypopressive group had statistically better improvements in some measures. Published in Medico Publication.
A more recent 6-week trial found that both Hypopressives and conventional abdominal exercises reduced inter-rectus distance, with similar positive effects overall, and slightly different patterns. Research from University of Lisbon details these findings.
Interpretation: Hypopressives are at least as effective as conventional core work for diastasis in these studies, with added advantages for pelvic floor and pressure management—making them a strong option for women with both diastasis and pelvic floor issues.
4. Back pain, posture and respiratory function
Low Pressure Fitness positions Hypopressives as a global postural and breathing method, not just a pelvic floor technique. Low Pressure Fitness research highlights this holistic approach.
A 5-week study referenced previous RCTs showing improvements in:
- Low back pain intensity and disability
- Lumbar mobility
- Postural control and scoliosis degree in clinical populations
Published in PMC, this research supports the broader postural benefits.
A systematic review on Hypopressives in healthy women noted plausible positive effects on waist circumference, trunk height, lower back mobility, abdominal and pelvic floor contraction, respiratory flow and apnoea performance, though it also called for more robust trials. Available on PubMed.
From a practical standpoint, many women report:
- Reduced back ache due to better posture and more balanced core recruitment
- Easier breathing and rib movement, particularly if they were chest breathers or felt “stuck” in their upper body
5. Waist circumference, digestion and metabolic health
Early research and Low Pressure Fitness material suggest:
Waist circumference can decrease with Hypopressive programmes, likely due to improved postural tone, core activation and breathing patterns.
Digestion and bowel function may improve through:
- Gentle visceral mobilising effect of the vacuum
- Better diaphragm movement and autonomic regulation
Metabolic health may be indirectly supported via improved breathing mechanics, posture, circulation and safely increased activity levels (though high-quality data are limited so far).
Sexual function: By enhancing pelvic floor awareness, blood flow and reflex activation, many users report improved sexual sensation, arousal and orgasm quality, especially when Hypopressives are combined with other pelvic floor rehabilitation.
The 2024 systematic review stressed that the literature on healthy women is still small and methodologically mixed, so these broader benefits should be presented as promising but still emerging, whilst the pelvic floor and diastasis evidence is more robust.
How Hypopressives compare to traditional approaches
Hypopressives are not a replacement for everything else; they are a complementary way of training the system.
Hypopressives vs Kegels (PFMT)
Kegels (PFMT): Train voluntary contraction and endurance of pelvic floor muscles. Strong evidence for stress incontinence and early prolapse. But many women:
- Struggle to recruit the right muscles
- Accidentally over-brace or hold their breath, increasing downward pressure
- Find that PFMT alone doesn’t fully solve their symptoms
Hypopressives:
- Use reflex activation instead of voluntary squeezing
- Keep intra-abdominal pressure stable or lower whilst activating pelvic floor strongly
- Train breath, posture and global tension patterns
The best results often come when the two are combined: Hypopressives for pressure strategy and reflex support; PFMT for specific muscle strengthening.
Hypopressives vs conventional core work
Conventional core exercises can strengthen abdominals and core musculature, but if performed with poor technique (breath-holding, doming, bearing down), they may overload the pelvic floor or widen diastasis.
Hypopressives:
- Offer similar or better improvements in diastasis recti in some contexts without increasing pressure
- Integrate the diaphragm and pelvic floor in a way many standard programmes don’t
For women with incontinence, prolapse or diastasis, Hypopressives can be a safer starting point or anchor—especially in early postpartum, menopause and after pelvic surgery, under professional guidance.
Who can benefit from Hypopressives
Based on current evidence and clinical experience, Hypopressives are particularly suited to:
✓ Women with urinary incontinence (stress, mixed) and pelvic floor dysfunction who want a low-impact method with RCT support
✓ Women with mild to moderate prolapse who need support but must avoid high-pressure exercises
✓ Postnatal women with diastasis and pelvic symptoms, once cleared to exercise
✓ Perimenopausal and menopausal women experiencing new leaks, heaviness or core instability as hormones change
✓ Women with back pain, postural issues or breathing dysfunction who want a whole-body solution
✓ Athletes and lifters who need better pressure strategies to protect their pelvic floor in high-load contexts
Important considerations
Contraindications and precautions include pregnancy (especially later stages, due to apnoea), uncontrolled hypertension, certain cardiovascular or respiratory conditions, and situations where breath-holding is not advised. These should be screened by a qualified teacher or healthcare professional.
Your Hypopressives journey: what to expect
Learning phase (0–4 weeks)
1:1 or small-group sessions to learn:
- Neutral alignment and axial elongation
- Lateral rib breathing
- Safe apnoea technique (where appropriate)
Short home practices (5–10 minutes) 2–3 times per week.
Consolidation phase (4–8+ weeks)
Progress to 15–20 minute sequences, 3 times per week.
Begin to notice:
- Better posture and rib movement
- Less heaviness or leakage in everyday life
- More responsive pelvic floor without thinking about it
In the RCT, this 8-week window is where significant improvements in incontinence, pelvic floor strength and symptom burden were recorded.
Integration phase (beyond 8 weeks)
Use Hypopressives as:
- A standalone practice a few times per week
- A warm-up or cool-down alongside Pilates, strength work or running
- A tool to maintain pelvic health after rehab from pregnancy, surgery or during menopause
At re-centre, this is where Hypopressives plug into our broader ecosystem: postnatal recovery, prolapse support, perimenopause/menopause programmes and general pelvic floor rehabilitation.
