Pilates for bloating, IBS and constipation: what helps a swollen tummy, what to skip, and a 20-minute class

Move, and stay upright

Gas moves through the gut faster when you're upright and moving, and a 10 to 15 minute walk after meals eased fullness and bloating in a trial. The NHS says exercise "can also help when you're feeling bloated".

Sources 1, 2, 3, 4

A visibly swollen tummy is mostly a reflex

In many people the diaphragm pushes down while the tummy wall lets go, with little extra gas inside. Retraining that reflex with biofeedback, which shows people their breathing muscles at work, cut the swelling by more than half in two trials.

Sources 5, 6, 7, 8

Breathe into your ribs, not by pushing your belly out

The retraining that worked taught "chest up" and "abdomen in", and pushing the belly out after a meal made bloating feel worse in a lab study. Pilates lateral breathing is similar, but hasn't been tested for bloating (our suggestion).

Sources 5, 9

One small Pilates trial

In 60 women with IBS and constipation, twice-weekly Pilates added to diet advice eased symptoms more than diet advice alone. But the people measuring the results knew who did Pilates, and the groups started unequal, so treat it as promising, not proven.

Source 10

Skip curls and face-down moves on a bloated day

Roll-ups kept pressure inside the tummy highest for longest in a lab study. On a swollen day, choose standing, all-fours and side-lying moves (our suggestion).

Source 11

Check the cause first

The warning signs below say when bloating needs a GP or urgent help, word for word from the NHS lines our digestion and belly fat guides use.

Sources 4, 12

Bloating and swelling are different

Bloating is "an uncomfortable feeling of fullness"; a visible widening of the waist is called distension, Guts UK explains. The NHS says "The most common reason for bloating is having a lot of gas in your gut", and lists constipation, food intolerance, coeliac disease, IBS and periods among the causes.

Sources 13, 4

How common it is

In a survey of 51,425 people in 26 countries, nearly 18% had bloating at least once a week, women about twice as often as men. Most people with IBS have bloating.

Sources 14, 5

Why the tummy swellsEmerging evidence

Normally, when the gut fills, the diaphragm relaxes and the tummy wall tightens a little. In people with visible swelling the opposite happens: the diaphragm pushes down and the tummy wall relaxes, so the belly bulges. Doctors call this abdomino-phrenic dyssynergia. In scans, the total volume inside the tummy barely changed; the contents were pushed down and forward. So a swollen tummy is mostly a reflex, not a lot of extra gas, and not just weak muscles.

Sources 5, 15, 6, 16

IBS

The NHS's main IBS symptoms are stomach pain or cramps that usually ease after a poo, bloating, diarrhoea and constipation. Triggers include alcohol, caffeine, spicy or fatty food, stress and anxiety. The National Institute for Health and Care Excellence (NICE) suggests thinking of IBS when tummy pain, bloating or a change in bowel habit has lasted 6 months or more; a GP rules out other causes first.

Sources 12, 17

Constipation

The NHS lists "not moving enough and spending long periods sitting or lying down" among the causes, and says "A daily walk or run can help you poo more regularly".

Source 18

Lying down slows gasEmerging evidence

In 8 healthy people, much less gas fed into the gut stayed there when they were upright than when they lay on their backs (13 mL against 146 mL after an hour). Most mat Pilates is done lying down, which is why our bloated-day class spends most of its time standing, on all fours or on your side.

Source 1

Be active and make time to relaxStrong evidence

NICE asks GPs to give people with IBS information about physical activity, to encourage them "to create relaxation time", and to give brief advice to people who aren't very active. UK gut specialists say people with IBS "should be encouraged to increase physical activity, where feasible". The NHS says to "get plenty of exercise" for IBS, and to "exercise regularly to improve your digestion and help prevent bloating". None of them names Pilates.

Sources 17, 19, 20, 21, 4

Being active helps IBS a littleMixed evidence

In Cochrane's review of 11 trials (622 people), activity improved IBS symptoms against usual care, but not quality of life or tummy pain, at very low certainty. In the largest trial, 102 people helped to be more active by a physiotherapist improved by 51 points on a 500-point symptom scale, against 5 points without help, and about 5 years later the 39 people followed up still had milder symptoms than at the start. A 2026 review of 10 studies (437 people) found symptoms eased by about 61 points, at low certainty.

Sources 22, 23, 24, 25

The one Pilates trialMixed evidence

In Egypt, 60 women with constipation-type IBS had diet advice; half also did 16 supervised Pilates sessions (twice a week for 8 weeks, 45 to 50 minutes, on a mat and a Swiss ball). Symptom scores fell from 313 to 104 with Pilates and from 284 to 175 without it, and bowel movements rose from about 2.5 to 4.9 a week, against 2.4 to 3.8. But the people measuring the results knew who did Pilates, the Pilates group started more swollen, the comparison group had no extra sessions of any kind, and it lasted only 8 weeks. A 2026 analysis that ranked Pilates second of six exercise types rests on this one trial.

Sources 10, 26

Yoga hasn't beaten control groupsMixed evidence

Across 11 yoga trials (535 people), yoga made no clear difference to IBS symptoms compared with control groups. Our yoga for IBS guide covers it.

Source 27

Moving helps gas move onEmerging evidence

In 8 people with bloating, light pedalling cut the gas their guts held on to from 45% to 24% and eased their symptoms, and in 8 healthy people it reduced swelling of the tummy. In a trial of 94 adults with bloating, a 10 to 15 minute walk after each meal for 4 weeks eased fullness and bloating after meals more than a medicine did. The 2025 European consensus says activity "seems to have a positive impact", at very low certainty.

Sources 2, 28, 3, 5

Retraining the tummy wall and diaphragmEmerging evidence

In two placebo-controlled trials from one research group, people with visible swelling learned to control their diaphragm and tummy wall with biofeedback over 3 sessions: swelling fell by 56% (against 13% with a placebo; 48 people) and by 66% (42 people, with home practice 3 times a day). American gut specialists list diaphragmatic breathing as a treatment for the reflex. This needs a trained clinician; it isn't a Pilates class.

Sources 7, 8, 16, 29

Breathing at home: the direction mattersMixed evidence

The retraining taught people first to relax the diaphragm with the "chest up" and the "abdomen in". In 16 healthy women after a big meal, holding the diaphragm down with the belly pushed out caused more swelling and a stronger feeling of bloating. Common home advice to breathe with the belly pushed out hasn't been shown to treat swelling, and a version without equipment is "still under development". In a trial with no untreated group, written breathing instructions practised 3 times a day were followed by less bloating; slow deep breathing alone didn't change IBS symptoms in 14 people.

Sources 5, 9, 30, 31, 32

Curls and tummy pressureEmerging evidence

In 20 healthy women, most beginner mat and reformer moves raised pressure inside the tummy no more than standing up from a chair; only roll-ups kept it high for longest. That supports saving roll-ups for good days, not avoiding them for ever.

Source 11

ConstipationMixed evidence

In 9 small trials (680 people), mostly of walking and qigong, more people improved with exercise, but the trials were at high risk of bias. In studies following 119,426 people, those meeting activity guidelines were less often constipated. In one IBS trial, exercise helped constipation most.

Sources 33, 34, 35

Straining and a pelvic floor that won't relaxEmerging evidence

If you strain and can't empty fully, the pelvic floor may not be relaxing. Specialist biofeedback helped 80% against 22% with laxatives at 6 months in one trial, though the trials overall are low quality. American gut specialists suggest tests when bloating comes with this kind of constipation.

Sources 36, 37, 29

Walk every day

"A daily walk or run can help you poo more regularly", the NHS says. Pilates can be part of being active, but walking has more evidence.

Sources 18, 33

Learn to let go, not only squeeze

Pilates teaches you to draw the pelvic floor in. If you strain on the toilet, practise letting it go as well: the pelvic floor relaxation move, 5 to 10 slow breaths, 1 to 3 times a day (the move's page). See a GP if straining goes on; specialist biofeedback helps.

Sources 36, 29

Never push down or strain

Our pelvic floor relaxation move says to "see a GP or pelvic health physiotherapist about pelvic pain, pain with sex, or trouble emptying your bladder or bowel."

Lying face down

The swan, swimming, the single and double leg kick: skip them, or put a pillow under your tummy, as our Pilates for endometriosis guide suggests (our suggestion).

Long curls and roll-ups

The roll-up, chest lift, criss-cross, teaser and neck pull press on a swollen tummy, and roll-ups kept tummy pressure highest for longest in a lab study. Keep them for good days, or use the head-down hundred and dead bug heel taps (our suggestion).

Source 11

Rolling and legs over your head

Rolling like a ball, the roll-over and the jack knife: skip them after a meal or if you get heartburn (our suggestion). Our exercise for acid reflux guide suggests waiting about 2 hours after a main meal before head-down poses.

Pushing the belly out to breathe after a meal

Avoid it: it made bloating feel worse in a lab study, and belly breathing at home hasn't been shown to treat swelling.

Sources 9, 30

Fast, forceful breathing

Breath of fire and kapalabhati: leave them out, as our yoga for IBS guide advises, because they cause more side effects than slow breathing.

After tummy surgery or with a stoma

Follow your team's advice and our exercise with a stoma guide before you return to curls.

Call 999

The NHS says call 999 or go to accident and emergency (A&E) if you have severe tummy pain with vomiting or a swollen tummy, or bleeding from your bottom that won't stop, or a lot of blood or large clots when you poo.

It also says call 999 or go to A&E now if you have a stomach ache and:

• it started suddenly and is severe
• you're vomiting blood or your vomit looks green or like ground coffee
• there is a lot of blood coming from your bottom or your poo is black and sticky
• you cannot pee at all
• you cannot poo or fart at all
• spots or a rash that does not fade when you press it (the rash may be harder to see on brown or black skin)
• you're struggling to breathe

Source 38

Bloating: call 999 (911 in the US)

If you have bloating with a swollen stomach and a stomach ache that is severe and came on very suddenly, you're vomiting blood or your vomit looks like ground coffee, or you have severe difficulty breathing. Don't drive yourself to A&E. During exercise, stop and get help for chest pain or pressure, unusual breathlessness, dizziness or fainting, as our plans advise.

Source 4

Bloating: ask for an urgent GP appointment or call NHS 111

If you have bloating with being sick, diarrhoea or constipation, or with a stomach ache; a high temperature, or you feel hot, cold or shivery; a swelling or lump in your tummy; a burning feeling in your chest caused by stomach acid travelling up towards your throat (acid reflux); or you can't pee, poo or fart. In the US, contact your doctor or urgent care.

Source 4

Bloating: see a GP

If you feel bloated regularly, or have bloating with weight loss you can't explain or blood in your poo: the NHS says bloating that doesn't go away can sometimes be a sign of something more serious, such as ovarian cancer, whose symptoms include a swollen tummy or feeling bloated roughly 12 or more times a month.

Sources 4, 39

Ask for an urgent GP appointment or call NHS 111

The NHS says these could be signs of something more serious:

• You've lost a lot of weight for no reason.
• You're bleeding from your bottom or have bloody diarrhoea.
• Your poo is black or dark red.
• You've found a hard lump or swelling in your tummy.
• You're short of breath, with noticeable heartbeats (palpitations) and skin that's paler than usual.
• You're bloated and also being sick, have diarrhoea, a stomach ache, a high temperature, or a lump in your tummy.
• A stomach ache suddenly gets much worse, or you have a stomach ache while pregnant.

Sources 12, 4, 38

See a GP

• You think you have IBS and have had symptoms for more than 4 weeks.
• Your bowel habit has changed for 4 weeks or more, especially if you're over 40, even if you've already been diagnosed with IBS.
• Diarrhoea wakes you at night, or you have a fever, anaemia, or weight loss of more than 2 kg without trying.
• Bowel cancer, colitis or Crohn's disease runs in your family.
• Constipation isn't getting better with treatment, or comes with tummy pain or tiredness all the time.

Sources 12, 18

Chest pain or fainting while exercising: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Source 40

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

If your mood is low

IBS and anxiety or low mood can feed into each other, and our anxiety and depression guides can help. If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

"Twists wring out your organs and detox your digestion"Strong evidence

No study has tested a twist, or any single Pilates move, on how the gut works. What helps gas move on is ordinary: being upright and moving.

Sources 10, 1, 2

"Core work will flatten a bloated tummy for good"Emerging evidence

A swollen tummy is mostly a reflex, with little extra gas inside, and the treatment that reduced it retrained the reflex with biofeedback, not sit-ups.

Sources 5, 6, 7, 8

"Bloating means your abs are weak"Emerging evidence

In people with visible swelling the tummy wall relaxes as part of a reflex; it hasn't been shown to be weakness.

Source 15

"Push your belly out with every breath to beat bloating"Emerging evidence

The retraining that worked taught the opposite after meals ("chest up", "abdomen in"), and pushing the belly out made bloating feel worse in a lab study.

Sources 5, 9, 30

"Lie down and rest when you're bloated"Emerging evidence

Gas moves through faster when you're upright, light exercise helped people with bloating clear it, and a short walk after meals helped fullness and bloating.

Sources 1, 2, 3

"Pilates cures IBS"Strong evidence

Being active helps IBS symptoms a little, at very low certainty, and there's one small Pilates trial with real weaknesses. Diet changes, medicines and talking therapies stay part of care.

Sources 22, 10, 17