Pilates guide
Pilates can be a good way to be active with irritable bowel syndrome (IBS): being more active eases IBS symptoms a little, the NHS counts Pilates as strength exercise, and a calm, breathing-led class can help with the stress side of IBS. It isn't a treatment for IBS. One small trial found Pilates added to diet advice eased IBS with constipation in 60 women, but it had real weaknesses, and diet changes, medicines and talking therapies have more evidence.
IBS is a different condition from inflammatory bowel disease (IBD: Crohn's disease and ulcerative colitis), which inflames the gut; if that's you, our Pilates for Crohn's disease guide is the one to read. For bloating on its own, see our Pilates for bloating guide.
This guide covers what IBS is and why stress matters, what the trials show, what Pilates can and can't do for the tummy muscles and the pelvic floor, what to skip on a bad day, whether Pilates can upset your gut, which of our classes to do on which day, and the warning signs that need a GP before you call it IBS.
About 4 in 100 to 1 in 10 adults have IBS, and twice as many women as men are diagnosed. It's a disorder of gut-brain interaction: an oversensitive gut that moves too fast or too slowly, without the inflammation of inflammatory bowel disease. The NHS says the two are different, and a GP's tests for IBS include a poo test for IBD.
Across 11 trials, being more active eased IBS symptoms, but the evidence is very uncertain and quality of life and tummy pain didn't clearly change. In the largest trial, 102 people helped to be more active saw their symptom scores fall by 51 points, against 5 with usual care. NICE and the NHS advise being active and making time to relax.
In 60 Egyptian women with IBS with constipation, Pilates twice a week for 8 weeks added to diet advice cut symptom scores from 313 to 104, against 284 to 175 with diet advice alone. But the people measuring the results knew who did Pilates, the comparison group had no extra sessions, the groups started unevenly, and harms weren't reported. No other Pilates trial in IBS has been published.
As one of the 2 strength days a week the NHS asks for, beside walking or other activity most days, and as calm time. The trial ran twice a week.
Some bowel leaking is common with IBS, and pelvic floor squeezes suit urgency and leaking. Straining and not emptying can be a pelvic floor that won't let go: that needs the release, not more squeezing, and a GP referral for biofeedback, which helped 80% of people in one trial.
On a crampy or bloated day, skip curls, roll-ups and face-down moves and do standing, side-lying and all-fours moves instead (our suggestion). Diet changes, medicines and talking therapies made for IBS carry most of the treatment evidence.
The NHS calls IBS a common condition that affects the digestive system, causing stomach cramps, bloating, diarrhoea and constipation that come and go, and usually lifelong. It can also cause tiredness, backache, problems peeing, pelvic pain and not always being able to control when you poo. Stress and anxiety, alcohol, caffeine and some foods can trigger flare-ups.
In 5,931 adults surveyed in the UK, US and Canada, 4.4% to 4.8% had IBS by today's criteria (Rome IV), half the figure by older criteria, and it was more common in women and less common with age. Guts UK says 4 in 100 to 1 in 10 people have it, and twice as many women as men are diagnosed. Older figures of 1 in 5 used looser definitions.
Doctors now call IBS a disorder of gut-brain interaction: the gut is oversensitive, moves food too fast or too slowly, and signals to and from the brain work differently. That's why stress can set symptoms off, and why calming the nervous system is part of treatment.
Inflammatory bowel disease (Crohn's disease and ulcerative colitis) inflames and can damage the gut, and is treated with medicines that calm the immune system and sometimes surgery. The NHS says IBD is different from IBS, even though some symptoms are similar. A GP's tests for IBS include a poo sample to check for infections and IBD.
See a GP if you've had symptoms for over 4 weeks. There's no single test for IBS: the GP asks about your symptoms and may arrange blood and poo tests to rule out other causes. Don't use a Pilates page to decide that new bowel symptoms are IBS.
One small Pilates trial, some small trials of other exercise and yoga, and stronger evidence for diet, medicines and talking therapies.
In the Cochrane review (11 trials, 622 people, none at low risk of bias), physical activity improved IBS symptoms against usual care by a large standardised amount (5 trials, 185 people), but the certainty is very low, and quality of life and tummy pain didn't clearly change. NICE asks clinicians to give advice on physical activity and to encourage leisure and relaxation time; the NHS says get plenty of exercise; and the authors of the British guideline say people with IBS should be encouraged to be more active where they can. The US guideline makes no exercise recommendation either way.
In Sweden, 102 people were helped by a physiotherapist to be more active for 12 weeks: symptom scores fell by 51 points, against 5 with usual care, and fewer got worse. About 5 years later, 39 of 76 followed up still had lower scores and were more active, mostly walking, aerobics and cycling, though nobody was compared with them. In a UK trial of exercise consultations, constipation improved but quality of life didn't.
A 2026 review of 10 trials (437 people) found symptom scores about 61 points lower with exercise, but the trials disagreed a lot and the certainty is low; quality of life and anxiety didn't change. A 2026 network analysis ranked Pilates second of six exercise types for symptoms, but on one trial, and low for quality of life; running and aerobic exercise ranked best overall.
In Egypt, 60 women aged 20 to 45 with IBS with constipation all 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 gym ball: the swan, leg circles, single leg stretch, the saw, side kicks, the hundred, a pelvic lift and curls on the 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. Tiredness, anxiety and low mood improved more; weight didn't differ between the groups.
The people measuring the results knew who did Pilates, the results were self-reported, the comparison group had no extra sessions of any kind, the Pilates group started with more swelling, it lasted only 8 weeks with no follow-up, and it included only women with IBS with constipation and a higher weight. The paper doesn't report harms at all, so we can't say there were none. The authors note that diet advice alone also helped.
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Our searches found no other Pilates trial in IBS, published or registered, and no trial of core or tummy-muscle training in IBS. A calisthenics trial is registered in Egypt but hasn't started recruiting.
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Across 11 yoga trials (535 people), there was no clear difference from control groups for symptoms, anxiety, low mood or quality of life. Yoga did about as well as a low-FODMAP diet in 59 people, and an online yoga course wasn't better than advice on its main measure in 79 people, though quality of life and tiredness improved. Our yoga for IBS guide covers yoga.
Slow breathing on its own didn't change IBS symptom scores in a 4-week pilot of 14 people. Muscle relaxation isn't inert, though: in 378 adults, an app of muscle relaxation exercises eased pain about as often as an app of gut-directed hypnotherapy on the main measure, and in 57 adults, daily muscle relaxation for 6 weeks lowered symptom scores against no treatment. That supports a calm Pilates class as relaxation time, not as a treatment.
Talking therapies made for IBS, such as cognitive behavioural therapy (CBT) and gut-directed hypnotherapy, helped across 41 trials (4,072 people) and again in a 2025 update of 67 trials, though the trials were at high risk of bias. The NHS treatments are diet changes, pharmacy medicines, a dietitian-led low-FODMAP diet, prescribed medicines and talking therapies.
Across 73 studies, about 39% of people with IBS had anxiety symptoms and 29% depressive symptoms, about 3 times the odds of people without IBS. The NHS lists stress and anxiety among the triggers for flare-ups.
NICE advises making time to relax, and the NHS breathing exercise for stress is slow breathing for at least 5 minutes a day. A slow, breathing-led Pilates class is one way to do that; it may help you feel calmer, but breathing alone hasn't been shown to change IBS symptoms.
If stress or anxiety sets off your symptoms, the NHS says a GP can refer you for a talking therapy such as CBT, and you can refer yourself to NHS talking therapies. IBS-specific CBT and gut-directed hypnotherapy have the best evidence for the gut-brain side of IBS.
Pilates works the deep tummy muscle (in one ultrasound study, the dead bug most of five moves), but no trial has tested core training for IBS, and a stronger core won't settle an oversensitive gut or flatten a bloated tummy for good. A visibly swollen tummy is mostly a reflex of the diaphragm and tummy wall, which our Pilates for bloating guide explains.
In an online survey of 752 UK adults with IBS, 26.9% met the criteria for faecal incontinence, more often with IBS with diarrhoea, and urgency was the most troublesome symptom for 44.6% of them; in patients in Sweden and the US, monthly leaking affected 13.7% to 19.7%. These are selected groups, but leaking is common and worth raising with a GP: the authors say doctors should ask about it routinely.
Straining can come from a pelvic floor that tightens instead of letting go. In 231 people referred for tests (a clinic sample, 88% men), about half of those with IBS with constipation had an abnormal pattern, mostly this. The US guideline suggests tests when a pelvic floor problem is suspected. Specialist biofeedback is the treatment: 80% improved against 22% with laxatives in one trial, it beat sham feedback in another, and across 19 trials it helped at moderate certainty.
Pelvic floor squeezes suit urgency and leaking; the release, breathing in and letting the pelvic floor soften, suits straining and a tight pelvic floor. Never push down or strain. If leaking or straining isn't improving, see a GP or pelvic health physiotherapist (our suggestion, from the move pages' cautions).
Our suggestion, built from the site's pelvic floor exercise and pelvic floor relaxation moves. It isn't a treatment for IBS.
See the movement on the 3D figure: Pelvic floor relaxation (reverse Kegel)
Lateral breathing, 5 to 8 breaths at the start of every session (the move page's dose), ribs wide and lower tummy gently in, never pushing the belly out after a meal; slow breathing, at least 5 minutes, done regularly as part of your daily routine (the move page's dose, from the NHS breathing exercise), or 2 minutes inside a class (our Pilates for endometriosis class).
Pelvic floor exercise: start with 8 slow holds of up to 10 seconds and 8 quick squeezes, three times a day, and build towards 10 of each (the move page's dose), for urgency or leaking. Pelvic floor relaxation: 5 to 10 slow breaths, 1 to 3 times a day (the move page's dose), for straining or not emptying.
Standing march, 2 minutes (our Pilates for bloating class); cat-cow, 8 waves, slower than feels natural (the move page's dose); thoracic rotation, 6 rotations per side, moving with the breath (the move page's dose); mermaid, 3 each direction, each side (the move page's dose); side-lying tummy draw-in, hold for up to 10 seconds, up to 10 times (the move page's dose), at about a fifth of full effort; heel slides, 10 slow repetitions each side, once or twice a day (the move page's dose); hip windshield wipers, 10 slow passes side to side, 2 rounds (the move page's dose); child's pose, hold 1 to 3 minutes, breathing into the back ribs (the move page's dose), knees wide to leave room for your tummy.
3D demoStanding marchBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoMermaid (Pilates seated side bend)Beginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoChild's Pose (Balasana)Beginner · No equipmentDead bug heel taps, 6 each side (our Pilates for hip flexors class), head down; bird dog, 5 each side (our Pilates for bloating class); clamshell, 10 each side (our Pilates for basketball players class); side kick, 8 to 10 each side (the move page's dose); pelvic tilt into bridge, 8 slow (our Pilates for endometriosis class); the hundred, 50 beats to start, building to 100 (the move page's dose), head down; single-leg stretch, 6 to 10 each side (the move page's dose); swan, 5 to 6 reps (the move page's dose), not on a bloated day. The last three were in the Pilates trial.
3D demoDead bug heel tapsBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoHundred (Pilates)Intermediate · No equipment
3D demoSingle-leg stretch (Pilates one leg stretch)Intermediate · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipmentSkip face-down moves, long curls and roll-ups, and rolling moves, and do standing, side-lying and all-fours moves instead (our suggestion, as our Pilates for bloating guide advises). It's about comfort, not harm: in 20 healthy women, most beginner Pilates moves raised the pressure inside the tummy no more than standing up from a chair, and only roll-ups kept it high for longest.
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No study has looked. In athletes, 30% to 50% get gut symptoms during exercise, linked with hard exercise and being dehydrated, which reduce blood flow to the gut; Pilates is light work by comparison (1.8 to 2.8 METs, multiples of your resting energy use). A sensitive gut may still react to a first class, eating just before, gripping your tummy hard or holding your breath (our suggestion).
Ease off, switch to the gentle moves and breathe slowly. New, severe or worsening tummy pain needs a doctor, not a class: the warning signs are below.
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Empty your bladder and bowel before you start, keep a toilet close, and tell the teacher you may need to leave (our suggestion).
Leave a gap after a big meal before lying down or curling up, and if hot Pilates upsets your gut, choose a normal room and drink enough (our suggestion; neither has been studied in IBS).
No class has been tested for IBS. Pick by how your gut feels today.
Our walk and Pilates workout, or the beginner Pilates workout: activity and strength, the parts with evidence.
Our Pilates for bloating class: upright, side-lying and all-fours moves, with no curls, roll-ups or face-down moves.
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Our Pilates for your pelvic floor class: the squeeze and the release.
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Our pelvic floor relaxation exercises, and ask your GP about biofeedback.
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Our bedtime Pilates or slow somatic Pilates class: slow and breathing-led, for calm rather than treatment.
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The walk and Pilates workout and the beginner workout are for good days; the bloating class for bloated or crampy days; the pelvic floor class and relaxation exercises for urgency, leaking or straining; the bedtime and somatic classes for stressful days.
A 45-minute session for weight loss and health: a 20-minute brisk walk, which does more for the scales, then a short-rest Pilates circuit for strength.
45 minBeginner11 movesCardio machineA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA 20-minute Pilates class for a bloated day: upright movement first, rib breathing, then all-fours, side-lying and knees-bent moves, with no curls or face-down work.
20 minBeginner15 movesNo equipmentA 20-minute Pilates workout for your pelvic floor, built on UK pelvic health physiotherapists' booklet: squeeze as you breathe out, move, then fully release.
20 minBeginner18 movesWall, bench or boxAn 8-minute routine for a tight pelvic floor: slow breathing and comfortable positions to help the muscles let go, with no strengthening squeezes.
8 minBeginner5 movesFirm cushionA slow 15-minute Pilates wind-down for the last hour before bed: slow breathing, small lying moves and a few minutes of stillness, with no effort or holds.
15 minBeginner9 movesFirm cushionA slow, 20-minute Pilates class with time to notice your breath and how each move feels. Every move is optional and you can pause or stop at any point.
20 minBeginner12 movesNo equipmentThe beginner plan builds a habit over 4 weeks; the Pilates trial in IBS ran twice a week.
This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111.
The NHS says these could be signs of something more serious:
The NHS says see a GP if you have any symptoms of bowel cancer, such as changes in your poo, blood in your poo, which may look red or black, tummy pain, a lump in your tummy or losing weight without trying. The NHS adds: try not to be embarrassed, because doctors are used to talking about these symptoms.
Blood in your poo after a hard endurance event can come from reduced blood flow to the gut and can be serious. Ask for an urgent GP appointment or call NHS 111 for bleeding from your bottom, bloody diarrhoea, or black or dark red poo.
Call 999 if:
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.
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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.
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A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans).
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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.
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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.
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IBS is usually lifelong and comes and goes. The one Pilates trial eased symptoms over 8 weeks in 60 women with IBS with constipation, with no follow-up and real weaknesses, and diet advice alone helped too.
No guideline recommends Pilates for IBS. NICE and the NHS recommend being active and making time to relax, alongside diet changes, medicines and talking therapies, which have more evidence.
No trial has tested core training in IBS. A visibly swollen tummy is mostly a reflex of the diaphragm and tummy wall, not weak muscles, and our Pilates for bloating guide covers what helps.
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No study has tested it. What is true is that moving helps trapped gas move on, which any gentle exercise can do.
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No study shows harm. Most beginner moves raised tummy pressure no more than standing up, and the women in the trial did curls and the hundred. Long curls can feel bad on a crampy day, so skip them then.
They're different conditions. Inflammatory bowel disease inflames the gut and is treated with medicines and sometimes surgery; IBS doesn't, and a GP's tests check for IBD.
If you strain or can't empty, the pelvic floor may need to relax, not squeeze. Biofeedback with a specialist treats that.
It can be a good way to be active, and being active eases IBS a little. One small trial found Pilates added to diet advice eased IBS with constipation in 60 women, but it had real weaknesses. It isn't a treatment for IBS.
For most people, yes: it's low-impact and you choose the moves. On a crampy or bloated day, skip curls, roll-ups and face-down moves, and stop if you feel unwell.
No single move has been tested. On a good day, a normal beginner class, like the trial's mat and ball class with the hundred, leg circles and the swan. On a bad day, standing, side-lying and all-fours moves, plus pelvic floor squeezes for leaking or the release for straining.
No study has looked. Gut symptoms during exercise are linked with hard efforts and being dehydrated, and Pilates is light work, but a sensitive gut can still react to a first class, eating just before or gripping your tummy hard. Blood in your poo after exercise needs an urgent GP appointment or NHS 111.
It can feel uncomfortable on a bad day, especially long curls or lying on your front. Most beginner moves raise the pressure in your tummy no more than standing up from a chair. New, severe or worsening tummy pain needs a doctor.
Twice a week, as in the trial, as part of being active most days. Give it at least 8 weeks. Walking has the most data for IBS, so keep that up too.
No trial has compared them. Yoga hasn't clearly beaten control groups, and walking has the most data. Pick the one you'll keep doing.
In the one trial, all in women with IBS with constipation, bowel movements rose from about 2.5 to 4.9 a week with Pilates and diet advice, against 2.4 to 3.8 with diet advice alone. If you strain or can't empty your bowel, ask your GP about pelvic floor biofeedback.
Some leaking is common with IBS, more so with diarrhoea, and worth telling a GP about. Pelvic floor squeezes can help with control, and a toilet nearby helps confidence.
A calm, breathing-led class can help you relax, which NICE and the NHS advise, but slow breathing alone didn't change IBS symptoms in a small study. Talking therapies made for IBS have the best evidence for the gut-brain side.
Yes, if you feel well. The trial used a mat and a gym ball, and roll-ups on the reformer keep the pressure in your tummy up for longest, so leave those for good days.
Losing weight for no reason, bleeding from your bottom, bloody diarrhoea, black or dark red poo, or a hard lump in your tummy need an urgent appointment or NHS 111. See a GP if your bowel habit has changed for 4 weeks or more, even with an IBS diagnosis.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
