Pilates guide
Pilates is often sold as a pelvic floor workout, but on its own it does little for those muscles. What works is squeezing them on purpose: pelvic floor exercises (Kegels) are the first treatment for leaking, and in trials Pilates helped mainly when deliberate squeezes were built into each move.
Done that way, which is how UK pelvic health physiotherapists teach it, Pilates is a good partner to your daily pelvic floor exercises. Most Pilates moves press on the pelvic floor no more than standing up from a chair; roll-ups are the main exception.
This guide covers what the trials found for leaking and prolapse, Pilates against Kegels and yoga, how to squeeze and release in a class, which moves to swap, Pilates after birth and for men, and a free 20-minute follow-along class. If you leak, or feel a bulge or heaviness, see a GP: these problems are common and treatable.
In healthy women, Pilates didn't change how well the pelvic floor muscles worked, and a review of 7 studies found that Pilates and similar exercise didn't make them stronger unless pelvic floor training was added.
In a 2024 Cochrane review, exercise without deliberate pelvic floor squeezes did worse than the squeezes, while movement with the squeezes built in may do slightly better than squeezes alone (low certainty). In one trial, adding a squeeze to each Pilates exercise built more strength than Pilates alone.
The National Institute for Health and Care Excellence (NICE) recommends supervised pelvic floor muscle training for at least 3 months as the first treatment for stress or mixed leaking. In trials, it cured stress leaking in 56% of women, against 6% without treatment.
UK pelvic health physiotherapists teach Pilates with a pelvic floor squeeze on each out-breath, held through the move, and a full release before the next repetition.
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On average, no Pilates move tested raised the pressure on the pelvic floor more than standing up from a chair, but roll-ups kept it up longest. The NHS says sit-ups and high-impact exercise can make leaks worse.
Leaking and prolapse are common and treatable. See a GP about any leaking, or a lump or bulge in or around the vagina.
The pelvic floor muscles stretch from the pubic bone at the front to the tailbone at the back, and support the bladder and bowel, and the womb in women. They "surround the bladder and urethra ... and control the flow of urine as you pee", the NHS says.
To find them, imagine you're trying to stop yourself passing wind and urine at the same time, drawing the muscles upwards and forwards from the back passage towards the bladder.
Stress leaking happens when your bladder is under pressure, for example when you cough or laugh. Urge leaking comes with a sudden, intense need to pee, and some people have both (mixed leaking).
A prolapse is when the pelvic organs drop down into the vagina. It can cause heaviness or pressure, a bulge, problems emptying the bladder or bowel, or leaking, and it's common in women over 50.
The 2024 Cochrane review separates three approaches:
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"Pilates-based exercises in women's health encourage the pelvic floor muscles to work with the deep tummy muscles to build up the strength of your trunk", the UK's pelvic health physiotherapists say in their Pilates booklet. Every exercise in it starts "Breathe in, breathe out, and engage your deep abdominal muscles and pelvic floor", and ends with a release.
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For stress or mixed leaking, NICE recommends supervised pelvic floor muscle training for at least 3 months, with at least 8 contractions 3 times a day, continued if it helps. For a mild prolapse with symptoms, it suggests supervised training for at least 16 weeks. Supervision should check that you can both squeeze and relax the muscles.
"For women who are doing supervised pelvic floor muscle training and want to be physically active, advise them that supervised exercise (for example, yoga) may help with their symptoms." NICE found the trials of yoga, Pilates and other exercise hard to judge, because they were usually combined with pelvic floor training, and says supervision matters because "certain exercises, if done incorrectly, can weaken the pelvic floor by increasing intra-abdominal pressure".
The NHS self-help page suggests replacing high-impact exercise, such as jogging and aerobics, "with strengthening exercise, such as pilates", and says "Pilates strengthens your core muscles, which is beneficial for stress incontinence". It also says a pelvic floor programme should include at least 8 contractions at least 3 times a day, for at least 3 months.
The Pelvic, Obstetric and Gynaecological Physiotherapy group (POGP), the UK's pelvic health physiotherapists, publishes a Pilates booklet that pairs every move with a pelvic floor squeeze on the out-breath and a full release afterwards. It says the exercises are safe and suitable for all women when done correctly.
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Two studies in healthy women found Pilates didn't change pelvic floor function, and a review of 7 studies found Pilates, the Paula method and hypopressive exercise "ineffective in increasing pelvic muscle strength unless they are performed in conjunction with pelvic floor muscle training". Women who did Pilates regularly had pelvic floor muscles that worked no better than those of sedentary women. All these studies were small.
In the 2024 Cochrane review of 63 trials, direct pelvic floor training improved leaking-related quality of life more than exercise without deliberate squeezes (4 trials, 170 women, low certainty). Movement with the squeezes built in may be slightly better than squeezes alone (8 trials, 356 women, low certainty). Group and one-to-one supervision worked about equally well.
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In 57 women who didn't exercise, 24 Pilates sessions with a deliberate pelvic floor squeeze built more pelvic floor strength than the same Pilates without it. In the newest trial, adding the squeeze to Pilates added a little strength, but not less leaking.
In the newest trial, in women with stress leaking, 12 supervised sessions of pelvic floor training cut a leaking score by 4.4 points, against 0.7 with Pilates, with or without squeezes, and built far more squeeze strength. Smaller trials found little difference: in 40 women after the menopause, both helped, and the authors found no difference as long as the women deliberately squeezed their pelvic floor; in 34 older women, both eased symptoms; and in 62 women with few symptoms, both built strength equally.
In 30 older women, yoga eased leaking more than Pilates. One 2026 review of 14 trials, which we could read only as an abstract, found Pilates and other exercise about as good as pelvic floor training, a different result from Cochrane's.
In 18 women who finished a 12-week Pilates programme built around the pelvic floor, leaking scores fell and stayed lower at 6 months, but there was no comparison group. In an NHS pilot of 73 women, 6 weeks of modified Pilates classes alongside physiotherapy improved self-esteem and embarrassment in women with milder leaking.
Drawing in the lower tummy switches on the pelvic floor in many women, but a direct pelvic floor squeeze lifted it more than twice as much, and in 6 of 20 women the tummy draw-in pushed it down. Holding Pilates positions such as a plank raised pelvic floor activity, and a deliberate squeeze on top was still possible.
In 46 women who did Pilates, most could squeeze correctly, but 95% didn't squeeze during leg movements unless told to. In 15 women, the bladder neck dropped during common exercises, less with a squeeze first, and the Pilates clam held it best. All these were small laboratory studies.
In 20 healthy women, the average peak pressure in 22 Pilates mat and reformer exercises was no higher than when standing up from a chair. Some women went above their own sit-to-stand level in some moves, and only the mat and reformer roll-ups kept the pressure up for longer than standing up.
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Two small trials favoured yoga: in 30 older women, yoga eased leaking more than Pilates, and in 46 women, yoga-based breathing improved quality of life and relaxed the pelvic floor more than Pilates-based breathing, though both helped. Neither replaces pelvic floor training.
From the Pelvic, Obstetric and Gynaecological Physiotherapy group's Pilates booklet. Keep doing your separate daily pelvic floor exercises as well.
See the movement on the 3D figure: Pelvic floor exercise (Kegel)
NICE recommends at least 8 contractions 3 times a day, for at least 3 months, and carrying on if it helps. The move page's dose: start with 8 slow squeezes held for up to 10 seconds and 8 quick squeezes, 3 times a day, building to 10 of each.
When you lift something, cough or sneeze, squeeze first. The NHS says to "tighten your pelvic floor muscles before and during the lift".
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The trials used 2 or 3 supervised sessions a week for 6 to 12 weeks. Our editorial starting point: the 20-minute class below 2 or 3 times a week, alongside your daily squeezes, not instead of them.
NICE recommends that pelvic floor training is supervised by a physiotherapist or another health professional with the right expertise, who checks that you can both squeeze and relax. Group and one-to-one sessions worked about equally well in the Cochrane review.
For a prolapse with symptoms that doesn't extend far beyond the entrance of the vagina, NICE suggests supervised pelvic floor training for at least 16 weeks as a first option, along with losing weight if needed, keeping heavy lifting to a minimum and avoiding constipation.
In a UK and New Zealand trial of 414 women with a prolapse they hadn't sought treatment for, one-to-one pelvic floor training (5 physiotherapy appointments over 16 weeks) plus Pilates-based pelvic floor classes and a DVD gave slightly fewer prolapse symptoms 2 years later than a leaflet (a score of 3.2 against 4.2). The researchers called it small, but probably important. The Pilates classes can't be separated from the one-to-one training.
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A 2023 review of exercise other than pelvic floor training for prolapse found 7 trials, none of them of Pilates, and no evidence that any other exercise programme works better than pelvic floor muscle training for a prolapse.
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In 115 women after the menopause with low bone density, 8 months of either high-intensity strength and impact training or a gentle Pilates-based programme, both supervised, didn't worsen pelvic floor symptoms, and women who had had a prolapse improved slightly.
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The NHS advises avoiding "physical activities that put a lot of strain on the pelvic floor, like heavy lifting, running and trampolining", and doing regular pelvic floor exercises.
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Our suggestion, from the pressure study and the NHS advice on sit-ups: swap the roll-up, the wall roll-up, the teaser and curl-ups held for a long time (such as the hundred and the double leg stretch) for head-down moves such as the knee fold, heel slides and the bird dog. Add them back gradually if they don't bring on leaking or heaviness.
Leave out jumping, including on a reformer jumpboard, while you leak or have a prolapse: the NHS says high-impact exercise can make leaks worse and advises avoiding trampolining and running with a prolapse.
Make a move smaller or leave it out if it brings on:
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"It is safe to start with gentle pilates from 4 weeks" after birth, POGP says, if you have no concerns about bleeding, wound healing, leaking or signs of a prolapse. If you do, or you've been told you have a gap between your tummy muscles, see a pelvic health physiotherapist first.
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In 50 pregnant women, Pilates with pelvic floor squeezes didn't change squeeze pressure compared with walking and strength exercise, though women stuck with it better. A trial of 126 women found less leaking in pregnancy and after birth, but also reported effects on birth so large that the whole report is hard to trust. POGP says its head lift and pelvic curl exercises aren't suitable after 20 weeks of pregnancy; our Pilates in pregnancy guide has more.
In two small trials, men who did Pilates after prostate removal were about as likely to be dry at 4 months as men who did pelvic floor exercises with electrical stimulation (about 58% against 50% in one, 59% against 54% in the other), and both did better than no treatment. A 2025 network meta-analysis ranked Pilates poorly. Do the pelvic floor exercises your surgical team gives you.
In a survey of 685 female fitness instructors, about 1 in 4 leaked, including 25.9% of yoga and Pilates teachers. Being fit, or teaching Pilates, doesn't protect the pelvic floor on its own.
POGP says "Let your pelvic floor muscles relax fully after every contraction", and NICE says supervision should check that you can relax the muscles as well as squeeze them. If you have pelvic pain, pain with sex or trouble emptying your bladder, get checked before adding more squeezes: the muscles may need to learn to relax rather than to get stronger.
Squeeze with each repetition and let go, rather than holding the pelvic floor tight for the whole class. A held squeeze doesn't always stop the bladder neck dropping, and in a trial of 152 people with back pain, Pilates with a relaxed tummy did slightly better for disability than Pilates with the core held tight.
Start here, before you add the squeeze to Pilates moves. The pelvic floor exercise page has the daily dose.
These follow the first exercises in POGP's booklet. Keep your head down for the knee fold and heel slide, and skip the chest lift if it brings on heaviness or makes your tummy dome.
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoChest lift (Pilates curl-up)Beginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoSingle-leg glute bridgeIntermediate · No equipment
3D demoBent-knee fall-outBeginner · No equipmentSqueeze as you breathe out and move, then release. Finish with sit-to-stands, squeezing just before you stand.
3D demoClamshellBeginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoWall roll-down (wall Pilates)Beginner · A wall
3D demoBreath reachBeginner · No equipment
3D demoSit to stand from a chairBeginner · A bench or boxThe Pilates for your pelvic floor class builds the squeeze into every move. Keep the daily pelvic floor workout going alongside it, and use the relaxation routine if your pelvic floor is tight.
A 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 movesA wall, A bench or boxA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentAn 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 25-minute strength workout for a pelvic organ prolapse: pelvic floor squeezes, sit-to-stands, push-ups, rows, bridges and side-lying work, with no jumping or crunches.
25 minBeginner12 movesA bench or box, A wallA 20-minute Pilates workout for any trimester: seated, standing, all-fours and side-lying moves, with no lying on your back or front and no jumping.
20 minBeginner15 movesA wall, A bench or boxA gentle 25-minute routine for the first weeks after birth: pelvic floor, breathing, tummy and hip exercises on the floor, sit-to-stands and a walk.
25 minBeginner12 movesA bench or box, Cardio machineAfter a birth, the postpartum plan builds up step by step. The beginner Pilates plan suits everyone else; add your daily squeezes.
A postpartum workout plan from the first days after birth to running and lifting again, week by week, with a caesarean track and readiness checks.
5 training days25 minBeginner3 days a weekA free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginner"See a GP if you have any type of urinary incontinence", the NHS says, and don't feel embarrassed: it's common. See a GP too about a lump or bulge in or around your vagina, or other signs of a prolapse such as heaviness, dragging or problems emptying your bladder or bowel. NHS continence services, with specialist nurses and physiotherapists, can diagnose the problem and start treatment.
POGP suggests advice from a physiotherapist before you start if you:
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New problems with your bladder or bowels together with back pain or numbness can be a spinal emergency rather than a pelvic floor problem. Call 999 (911 in the US) or go to A&E if you have back pain with:
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If your leaking isn't improving after 3 months of daily squeezes, or it's getting worse, go back to your GP or physiotherapist (our suggestion, from the 3-month trial NICE recommends).
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Pilates alone didn't change pelvic floor function or strength in reviews, exercise without deliberate squeezes did worse than the squeezes, and pelvic floor training beat Pilates in the newest trial. Do the squeezes as well.
Squeeze with the movement and relax fully after every contraction, as POGP teaches. A held squeeze doesn't always protect the bladder neck, and constant bracing isn't needed for back pain either.
A direct pelvic floor squeeze lifted the pelvic floor more than twice as much as a tummy draw-in, and in some women the draw-in pushed it down.
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No study shows that. On average no Pilates move tested raised pressure more than standing up from a chair, though roll-ups kept it up longest, and a Pilates-based programme didn't worsen pelvic floor symptoms over 8 months. NICE's caution is about exercise done incorrectly, which is why it prefers supervised classes.
About 1 in 4 female fitness instructors leak, including yoga and Pilates teachers, and regular Pilates-goers' pelvic floors worked no better than sedentary women's.
It's common but treatable: pelvic floor training cured stress leaking in 56% of women in trials, against 6% without treatment. The NHS says to see a GP about any type of leaking.
Only a little on its own; it helps when you add deliberate pelvic floor squeezes. In healthy women Pilates didn't change pelvic floor function, and Pilates without squeezes didn't increase strength, while adding a squeeze to each Pilates exercise did. Keep doing your separate pelvic floor exercises too.
For leaking, pelvic floor exercises (Kegels) come first: NICE recommends at least 3 months of supervised training, and in trials it cured stress leaking about 8 times as often as no treatment. Pelvic floor training beat Pilates in the newest trial, so use Pilates, with the squeeze built in, as an extra.
It can help alongside pelvic floor training. Pilates programmes that included pelvic floor work helped leaking in small studies, and NICE says supervised exercise may help women who are also doing supervised pelvic floor training. See a GP about any leaking.
Breathe in, then as you breathe out squeeze as if stopping wind and urine, drawing up and forwards, and gently draw in your lower tummy. Do the move, then let everything relax fully before the next one. Don't hold your breath, and keep your buttocks and legs relaxed.
It can be part of the plan, adapted. In a trial of 414 women, one-to-one pelvic floor training plus Pilates-based classes slightly reduced prolapse symptoms over 2 years. Supervised pelvic floor training for at least 16 weeks comes first, and moves that bring on heaviness should be changed.
There's no evidence that it does: on average, Pilates moves raised pressure no more than standing up from a chair, though roll-ups kept it up longest. Change or leave out any move that brings on heaviness, dragging or a bulge, and see a GP about a lump in the vagina.
Roll-ups, the teaser, long held curl-ups and any jumping are the ones to swap first (our suggestion); the NHS says sit-ups and high-impact exercise can make leaks worse. Use head-down moves such as the knee fold instead, and stop anything that brings on leaking or heaviness.
Reformer moves work the same way as mat moves: they help most when you squeeze and release with each repetition. Jumpboard work is impact, which the NHS advises swapping for lower-impact exercise while you leak.
Two small trials favoured yoga: it eased leaking more than Pilates in 30 older women, and yoga-based breathing helped quality of life more than Pilates-based breathing. Whichever you choose, add the pelvic floor squeezes.
It doesn't have to be, but a tight (overactive) pelvic floor needs relaxing, not more squeezing. POGP says to let the muscles relax fully after every contraction, and NICE says supervision should check relaxation as well as squeezing. Get pelvic pain or pain with sex checked first.
POGP says gentle Pilates is safe from 4 weeks after birth if you have no concerns about bleeding, wound healing, leaking or prolapse. If you do, or you have a gap between your tummy muscles, see a pelvic health physiotherapist first.
Two small trials found Pilates about as good as pelvic floor exercises for getting dry, but a 2025 analysis ranked Pilates poorly. Do the pelvic floor exercises your surgical team gives you; our Pilates for men guide covers this.
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.
