Pilates guide
Pilates is fine with piles (haemorrhoids, or hemorrhoids in the US), and it can help in the ways that matter: moving regularly keeps your bowels regular, Pilates teaches you to breathe out on an effort rather than hold your breath and push, and its release work helps you let go on the toilet instead of straining. No study has tested Pilates for piles, though, and no move shrinks them. Soft poo, no straining and short toilet visits do the most.
Pilates doesn't replace the usual care for piles: fibre and fluids, a pharmacist's advice, and a GP if they don't settle or you see blood. This guide covers how piles and straining are linked, what the evidence shows, the Pilates breath, letting go, which moves to change while your piles are sore, the reformer, pregnancy and after the birth, and when bleeding needs a GP. Bleeding from the bottom always needs checking, because it can be a sign of bowel cancer.
The NHS says "A daily walk or run can help you poo more regularly", and the UK's pelvic health physiotherapists list Pilates among good everyday exercise for bowel health. Pilates adds two useful skills: breathing out on an effort, and letting your pelvic floor relax.
Our searches found none, and no move shrinks a pile. Soft poo and no straining do the most: in a Cochrane review of 7 trials (378 people), extra fibre roughly halved the chance of symptoms carrying on, and US colorectal surgeons make diet and toilet habits the first treatment.
The NHS lists constipation, pushing too hard when you poo and heavy lifting among the things that make piles more likely. In laboratory studies, holding your breath and bearing down raised the pressure in the tummy more than any exercise did. Breathe out on every effort, on the mat and on the toilet.
People with piles tend to have tighter muscles around the back passage. No trial supports pelvic floor squeezes (Kegels) for piles; learning to relax, and sitting with your feet on a low stool, fit better.
Swap long curl-ups and roll-ups for moves with your head down, sit on a cushion or a chair for seated work, and skip rolling on your bottom. These are our suggestions for comfort, and no study has tested them in piles.
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See a GP about any blood in your poo. Get urgent help for heavy bleeding, black or dark red poo, or bleeding with weight loss or a change in your poo. The signs are listed below.
"Piles (haemorrhoids) are lumps inside and around your bottom (anus). They often get better on their own after a few days." They are the normal cushions of blood vessels in the back passage, swollen and slipping down.
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The NHS lists:
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The NHS says it's not clear what causes piles, and lists constipation, pushing too hard when pooing, heavy lifting, pregnancy, getting older and being overweight. Across 19 studies, constipation was about twice as common in people with piles, but piles weren't clearly more common in people with constipation, and an older US study linked diarrhoea and a higher body weight with piles instead. So the link with constipation is real but its direction is contested.
Very common: a 2026 review of 150 studies put it at about 1 in 4 people at any one time. In 976 adults having a routine bowel check, 38.9% had piles, most of them mild, and fewer than half of those had symptoms.
Most piles settle with self-care: soft poo from fluids and fibre, not pushing too hard, not spending longer on the toilet than you need, a warm bath, and an ice pack wrapped in a towel. A pharmacist can suggest creams and treatments for constipation. If they don't settle, hospital treatments include banding, injections and surgery.
A severe, sharp pain when you poo, with bright red blood, may be an anal fissure (a small tear). Bleeding from the bottom can also come from other conditions, including bowel cancer, which is why it needs checking.
Nothing in Pilates reaches the cushions directly. What it can change: how often you move, how you breathe when you make an effort (the UK pelvic health physiotherapists' Pilates booklet says "Try not to hold your breath"), and how well you let your pelvic floor relax. A class can also be a place where people hold their breath: in long curl-ups, planks and on heavy reformer springs (our reading).
No one has tested Pilates for piles. The evidence below is about fibre, toilet habits, constipation, exercise and tummy pressure, and much of it is observational.
Our searches of PubMed, Europe PMC and ClinicalTrials.gov in November 2026 found no trial of Pilates, yoga, stretching or pelvic floor training for piles, in pregnancy, after the birth or after piles surgery. Everything this page says about Pilates is our reading of the wider evidence.
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In a Cochrane review of 7 trials (378 people), extra fibre cut the chance of symptoms carrying on by 53% and of bleeding by half (moderate-quality evidence). US colorectal surgeons recommend diet and behaviour changes as the first treatment, a strong recommendation based on moderate-quality evidence.
US surgeons advise avoiding straining and limiting time on the toilet; US gastroenterologists add 20 to 30 g of fibre and 6 to 8 glasses of fluid a day and advise against long spells on the toilet, including reading or using a phone. A 2026 US expert update agrees. None of them mentions exercise or Pilates.
Across 19 studies, constipation was about twice as common in people with piles, and in 2,813 adults having a colonoscopy it went with more piles. In a Swedish study, people with large piles went to the toilet no more often than others, but strained more and felt they hadn't emptied. An older US study found diarrhoea and a higher body weight linked with piles instead of constipation. These are observational links, so they can't prove cause.
A 2026 review found no link between physical activity and piles (7 studies), and in the colonoscopy study, being active wasn't clearly linked with fewer piles. A genetic study linked more leisure-time activity with slightly fewer piles in only some of its analyses. After piles surgery, people who exercised were less likely to have them come back in one retrospective study. So exercise helps mainly by keeping you regular, not by preventing piles directly.
In 9 trials (680 people), mostly walking and qigong, exercise improved constipation, but the trials varied a lot and had a high risk of bias, so the authors say the real effect can't be pinned down. The NHS still recommends a daily walk or run.
No study has tested lifting or holding your breath as a cause of piles. In an online survey of 312 people who play sport, bodybuilding was linked with reported piles, while cycling and riding weren't once age and other factors were allowed for. A small 1990 study found the pressure in the anal cushions rose more with coughing and straining in men with piles than in men without. A review says strenuous lifting and exercise may raise tummy pressure but haven't been studied in detail.
In 125 adults having a bowel check, people who used their phone on the toilet were more likely to sit there for over 5 minutes, and had 46% higher odds of piles. In a Turkish study, people with anal conditions were more likely to sit on the toilet for over 20 minutes. Both are one-off snapshots, not trials.
A footrest reduced straining and shortened bowel movements in 52 healthy adults, and leaning forward helped half of 22 people who couldn't empty sitting upright. But a footstool didn't help simulated emptying in 41 people with constipation, and a 2025 review found the studies too small for firm conclusions. It's cheap and harmless to try.
In one laboratory study of 18 healthy women who already did Pilates, most beginner mat and reformer moves raised the pressure in the tummy no more than getting up from a chair; roll-ups kept it highest for longest. Holding your breath and bearing down raised it more than any exercise in a related study. The measure was indirect, and it hasn't been tested in men or in people with piles.
In a trial of 260 pregnant women in Lithuania, advice on daily walking or exercise (30 to 60 minutes, 3 to 5 times a week), fluids, fibre, not ignoring the urge and spending under 3 minutes on the toilet cut piles by the time women left hospital after the birth (a relative risk of 0.38). Exercise was one part of the package, so its own effect can't be separated, and more women dropped out of the advice group.
Tightening the pelvic floor instead of relaxing it when you push (dyssynergic defecation) was more common in people with fissures, piles or rectal ulcers than in people with normal tests, and people with piles have higher resting pressure in the anal muscles. Specialist biofeedback treats this, often through pelvic floor physiotherapists. No trial has tested relaxation training for piles.
Pilates teaches you to breathe in to prepare and breathe out as you make the effort. The UK pelvic health physiotherapists' Pilates booklet cues "Breathe in, breathe out, and engage" before each move, and asks you not to hold your breath. That's the opposite of straining, which is holding your breath and bearing down.
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The same booklet says "Let your pelvic floor muscles relax fully after every contraction". With piles, the release matters more than the squeeze: people with piles tend to have tighter muscles around the back passage. The pelvic floor relaxation move below shows how.
Go when you feel the urge, rest your feet on a low stool so your knees are above your hips, lean forward and breathe out gently. The UK pelvic health physiotherapists' advice is to "Relax, lean forward, keep your tummy soft, breath normally and do not strain" (their spelling). If nothing happens after about 5 minutes, get up and try later. Our exercise with piles guide has the steps in full.
We found no trial of pelvic floor exercises (Kegels) for piles. Do them if you also leak. If emptying is hard, or you feel you can't let go, see a GP or a pelvic health physiotherapist rather than adding more squeezes. Our pelvic floor guide covers both.
A daily walk keeps your bowels regular and counts towards the NHS guideline of 150 minutes of moderate activity a week. A walk after breakfast fits well, because the urge to poo often comes after a meal (our suggestion).
Our editorial starting point: the bloating class below, or another class that leaves out long curl-ups and rolling while your piles are sore. No trial has tested a Pilates dose for piles.
The NHS says drink lots of fluid and eat plenty of fibre to keep your poo soft, and cut down on alcohol and caffeine. US gastroenterologists suggest 20 to 30 g of fibre and 6 to 8 glasses of fluid a day. Build fibre up gradually.
Lateral breathing: "5 to 8 breaths at the start of every session" (the move page's dose), then breathe out on every effort. Pelvic floor relaxation: "5 to 10 slow breaths, 1 to 3 times a day" (the move page's dose). Slow breathing: 2 minutes, about 4 counts in and 6 out (our constipation routine's dose, adapted from the move page's dose). Toilet position: "Every time you go, for no more than about 5 minutes at a time" (the move page's dose; written steps, no 3D demo). Standing march: 2 minutes to start a class (our bloating class's dose). Cat-cow: "8 waves, slower than feels natural" (the move page's dose). Single knee to chest: 5 to 10 each side, alternating, and supine twist: 30 to 45 seconds each side (our constipation routine's doses; the knee to chest adapted from the move page's dose).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoPelvic floor relaxation (reverse Kegel)Beginner · No equipment
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
Toilet position for pooing (feet up, lean forward, breathe out)Beginner · A step
3D demoStanding marchBeginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoSupine spinal twist (Supta Matsyendrasana)Beginner · No equipmentBreathe out as you lift. Pelvic tilt into bridge: 8 tilts, then 6 bridges (our bloating class's dose). Heel slide: "10 slow repetitions each side, once or twice a day" (the move page's dose). Knee fold: "2 sets of 5 to 10 each side, every other day" (the move page's dose). Dead bug heel taps: 5 to 8 each side, head down (our editorial starting point). Clamshell: 10 each side, and bird dog: 5 each side with no long hold (our bloating class's doses). Side kick: "8 to 10 each side" (the move page's dose). Side-lying leg circles: "8 each direction, each side" (the move page's dose). Swan: "5 to 6 reps" (the move page's dose). Sit to stand: 8 to 10, breathing out as you stand (our editorial starting point). Wall side leg lift: "10 to 12 each side" (the move page's dose).
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoSupine heel slideBeginner · No equipment
3D demoKnee foldBeginner · No equipment
3D demoDead bug heel tapsBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying leg circles (Pilates side kick series)Beginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall side leg lift (standing side kick at the wall)Beginner · A wallThese are our suggestions for comfort, from the NHS's advice not to push too hard and the tummy pressure studies. No study has tested any of them in piles.
In any move, breathe out on the effort. Straining with a held breath raised tummy pressure more than any exercise in one research group's studies, and breathing in and holding raised it during lifting in another small study.
Swap the roll-up, the teaser, a long hundred and double leg lowering for head-down moves such as the knee fold, heel slide and dead bug heel taps. The roll-up kept tummy pressure up longest of 22 Pilates moves. The roll-up's and teaser's own cautions already suggest the same swap for leaking or a prolapse.
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Rolling like a ball, the seal, the open-leg rocker and the boomerang roll you over your tailbone. Leave them out while you're sore, or roll on a thick mat (our suggestion).
For the spine stretch forward, the saw, the spine twist and the mermaid, sit on a folded blanket or cushion, or use a chair (our suggestion, as our yoga for piles guide advises for seated poses).
Footwork and lying arm work put no weight on your bottom and were among the lowest-pressure moves in the Pilates pressure study. Pad or skip seated work on the box or carriage while you're sore, and keep breathing on heavier springs (our suggestion).
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Keep ring and ball squeezes light and keep breathing. Repeated squeezes of the back passage aren't a treatment for piles: see the note on letting go above.
We found no study showing that the roll-over, jack knife or other upside-down moves help piles, and their own cautions (neck problems, glaucoma, blood pressure that isn't under control, osteoporosis, pregnancy) still apply (our reading).
Drink enough: the NHS's advice for piles is to drink lots of fluid to keep your poo soft (our suggestion).
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In a Lithuanian study of 280 women, 40.7% developed piles, mostly in the third trimester or after the birth, and constipation was one of the strongest links. In a Spanish study, 36.2% had piles a month after the birth and 16.9% at 3 months. A US expert update says they occur in up to two-thirds of pregnancies.
For piles in pregnancy, the NHS suggests:
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In pregnancy, after the first trimester, keep time flat on your back to a few minutes: prop your upper body up, or use a side-lying or all-fours version.
In the Lithuanian trial, daily walking or exercise was part of the advice that cut piles after the birth. Our Pilates in pregnancy guide covers the rest.
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The NHS advises avoiding sit-ups, planks and high-impact exercise to start with, and avoiding straining on the toilet and heavy lifting. Our Pilates after having a baby guide covers the return to classes.
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Our exercise with piles guide summarises the NHS leaflets: most people are back to their normal routine within 1 to 2 days of banding, and one hospital's older leaflet says no exercise for 1 to 2 weeks after piles surgery. Once your hospital's rest period is over, start with the breathing and side-lying moves (our suggestion).
Piles are less likely to come back if you avoid constipation and straining. In one study after piles surgery, people with emptying problems were much more likely to have them come back.
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No class is written for piles, and no trial has tested one. The bloating class fits best: it starts upright and moving, uses rib breathing with no breath holds, then all-fours, side-lying and knees-bent moves, with no curls, roll-ups, face-down moves or rolling, and ends with pelvic floor relaxation (sit the mermaid on a cushion or chair while you're sore). The pelvic floor relaxation and morning constipation routines help if you strain. The clinical Pilates routine is curl-free, and the walk and Pilates class adds walking (do its hundred with your head down while sore). Do the pelvic floor class only if you also leak.
A 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 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 daily morning routine for constipation: a brisk walk, slow breathing, knee hugs and relaxing your pelvic floor, then tummy massage and unhurried toilet time.
25 minBeginner7 movesCardio machineA 15-minute routine of the exercises NHS physiotherapy Pilates classes send home: bridge, knee folds, leg slides, clam, side kick and side openings.
15 minBeginner10 movesNo equipmentA 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 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 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 cushionThe walking plan builds to 150 minutes a week; add Pilates on 2 or 3 days.
The piles lines are from our exercise with piles guide, word for word, and the heart lines from our other Pilates guides. 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 go to accident and emergency (A&E) or call 999, and don't drive yourself, if you have piles and:
Bleeding from the bottom is sometimes a sign of bowel cancer, and US colorectal surgeons warn that bleeding put down to piles is a common way it gets missed. A GP may examine your bottom or arrange tests, which is routine. The NHS says try not to be embarrassed: doctors are used to talking about this.
A severe, sharp pain when you poo, with bright red blood, may be an anal fissure. See a GP if it isn't getting better after 7 days.
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If a session brings on pain, a lump that won't go back in, or bleeding, stop, swap to gentler exercise for a while, and see a GP if it keeps happening (our suggestion).
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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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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No study has tested Pilates in piles, and no move shrinks a pile. Fibre, fluids and not straining have the evidence.
We found no study linking Pilates with piles. The NHS links them with constipation, pushing too hard and heavy lifting; in a class, the habit to avoid is holding your breath and bearing down.
We found no trial of pelvic floor squeezes (Kegels) for piles. People with piles tend to have tighter muscles around the back passage, so learning to relax them may matter more.
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We found no study of upside-down moves in piles. If you like legs up the wall as a rest, that's fine, but it isn't a treatment.
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The NHS suggests regular exercise to help with constipation, including with piles in pregnancy. Change the moves that hurt instead.
Bright red blood is common with piles, but bleeding from the bottom can be a sign of bowel cancer, and bleeding put down to piles is a common way it gets missed. See a GP about any blood in your poo.
Mat Pilates is Pilates. With sore piles, mat work lying down or on your side can be easier on your bottom than the reformer's seated work (our reading).
It can help in the ways that matter: moving regularly keeps your bowels regular, and Pilates teaches you to breathe out on an effort rather than hold your breath and push. No study has tested Pilates for piles, though, and fibre, fluids and not straining on the toilet do the most.
We found no study linking Pilates with piles. The NHS links them with constipation, pushing too hard when you poo and heavy lifting. In a class, the habit to avoid is holding your breath and bearing down, so breathe out on every effort.
Usually, yes. While they're sore, swap long curl-ups and roll-ups for head-down moves, sit on a cushion or chair for seated work, and skip rolling on your bottom. Stop if a move brings on pain or bleeding, and see a GP if that keeps happening.
Yes, with the same changes. Footwork and lying arm work put no weight on your bottom; pad or skip seated work on the box or carriage while you're sore, and keep breathing on heavier springs.
None is banned, but while you're sore, change the long curl-ups (the roll-up, the teaser, a long hundred), the rolling moves and long sitting on a hard floor. These are comfort suggestions; no study has tested them in piles.
No trial has tested them for piles. People with piles tend to have tighter muscles around the back passage, so learning to let go on the toilet may matter more. Do the squeezes if you also leak.
Breathe out slowly as you make an effort, in class and on the toilet, and never hold your breath and push. On the toilet, rest your feet on a low stool so your knees are above your hips, lean forward and breathe out gently.
Yes, with the usual pregnancy changes: after the first trimester, keep time flat on your back to a few minutes. The NHS suggests regular exercise to relieve constipation, and avoiding straining and long spells standing or sitting.
Follow your hospital's leaflet: most people are back to their normal routine within 1 to 2 days of banding, and recovery from surgery takes longer. Start with breathing and side-lying moves once your hospital's rest period is over.
We found no study of it. Sitting on a firm surface can press on sore piles, so use whatever is comfortable and keep sitting time short while you're sore.
See a GP for any blood in your poo, a change in your poo that isn't usual for you, weight loss without trying, or piles that keep coming back or aren't improving. Get urgent help for heavy bleeding, black or dark red poo, or severe pain.
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.
