Pilates guide
A pelvic organ prolapse is when the womb, bladder or bowel bulges into the vagina. Pilates is generally fine with a prolapse if you adapt it, and it can be the supervised exercise that goes alongside the treatment that comes first: pelvic floor muscle training for at least 16 weeks. In a trial of 414 women, one-to-one training plus Pilates-based classes slightly reduced prolapse symptoms over 2 years. No trial has tested Pilates on its own.
Pilates sits beside care from your GP and a pelvic health physiotherapist, and after surgery your surgical team's advice comes first. This guide covers what happens to the pressure inside your tummy in Pilates, the moves to use and the ones to swap, reformer and wall Pilates, lifting and impact, Pilates with a pessary and after surgery, our free pelvic floor class, and the signs that need a GP.
Looking for a prolapsed (slipped) disc in your back? That's a different problem: see our Pilates for back pain guide.
The UK's pelvic health physiotherapists, the Pelvic, Obstetric and Gynaecological Physiotherapy group (POGP), say a prolapse is "not a life threatening condition, and not all prolapses get worse; some may improve". See a GP about a lump or bulge in or around your vagina.
The National Institute for Health and Care Excellence (NICE) suggests supervised pelvic floor muscle training for at least 16 weeks for a mild prolapse with symptoms. In a trial of 447 women it eased symptoms more than a leaflet, and 11 years later fewer of those women had needed further prolapse treatment.
NICE says supervised exercise, such as yoga, may help women doing supervised pelvic floor training. In a trial of 414 women, one-to-one training plus Pilates-based classes slightly reduced symptoms over 2 years; the classes can't be separated from the one-to-one training.
No trial has tested Pilates on its own for prolapse, and no other exercise has been shown to work better than pelvic floor training.
In a lab study of 22 beginner Pilates moves, none raised the pressure inside the tummy more than standing up from a chair, though roll-ups kept it high for longest. In 115 older women, gentle Pilates-based exercise didn't worsen pelvic floor symptoms.
Squeeze your pelvic floor as you breathe out and move, then let it go fully. Keep your head down in tummy work, swap roll-ups and the teaser, leave out jumping, and stop any move that brings on heaviness, dragging or a bulge.
The NHS lists:
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The NHS says "If you do not have any symptoms, or the prolapse is not bothering you, you may not need medical treatment." Symptoms are often worse at the end of the day, after standing for a long time or after lifting.
It depends on how it's counted: 3% to 6% of women by symptoms, and up to half on examination. The Royal College of Obstetricians and Gynaecologists (RCOG) says 1 in 10 women over 50; POGP says about 1 in 3 women who have had children.
Across 15 studies, having children, vaginal birth, age and body weight were the risk factors that held up; physical activity and heavy work weren't. POGP says heavy lifting, long standing and repeated bending may push pressure downwards and make a prolapse more likely.
POGP's Pilates booklet builds the pelvic floor into every move: "Breathe in, breathe out, and engage your deep abdominal muscles and pelvic floor", then "Let your pelvic floor muscles relax fully after every contraction", and "Your tummy should not bulge upwards or dome".
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NICE: "Consider a programme of supervised pelvic floor muscle training for at least 16 weeks as a first option" for a mild prolapse with symptoms. In the POPPY trial, 447 women had one-to-one training or a leaflet; at 12 months symptoms had eased more with training, by a modest amount. In 109 women, 19% improved by one prolapse stage with training against 8% without. Across 16 trials the benefit was clearest in the first 6 months.
In the PREVPROL trial, 414 women with a prolapse they hadn't sought treatment for had one-to-one pelvic floor training (five physiotherapy appointments over 16 weeks) plus Pilates-based pelvic floor classes and a DVD, or a lifestyle leaflet. Two years later symptoms were slightly lower (a score of 3.2 against 4.2), which the researchers called "small, but probably important". We know the classes only from the trial registration: two 6-week blocks a year, led by a physiotherapist with Pilates training, with the pelvic floor training built in. Their effect can't be separated from the one-to-one training.
Our Europe PMC search found no trial of Pilates alone in women with prolapse. A 2023 review of 7 trials of other exercise for prolapse included none of Pilates and found no evidence that any works better than pelvic floor training. For leaking, reviewers concluded other exercise "should not yet be recommended" in place of it. In 62 women without pelvic floor problems, Pilates and pelvic floor training built pelvic floor strength equally, but that doesn't show Pilates treats a prolapse.
A 2026 Indian study of 100 women reported that Pilates beat conventional exercise for prolapse quality of life, but it gave no spread of results, no registration and few methods, and its pelvic floor training was below NICE's dose.
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NICE says supervised exercise "(for example, yoga) may help" women doing supervised pelvic floor training, because some exercises done incorrectly can raise the pressure on the pelvic floor. It found no evidence that unsupervised activity such as walking or swimming makes symptoms better or worse.
In 20 women without a prolapse, a sensor measured pressure during 22 beginner mat and reformer moves. No move's peak was higher on average than standing up from a chair; bridging and reformer footwork were among the lowest, and roll-ups the highest. Only the roll-ups kept pressure high for longer than standing up. The authors support these moves for women who want a low-pressure routine, but say the results can't be applied to other moves.
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In 57 active women, coughing and jumping raised pressure most, and abdominal curl-ups far less than lifting a heavy box. In 147 women with prolapse or leaking, standing up and coughing raised pressure more than lifting 10 or 20 lb. No study has linked a given pressure to a prolapse starting or getting worse.
In 115 women after the menopause with low bone density, 8 months of supervised heavy lifting or a gentle, mostly mat Pilates-based programme didn't worsen pelvic floor symptoms. Only 15 of them had had a prolapse, so this is reassuring rather than proof.
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Breathe in to prepare; as you breathe out, squeeze your pelvic floor and move; then let it go fully. Don't hold your breath or bear down. POGP's prolapse booklet adds "the knack": tighten your pelvic floor before each lift, cough or sneeze.
POGP's 2023 prolapse booklet's routine, in our words. NICE suggests at least 16 weeks of training supervised by a specialist; ask your GP or refer yourself to a pelvic health physiotherapist.
See the movement on the 3D figure: Pelvic floor exercise (Kegel)
Pelvic floor exercises, 8 slow holds of up to 10 seconds and 8 quick squeezes, 3 times a day, building towards 10 of each; pelvic floor relaxation, 5 to 10 slow breaths, 1 to 3 times a day; lateral breathing, 5 to 8 breaths; side-lying tummy draw-in, up to 10 holds of up to 10 seconds (the moves' pages).
Squeeze as you breathe out and move, release as you return. Heel slides, 10 slow repetitions each side; knee folds and bent-knee fall-outs, 2 sets of 5 to 10 each side, every other day (the moves' pages, POGP's dose); pelvic tilt into bridge, 6 to 8 slow reps (our Pilates for your pelvic floor class); glute bridge, 2 sets of 8 to 10 (our editorial starting point).
Side kick, 8 to 10 each side; cat-cow, 8 slow waves (the moves' pages); clamshell, 8 each side; side-lying open book, 5 each side; bird dog, one limb at a time and then the full move, 5 each side; swan, 5 small lifts if lying face down is comfortable (our Pilates for your pelvic floor class).
3D demoClamshellBeginner · No equipment
3D demoSide kick (Pilates side kick series)Beginner · No equipment
3D demoSide-lying open bookBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBird dogBeginner · No equipment
3D demoSwan (Pilates swan dive)Intermediate · No equipment
3D demoCat-cowBeginner · No equipmentSit to stand, 8 slow reps, squeezing just before you stand; mountain pose, 5 slow breaths (our Pilates for your pelvic floor class); wall push-up, 2 sets of 8 to 10 (our office workers' class); band row, 2 sets of 10 to 15 with a light band, breathing out as you pull (our editorial starting point).
Swap the roll-up, wall roll-up and teaser for a head-down move such as the knee fold. In the pressure study, roll-ups kept pressure up for longest of 22 Pilates moves. Add them back gradually if they don't bring on heaviness or leaking (our suggestion).
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Keep the hundred, the double- and single-leg stretch, the criss-cross and the chest lift short, with your head down if you like, or leave them out if they bring on heaviness (our suggestion). An NHS pelvic health service advises avoiding abdominal crunches, and POGP says your tummy shouldn't bulge upwards or dome.
Leave out jumping, including on a reformer jumpboard: the NHS advises avoiding "physical activities that put a lot of strain on the pelvic floor, like heavy lifting, running and trampolining".
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Heavy springs on leg work, heavy weights and deep squats can wait. An NHS pelvic health physiotherapy service advises avoiding deep squats, "as your pelvic floor is vulnerable in this position", and deadweight lifting.
Don't hold your breath or bear down in any move, and keep long spells of standing still short, especially at the end of the day when symptoms are often worse.
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The NHS and RCOG advise avoiding heavy lifting, running and trampolining. POGP's November 2023 booklet says high-impact exercise and weights may make symptoms worse, especially if your pelvic floor isn't strong, and to "Try low impact exercise instead in the short-term, such as modified aerobics, cycling, a cross trainer, fast walking, Pilates or swimming". An NHS physiotherapy service lists "Yoga and Pilates, adapt any uncomfortable positions" among exercise generally safe with a prolapse.
NICE found no evidence on lifestyle changes for prolapse, so its advice to minimise heavy lifting is its committee's experience. Assistant nurses, who lift at work, had more prolapse surgery in one Danish study, but a review found heavy work and physical activity weren't clear risk factors. Women who lift heavy weights for exercise didn't report more symptoms, while a review of strenuous exercise found it increased symptoms for a while. In 47,674 UK women followed for 8 years, moderate and vigorous activity weren't linked with a new prolapse.
An NHS physiotherapy service says: "Once your pelvic floor is strong with good endurance, you may trial other exercises, but you must stop if symptoms worsen." POGP says to speak to your specialist physiotherapist "about the best ways to start or keep exercising". Our suggestion: try one harder thing at a time, and drop back if you feel heaviness, dragging or a bulge, or you leak.
Reformer moves behave like mat moves: in the pressure study, footwork and bridging were among the lowest and the reformer roll-up among the highest. Use light springs, keep the same swaps, and skip the jumpboard. Wall Pilates hasn't been studied in prolapse; keep the wall roll-down small and squeeze as you roll back up (our suggestion).
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POGP says "You should be able to continue exercise with a pessary", and to keep doing your pelvic floor exercises. Change a position that makes it shift or hurt.
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The RCOG suggests walking from the day you get home, only light loads such as a 1-litre bottle of water for the first month, and nothing heavy or strenuous until 4 to 6 weeks. POGP suggests "low level pilates" from 6 to 12 weeks, once bleeding or discharge has stopped, and at least 3 months before high-impact exercise; its Pilates booklet says to wait until your post-operative check after vaginal surgery.
In 108 women, advice with no limits on activity after prolapse surgery did no worse than 3 months of restrictions, and a 2025 Cochrane review found no clinically relevant difference from either activity advice or pelvic floor training around surgery (low certainty). The RCOG says there's no evidence that normal activity is harmful.
Both POGP and the RCOG say to keep up pelvic floor exercises for life after surgery, and POGP says some exercises that need heavy straining may need to be avoided for life after an operation for prolapse.
Start with our 20-minute Pilates for your pelvic floor class, which builds the squeeze and release into every move. With a prolapse, swap its chest lift for a second set of knee folds, and keep the wall roll-down small or skip it at the end of the day. Do the daily pelvic floor workout alongside it, and 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 postnatal Pilates class: breathing and pelvic floor, lying, side-lying and hands-and-knees moves, upper back work for feeding and a standing lift.
20 minBeginner16 movesA bench or boxThe beginner Pilates plan suits you once your squeezes are going well; keep the swaps on this page. After a birth, the postpartum plan builds up week by week.
A 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 minBeginner5 days a weekA 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 minBeginnerThese are the warning signs from our pelvic floor and prolapse guides, word for word, with one line of our own, labelled. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999.
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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You can't pee at all.
If you cannot pee at all, get urgent help from a GP or NHS 111, and if it comes on suddenly with severe tummy pain, call 999 or go to A&E.
The NHS says see a GP if:
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A bulge that has come outside the vagina and is sore, bleeding or won't go back in: see a GP soon, and get help the same day if you also can't pee (our suggestion, from the NHS's advice to see a GP about any lump and our "can't pee at all" line; the NHS prolapse page gives no urgent line for this).
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"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.
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In many areas you can refer yourself. See one if the exercises are hard to do, if your symptoms haven't improved after about 3 months of regular practice, or before you go back to running, jumping or heavier lifting.
Stop, drop back to an easier level and rest if you feel heaviness, dragging, pressure or a bulge, or you leak, during or after an activity. If you see or feel a bulge when you squeeze, stop the pelvic floor exercises and get help.
See your clinic for bleeding, pain or a smelly discharge, or if your pessary keeps falling out. If it's stuck, contact the clinic where it was fitted, your GP or the nearest A&E.
The RCOG says to seek medical advice for:
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Chest pain, shortness of breath or coughing up blood can mean a clot in the lung: the RCOG says seek medical help immediately.
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Call 999 if:
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.
An NHS physiotherapy service lists adapted Pilates as generally safe, POGP lists Pilates among low-impact options, and the PREVPROL trial used Pilates-based classes.
Childbirth, age and body weight are the risk factors, not physical activity, and beginner Pilates moves raised pressure no more than standing up.
NICE puts supervised pelvic floor training first, no other exercise has beaten it, and in PREVPROL the classes came on top of one-to-one training.
POGP: "Let your pelvic floor muscles relax fully after every contraction".
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UK advice to avoid heavy lifting is expert opinion, and POGP now frames it as short-term. Standing up and coughing raised pressure more than lifting 20 lb in women with prolapse.
The one study claiming this is very low quality and under-dosed the pelvic floor training.
It can be, alongside pelvic floor training rather than instead of it. In a trial of 414 women, one-to-one training plus Pilates-based classes slightly reduced symptoms over 2 years, and NICE says supervised exercise may help alongside training.
There's no evidence that it does. In 22 beginner moves, none raised tummy pressure more than standing up from a chair, though roll-ups stayed high for longest. Change any move that brings on heaviness, dragging or a bulge.
No study links Pilates with causing a prolapse. The main risk factors are childbirth, age and body weight; physical activity wasn't one in a review of 15 studies.
Swap roll-ups and the teaser for head-down moves such as the knee fold, keep curl-ups such as the hundred short, and leave out jumping, including the jumpboard. Don't hold your breath or bear down in any move. This is our suggestion, built on the pressure study and NHS advice.
The ones in POGP's Pilates booklet: heel slides, knee folds, pelvic curls, clams, side-lying arm openings and all-fours work, each with a pelvic floor squeeze as you breathe out and a full release after. Our Pilates for your pelvic floor class follows it.
Usually, with light springs and the same changes. In the pressure study, reformer footwork and bridging raised pressure least and the reformer roll-up most. Skip the jumpboard.
Yes, with the same rules: squeeze as you breathe out, keep the wall roll-down small, and avoid long spells standing still if symptoms build through the day. Wall Pilates hasn't been studied in prolapse.
Yes. NICE suggests supervised pelvic floor training for at least 16 weeks first, and no other exercise has been shown to work better. POGP's aim is 10 long and 10 quick squeezes, at least 3 times a day.
The advice is the same for a bladder, bowel or womb prolapse: pelvic floor training first, then adapted Pilates. Training helped a back-wall prolapse less clearly in pooled trials, so a pelvic health physiotherapist's plan matters.
Follow your surgical team first. UK leaflets suggest light loads only for a month, low-level Pilates from about 6 to 12 weeks once bleeding or discharge has stopped, and high-impact exercise after at least 3 months.
Yes: POGP says you should be able to keep exercising with a pessary. Keep doing your pelvic floor exercises, and see your clinic for bleeding, pain or a pessary that keeps falling out.
That's a different problem: a slipped disc in your spine, not a pelvic organ prolapse. Our Pilates for back pain and Pilates for sciatica guides cover it.
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.
