Does Pilates Strengthen Your Pelvic Floor? What the Evidence Shows

If you're in your 40s or 50s and you've started leaking when you sneeze, feeling heaviness in your pelvis, or noticing urgency that wasn't there before, the chance that your pelvic floor is involved is high. According to Royal College of Obstetricians and Gynaecologists polling, over 60% of UK women have at least one symptom of poor pelvic floor health. And 69% of those women have never been spoken to by an NHS professional about what to do about it.

Most women who mention symptoms to their GP, their physio, or anyone holding an NHS leaflet end up being pointed at Pilates. Pilates can genuinely help. But the research makes one thing clear: the benefit depends on whether the class is deliberately engaging the pelvic floor as part of the work. Not all Pilates sessions are the same.

Here are 5 things to know about Pilates and the pelvic floor:

1. Pilates does strengthen the pelvic floor, and the research is consistent: multiple RCTs point in the same direction

2. Pelvic floor dysfunction in perimenopause is far more common than most women are told, and the window to act is before symptoms become significant

3. Pilates and dedicated pelvic floor exercises produce equivalent results for urinary incontinence, but only when the Pilates class explicitly cues the pelvic floor as part of the work

4. Not all pelvic floor dysfunction is weakness: a tight, overactive floor needs relaxation and lengthening, and the exercises that help weakness can make it worse

5. Supervised Pilates is safe and appropriate with prolapse, but a generic class is a different matter; the difference is individual assessment and deliberate modification

What is the pelvic floor and why does it change in perimenopause?

By the time most women notice pelvic floor symptoms, the hormonal changes driving them have often been underway for several years. In 2022, a study published in Scientific Reports analysed electronic health records from 25,425 women with a median age of 47 and found that 32% had at least one pelvic floor disorder: bowel dysfunction in 24.6%, urinary incontinence in 11.1%, pelvic organ prolapse in 4.0%, and multiple overlapping conditions in 6.5% (PMC9198100, Scientific Reports, 2022). These were women in ordinary primary care settings, not specialist clinics.

The pelvic floor is a group of muscles forming the base of the pelvis, supporting the bladder, bowel, and uterus. Its job isn't passive. It contracts and releases in coordination with breathing and movement, and with changes in intra-abdominal pressure. When it works well, it's invisible. When it doesn't, the effects are hard to ignore.

The hormonal mechanism is direct. Estrogen maintains muscle tone, connective tissue elasticity, and the health of the urogenital lining. As estrogen declines in perimenopause, pelvic floor muscle quality changes. A 2023 cross-sectional study of 1,446 women found that postmenopausal status increased the odds of urinary incontinence 1.89 times compared to premenopausal women (PMC10576367, 2023).

A 2024 systematic review of 11 studies involving 8,547 postmenopausal women found a combined prevalence of urinary incontinence of 63.1%, with a range of 13.6% to 84.4% depending on how incontinence was defined and which population was studied (PMC11550778, 2024). Even at the lower end of that range, you're talking about more than 1 in 8 postmenopausal women. At the upper end, it's most of them. Starting in perimenopause, before estrogen withdrawal accelerates that decline, is when intervention makes most sense.

There is more on exercise and perimenopause health in a separate post if you want the broader context on training in this life stage.

Does Pilates actually strengthen the pelvic floor?

Yes. In 2023, a double-blind, placebo-controlled RCT published in the Journal of Clinical Medicine followed 33 women with stress urinary incontinence through 12 weeks of Pilates. In the group doing Pilates on its own, pelvic floor muscle strength improved by 45% and quality of life, measured by the ICIQ-SF questionnaire, improved by 62% (Journal of Clinical Medicine, 2023). A second group combining Pilates with photobiomodulation improved more, by 73% and 76%, so the higher figures belong to the combined treatment rather than to Pilates alone. Leakage reduced significantly across all intervention groups.

Why does Pilates engage the pelvic floor? Because the pelvic floor is part of the deep core system: it works with the diaphragm, the transversus abdominis, and the multifidus muscles to manage intra-abdominal pressure. Every time you exhale in a controlled Pilates movement, the pelvic floor is part of that coordination. Well-taught Pilates doesn't treat the floor as a separate structure to be squeezed in isolation. It trains it as part of how the whole core functions together.

A 2025 systematic review of 15 RCTs involving 895 postmenopausal women found that 93% of studies showed statistically significant improvements in pelvic floor muscle function from training interventions (PMC12251402, 2025). The review covered a range of approaches. The findings point one way: training the pelvic floor works. What differs is how directly and explicitly the floor is engaged.

The same systematic review noted that in the one trial directly comparing Pilates with dedicated pelvic floor muscle training, peak muscle strength measured by manometry improved in the Pilates group but not the PFMT group. The picture is not one-sided though: strength measured by digital examination improved only in the PFMT group, and that was the one measure where the two groups differed significantly. Read it as two methods producing comparable symptom relief by slightly different routes.

Is Pilates as effective as dedicated pelvic floor exercises?

Most resources don't mention this trial. In 2024, a randomised controlled trial published in the International Urogynecology Journal compared Pilates and dedicated pelvic floor muscle training in 40 postmenopausal women with stress urinary incontinence over 12 weeks, three sessions per week (Int Urogynecol J, 2024). Both groups showed statistically significant improvements in the pad test, daily leakage, and ICIQ-SF quality of life scores, with no significant difference between them on any of those measures. On muscle strength the groups did differ, and there the dedicated pelvic floor training group came out ahead.

There's one detail that matters enormously for anyone choosing a class. The Pilates sessions in that trial included explicit voluntary pelvic floor contractions as part of each session. The instructor cued the floor deliberately, as an integrated component of the work, not as an afterthought.

Most clients I see who have been doing Pilates for years are surprised when I begin cueing the pelvic floor explicitly in sessions. They have been moving correctly, engaging their core, breathing well. But the floor itself was rarely spoken to directly in their previous classes. A class that doesn't cue the pelvic floor isn't doing nothing, but it's likely delivering far less specific benefit than one that does. That difference is the instructor's job to bridge, not the client's to figure out alone.

General Pilates is fine. But if the pelvic floor is the goal, work with someone who knows enough to cue it deliberately.

 Does your pelvic floor need strengthening, or relaxing?

Most resources skip this question. Skipping it can cause harm.

Not all pelvic floor dysfunction is caused by weakness. A hypertonic pelvic floor is one that is overactive, tight, or unable to fully relax. Women with a hypertonic floor often experience urgency, frequency, pelvic pain, painful intercourse, or difficulty emptying the bladder or bowel completely. The symptoms can look like weakness. The treatment is the opposite.

Standard Kegel exercises, and Pilates sessions that focus heavily on pelvic floor activation without any lengthening or release work, can worsen a hypertonic presentation. The floor doesn't need more tension. It needs to learn to let go.

Pilates that includes diaphragmatic breathing, a conscious lengthening of the pelvic floor on the inhale, relaxation postures, and awareness of the release phase of each contraction is appropriate for hypertonic presentations. Activation-focused work without that release component is not.

The only reliable way to know which category applies is assessment. If you have symptoms and aren't sure whether they come from weakness or overactivity, that question matters before you begin any programme. For complex or acute presentations, a pelvic floor physiotherapist is the right first step. For most perimenopausal women without neurological involvement, a supervised intake session with a knowledgeable instructor can tell you quickly which it is.

Can Pilates help with pelvic organ prolapse?

For most women with mild to moderate diagnosed prolapse, supervised Pilates can reduce symptom severity and improve quality of life. In 2025, a randomised controlled trial followed 100 women with stages I-III pelvic organ prolapse through 12 weeks of either Pilates or conventional physiotherapy, three sessions per week. The Pilates group showed greater reduction in symptom severity and a higher increase in pelvic floor muscle strength than the conventional physiotherapy group. Both groups improved significantly on the PFIQ-7 quality of life questionnaire (Social Medicine, 2025). This is a lower-authority journal than the PMC sources elsewhere in this post, so treat it as supporting rather than lead evidence. It fits with what the rest of the literature shows.

The movements that carry the most risk with prolapse are those that increase intra-abdominal pressure suddenly: breath-holding under load, high-impact sequences, and deep abdominal crunching. In a supervised session, these are identified and modified for each person individually. In a general class or online video, they may not be.

For anyone with stage III-IV prolapse, symptoms that worsen during exercise, or prolapse alongside neurological symptoms or acute pain, assessment by a pelvic floor physiotherapist or gynaecologist should come before beginning Pilates. For mild to moderate prolapse that's been medically reviewed and doesn't involve an acute or neurological component, supervised Pilates with deliberate modification is both safe and beneficial.

There is more on Pilates and lower back pain in a separate post, which also covers the relationship between pelvic stability and spinal support.

What to expect from pelvic floor-focused Pilates at Shaw Lifestyle

Training at Shaw Lifestyle includes specific pelvic floor knowledge alongside her Pilates and personal training qualifications. If pelvic floor work is a priority for you, that shapes how sessions are structured: which exercises are selected, how breathing is cued, and where the focus sits.

A session built around pelvic floor concerns begins with a short intake: symptoms, history, what you've already been told or tried. From there the programme is built around the findings. For someone in early perimenopause doing preventive work, that looks different from the work with someone managing a prolapse diagnosis or a post-surgical recovery.

Frequently asked questions

Is Pilates good for the pelvic floor?

Yes. A 2023 double-blind RCT found that 12 weeks of Pilates alone improved pelvic floor muscle strength by 45% and quality of life by 62% in women with stress urinary incontinence (Journal of Clinical Medicine, 2023). The benefit is real, and it depends on the class explicitly cueing and engaging the pelvic floor as part of the work.

Is Pilates better than Kegels for the pelvic floor?

Neither is clearly superior. A 2024 RCT directly comparing Pilates with dedicated pelvic floor muscle training found no statistically significant difference in urinary leakage outcomes after 12 weeks (PubMed 38206341, 2024). Pilates produced greater gains in peak muscle strength by manometry. Both approaches work, and for many women the combination addresses the full picture.

Can Pilates make the pelvic floor worse?

It can, if the pelvic floor is hypertonic (tight or overactive) and the class focuses on more activation without any release or lengthening work. Standard advice to squeeze and hold is counterproductive for an overactive floor. Well-structured Pilates includes both the contraction and the release. Good instructors assess which is needed before prescribing either.

How often should I do pelvic floor Pilates?

The 2024 RCT showing equivalent results to dedicated PFMT used three sessions per week over 12 weeks. A 2024 scoping review of Pilates dosage in musculoskeletal conditions identified two sessions per week, 60 minutes per session, for a minimum of eight weeks as the evidence-based minimum for measurable change (PMC11556558, 2024). Consistency over at least three months produces the most reliable outcomes.

Can Pilates help with pelvic organ prolapse?

Yes, for most women with mild to moderate prolapse. A 2025 RCT of 100 women with stages I-III POP found Pilates reduced symptom severity more than conventional physiotherapy over 12 weeks. For stage III-IV prolapse, or symptoms worsening during exercise, a pelvic floor physiotherapist assessment should come first. Supervised Pilates with individual modification is appropriate for most non-acute, reviewed presentations.

The evidence, stated plainly

Pilates strengthens the pelvic floor. The research is consistent across a 2023 RCT, a 2024 head-to-head trial, and a 2025 systematic review of 15 RCTs. What the research also shows is that the class must cue the floor deliberately for that benefit to be reliable, that a hypertonic floor needs relaxation rather than more activation, and that the right starting point depends on what's actually going on. Getting that picture right is the difference between a programme that helps and one that doesn't.

Shaw Lifestyle's Pilates sessions and Corrective Exercise sessions are available to book directly. To talk through your situation first, book a call with Liz.

Sources

- [RCOG Position Statement: Pelvic Floor Health, Royal College of Obstetricians and Gynaecologists](https://www.rcog.org.uk/about-us/campaigning-and-opinions/position-statements/pelvic-floor-health-position-statement/)

- [PMC9198100: Prevalence of pelvic floor disorders in adult women in primary care, Scientific Reports (Nature), 25,425 women, 2022](https://pmc.ncbi.nlm.nih.gov/articles/PMC9198100/)

- [PMC10576367: Pelvic floor dysfunction prevalence and associated factors, cross-sectional study, 1,446 women, 2023](https://pmc.ncbi.nlm.nih.gov/articles/PMC10576367/)

- [PMC11550778: The Link Between Menopause and Urinary Incontinence, Systematic Review, 11 studies, 8,547 women, 2024](https://pmc.ncbi.nlm.nih.gov/articles/PMC11550778/)

- [PMC9917687: Pilates for stress urinary incontinence, double-blind placebo-controlled RCT, n=33, 2023](https://pmc.ncbi.nlm.nih.gov/articles/PMC9917687/)

- [PubMed 38206341: Comparative analysis of PFMT and Pilates in managing UI in postmenopausal women, RCT n=40, 12 weeks, Int Urogynecol J, 2024](https://pubmed.ncbi.nlm.nih.gov/38206341/)

- [PMC12251402: Training interventions in postmenopausal women to improve pelvic floor muscle function, Systematic Review, 15 RCTs, 895 women, 2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC12251402/)

- [Social Medicine 2025: Conventional therapy vs Pilates for pelvic organ prolapse, RCT n=100](https://www.socialmedicine.info/index.php/socialmedicine/article/view/2025)

- [PMC11556558: Pilates Dosage in Musculoskeletal Rehabilitation, Scoping Review, 2024](https://pmc.ncbi.nlm.nih.gov/articles/PMC11556558/)