Pilates for Your Pelvic Floor: Leaks, Kegels and Prolapse Explained

By Katherine, Lead Instructor, Certified Pilates Instructor · Last updated: September 2026

Pilates can support your pelvic floor, but only when it is trained on purpose. Research shows generic mat or reformer work does not reliably strengthen these muscles on its own — the benefit shows up when an instructor deliberately cues correct pelvic floor contractions alongside the exercises (Lemos et al., 2019). Think of Pilates as a helpful partner to targeted pelvic floor training, not a replacement for it.

Key takeaways

• The pelvic floor is a muscular sling supporting the bladder, bowel and (in women) the uterus, and it controls continence.

• Doing Pilates alone does not automatically train the pelvic floor — the exercises need deliberate pelvic floor cueing to help (Lemos et al., 2019).

• Urinary incontinence, including stress incontinence (leaking with a cough, laugh, sneeze or jump), affects roughly a third of Canadian women, but it is common, not normal, and not something you have to accept (Kolahdooz et al., 2026).

• Pelvic floor muscle training (Kegels) has strong evidence behind it as first-line conservative management (Dumoulin, Cacciari & Hay-Smith, 2018); Pilates and Kegels work well together rather than as substitutes for each other.

• Pelvic organ prolapse and men's pelvic floors both deserve attention — prolapse warrants a pelvic health physiotherapy assessment, and men have pelvic floors too.

What does the pelvic floor actually do?

The pelvic floor is a hammock-like layer of muscle that stretches from your pubic bone to your tailbone, supporting your bladder, bowel and, in women, your uterus (Cleveland Clinic, 2025). It works with your deep abdominal muscles, back muscles and diaphragm as part of your body's core system, and it does two jobs at once: it holds your pelvic organs in the right position, and it contracts and relaxes on cue to control when you urinate, pass stool, or pass gas (Cleveland Clinic, 2025).

Like any muscle group, the pelvic floor can be underactive (weak, poor endurance) or overactive (too tense to fully relax) — both patterns can cause symptoms, which is one reason a proper assessment matters more than guessing (Cleveland Clinic, 2025). This post is one of a series on Pilates through pregnancy and postpartum; if you're currently expecting, our trimester-by-trimester guide to Pilates during pregnancy is a good starting point.

Does Pilates strengthen the pelvic floor?

Not automatically. A systematic review and meta-analysis looking at Pilates and pelvic floor muscle strength found that generic Pilates classes are generally not effective at increasing pelvic floor strength unless the program explicitly incorporates pelvic-floor-muscle-training-style voluntary contractions — in other words, unless the instructor is specifically cueing the pelvic floor to engage (Lemos et al., 2019).

A more recent randomized controlled trial in postmenopausal women with stress urinary incontinence (40 participants, 12 weeks) compared dedicated pelvic floor muscle training with a Pilates program that did explicitly include correct voluntary pelvic floor contractions. It found no significant difference between the two approaches for reducing incontinence symptoms, though strength gains differed depending on how they were measured (Gonzaga et al., 2024). The evidence here is still low-to-moderate certainty, drawn from small trials with mixed outcome measures — promising, but not the final word.

The practical takeaway: Pilates is not a substitute for a pelvic health physiotherapy assessment if you have diagnosed incontinence or prolapse, and it is not automatically "pelvic floor training" just because it is core-focused. What matters is whether pelvic floor engagement is being cued correctly.

What is stress incontinence, and is it normal?

Stress urinary incontinence is leaking urine during a cough, sneeze, laugh, jump or other sudden increase in abdominal pressure. It is common: a 2026 Canadian meta-analysis estimated that about 34% of women live with urinary incontinence, rising to as high as 52% among women 85 and older, but common does not mean normal or something to just live with (Kolahdooz et al., 2026; Canadian Continence Foundation). The Canadian Continence Foundation puts it plainly: incontinence "is common but not normal, and treatments are effective."

If you are leaking regularly, that is worth mentioning to your doctor or a pelvic health physiotherapist rather than quietly working around it.

Pilates or Kegels: which one should you do?

Neither replaces the other — they are complementary. A Kegel is a deliberate, isolated contraction of the pelvic floor muscles, typically taught and progressed as part of structured pelvic floor muscle training (PFMT). A Cochrane systematic review of PFMT for urinary incontinence in women (31 trials, 1,817 participants) found high-quality evidence that women doing PFMT were substantially more likely to report their stress incontinence cured than women in control groups, along with fewer leakage episodes and improved quality of life; the review supports PFMT as first-line conservative management (Dumoulin, Cacciari & Hay-Smith, 2018).

Pilates, meanwhile, trains strength, control and body awareness more broadly. When it is layered on top of correct pelvic floor cueing, it can reinforce the coordination between your pelvic floor and the rest of your core — but it is not a like-for-like substitute for dedicated, progressive pelvic floor training, particularly if you have diagnosed dysfunction.

What about pelvic organ prolapse?

Pelvic organ prolapse (POP) is when the bladder, uterus, bowel or vaginal wall drops from its normal position due to weakened pelvic floor support, sometimes felt as a sensation of pressure, heaviness, or "something falling out" in the vagina (Cleveland Clinic, 2024). Some women have no symptoms at all, and prolapse is sometimes found incidentally during an unrelated exam.

How does breathing connect to the pelvic floor?

Your diaphragm and pelvic floor are thought to work as a coordinated pair, with the pelvic floor giving slightly as you inhale and recoiling as you exhale. A cross-sectional study of 64 women with pelvic floor dysfunction found the diaphragm and pelvic floor worked together most strongly in a hands-and-knees position, and a single week of pelvic floor training was followed by a small increase in diaphragm thickness (Korkmaz Dayican et al., 2024). This is part of why instructors pay attention to how you breathe during pelvic floor cueing, not only whether you squeeze — exhaling as you engage, rather than holding your breath and bearing down, tends to work with this natural coordination instead of against it.

Does this change during pregnancy, postpartum or menopause?

Briefly, yes, though each stage has its own considerations. During pregnancy, the pelvic floor supports growing weight, and your body changes in ways that affect how the pelvic floor is loaded, which our trimester-by-trimester pregnancy guide covers in full. After birth, the pelvic floor needs time and a gradual return to loading regardless of delivery type; our post on when to start Pilates after giving birth covers safe timing for vaginal birth and C-section. Stress incontinence is more common after childbirth and after menopause (Canadian Continence Foundation); how Pilates fits into perimenopause and menopause is a topic for a separate post.

Do men have pelvic floors too?

Yes. Men have pelvic floor muscles that support the bladder and bowel and help with erections and ejaculation (Cleveland Clinic, 2025), and men can develop incontinence too, especially with prostate issues or after prostate surgery (Canadian Continence Foundation). A narrative review found that structured pelvic floor training after prostate surgery improved continence and quality of life, especially in the first months and when started early or even before surgery, although some studies found similar continence rates by one year (Ali et al., 2022). The same principle applies as for women: deliberate, correctly cued pelvic floor engagement is what matters, not exercise volume alone.

Safety note: This article is general information, not medical advice, and it is not a substitute for individual assessment. If you notice a vaginal bulge, a feeling of heaviness or pressure, or new pelvic pain, see your family doctor, a pelvic health physiotherapist, or your gynaecologist. During any exercise, stop and tell your instructor if you leak, feel a dragging, bulging or heavy sensation in the pelvis, or feel pain. These are signs the exercise needs changing and your health care provider should know. If you have a diagnosed or suspected prolapse, avoid straining and heavy lifting (Cleveland Clinic, 2024). Until you have been assessed and cleared, it is also sensible to skip breath-holding under load and deep V-sit type positions that push pressure down onto the pelvic floor. We adapt sessions around what a client's health care provider recommends; we do not diagnose or treat prolapse ourselves. Cleveland Clinic lists pelvic floor (Kegel) exercises and physical therapy with a specialist among the non-surgical options (Cleveland Clinic, 2024), which is one more reason an individual assessment, not a general class, should come first.

Working on your pelvic floor with us in Markham

If you want your Pilates practice to genuinely support your pelvic floor rather than assume it does, or your doctor or pelvic health physiotherapist has cleared you to exercise, a Private 1:1 Pilates with Instructor session lets us build correct pelvic floor cueing in from the start. We're a Markham studio, and we work alongside your family doctor or pelvic health physiotherapist rather than in place of them. You can book a session online to get started.

Frequently asked questions

Can Pilates cure incontinence on its own?

There is no evidence that Pilates alone cures incontinence. The stronger evidence base is for dedicated pelvic floor muscle training, with Pilates as a possible complement when it includes correct pelvic floor cueing (Dumoulin, Cacciari & Hay-Smith, 2018; Lemos et al., 2019).

How do I know if I'm doing a Kegel correctly?

It's easy to squeeze nearby muscles such as the glutes or inner thighs, or to hold your breath, instead of isolating the pelvic floor. A pelvic health physiotherapist can confirm correct technique, which is why self-teaching from an article has real limits.

Is it safe to do core exercises if I have a prolapse?

This needs individual assessment first — see the safety note above. General guidance is to avoid heavy bearing-down and breath-holding under load until you've been evaluated by a pelvic health physiotherapist or your doctor.

Do I need a pelvic health assessment before starting Pilates?

If you have diagnosed or suspected incontinence, prolapse or pelvic pain, yes. Start with your doctor or a pelvic health physiotherapist, and Pilates can complement that care afterward. For how the two fit together more generally, see how to choose between Pilates and physiotherapy.

Does diastasis recti affect the pelvic floor?

The abdominal wall and pelvic floor are part of the same core system, so the two are often assessed together, especially postpartum. We cover this in detail in Diastasis Recti and Pilates.

Sources

1. Lemos AQ, Brasil CA, Valverde D, Ferreira JDS, Lordêlo P, Sá KN (2019). The Pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 23(2), 270-277. https://pubmed.ncbi.nlm.nih.gov/31103107/

2. Gonzaga S, de Oliveira RG, Dutra LL, Oliveira LS, de Oliveira LC (2024). Comparative analysis of pelvic floor muscle training and Pilates in managing urinary incontinence among postmenopausal women: a randomized controlled trial. International Urogynecology Journal. https://pubmed.ncbi.nlm.nih.gov/38206341/

3. Dumoulin C, Cacciari LP, Hay-Smith EJC (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, Issue 10, CD005654. https://doi.org/10.1002/14651858.CD005654.pub4

4. Kolahdooz F, Jang SL, Lawrence S, Harris R, Wagg A, Sharma S (2026). Prevalence and impact of urinary incontinence in Canada: a systematic review of the quantitative and qualitative literature and a meta-analysis of quantitative data. AJE Advances: Research in Epidemiology, 2(1), uuag006. https://doi.org/10.1093/ajeadv/uuag006

5. Canadian Continence Foundation. Urinary Incontinence. https://www.canadiancontinence.ca/urinary-incontinence

6. Cleveland Clinic (2025). Pelvic Floor Muscles: Anatomy, Function & Conditions. https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles

7. Cleveland Clinic (2024). Pelvic Organ Prolapse: Types, Causes & Treatment. https://my.clevelandclinic.org/health/diseases/24046-pelvic-organ-prolapse

8. Korkmaz Dayican D, Keser I, Celiker Tosun O, Yavuz O, Tosun G, Kurt S, Baser Secer M (2024). Exercise Position to Improve Synergy Between the Diaphragm and Pelvic Floor Muscles in Women With Pelvic Floor Dysfunction: A Cross Sectional Study. Journal of Manipulative and Physiological Therapeutics. https://pubmed.ncbi.nlm.nih.gov/38520441/

9. Ali M, Hutchison DD, Ortiz NM, Smith RP, Rapp DE (2022). A narrative review of pelvic floor muscle training in the management of incontinence following prostate treatment. Translational Andrology and Urology, 11(8), 1200-1209. https://doi.org/10.21037/tau-22-143