Pelvic Floor Pilates Exercises: The Best and Worst You Can Do

The pelvic floor is a group of muscles that support the bladder, uterus, and rectum. These muscles are vital in urinary and bowel control, sexual function, and overall pelvic stability (1). Pilates exercises can be highly beneficial for strengthening the pelvic floor muscles and improving their function (2).

However, not all Pilates exercises suit those with pelvic floor issues. Those with weak or dysfunctional pelvic floor muscles may worsen their condition by doing specific Pilates exercises.

We are not saying to avoid Pilates altogether, but rather to highlight the importance of understanding which exercises may need modification or avoidance for individual cases.

Here is a breakdown of some of the best and worst Pilates exercises for people with pelvic floor dysfunction (3).

What Is a Pelvic Floor Pilates?

Pelvic floor Pilates for women and men isn’t a specific type but a modified version of traditional Pilates exercises that focuses on strengthening the pelvic floor muscles. It involves slow and controlled movements that target the deep core muscles, including the pelvic floor.

Pilates has long been known for its focus on core strength and stability, making it an ideal form of exercise for promoting pelvic floor health. However, some Pilates exercises put more pressure on the pelvic floor than others, which can be problematic for those with specific pelvic floor issues.

Modifying or avoiding these exercises can help prevent further damage to the pelvic floor muscles and allow for proper healing and strengthening.

Note: you’ll need approval from your doctor or physical therapist before starting any exercise routine, including Pelvic floor pilates exercises, especially if you have pelvic floor issues.

Does Pilates Help Your Pelvic Floor?

Yes, Pilates can be highly beneficial for strengthening and improving the function of the pelvic floor muscles. Here’s how:

1. Builds Core Strength

Pilates focuses on the deep core muscles, including the pelvic floor (4). By strengthening these muscles, you can improve their ability to support your pelvic organs and maintain bladder and bowel control.

2. Promotes Proper Breathing Technique

Proper breathing is essential for engaging and strengthening the pelvic floor muscles. Pilates emphasizes diaphragmatic breathing, which involves using the diaphragm to draw air into the lungs and engage the deep abdominal muscles (5).

This type of breathing also helps relax tension in the pelvic floor muscles, which can be helpful for those with a hypertonic (overly tense) pelvic floor.

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3. Increases Body Awareness

Many Pilates exercises involve slow, controlled movements that require high body awareness. This awareness can help you better understand and feel how your pelvic floor muscles work and whether they are contracting or relaxing.

This increased body awareness can also translate into improved posture, which is essential for maintaining proper pelvic floor function (6).

4. Enhances Flexibility and Mobility

Research shows that Pilates can improve overall flexibility and mobility, indirectly benefiting the pelvic floor (7).

By encouraging flexibility, the muscles and tissues surrounding the pelvic area are less likely to experience tension or tightness, reducing the risk of strain or injury. 

Flexibility is significant for the pelvic floor, as it aids in maintaining normal pelvic alignment and function.

5. Strengthens the Transversus Abdominis

The transversus abdominis is a deep core muscle that works closely with the pelvic floor muscles to support and stabilize the lower abdominal region (5).

Pilates exercises that target the transversus abdominis, such as pelvic tilts and kneeling arm-leg extensions, can enhance pelvic floor function by reinforcing this interconnected muscle group. 

Studies indicate that a coordinated effort between these muscles can improve pelvic floor strength and endurance (4).

6. Supports Neuromuscular Control

Pilates emphasizes the connection between the mind and body, which can enhance neuromuscular control. Individuals can develop better neuromuscular coordination by practicing mindful movements and focusing on specific muscle engagement (8).

Research highlights that this improved control can lead to a more effective and timely activation of the pelvic floor muscles during daily activities, thereby preventing issues such as urinary incontinence and improving overall pelvic health.

Read more: Home Pilates Workout Guide: Strengthen Your Core

How To Cue Pelvic Floor in Pilates?

To cue the pelvic floor in Pilates, follow these steps:

1. Start with Breathing: Use diaphragmatic breathing by inhaling deeply through your nose, allowing your rib cage to expand and your abdomen to rise slightly. This breathing cycle helps engage your core and relaxes the pelvic floor.
2. Use Breath Control for Muscle Engagement: Inhale before a movement and exhale during exertion to maintain pelvic floor engagement. This controlled breathing aids in stabilizing the core and supporting the pelvic floor.
3. Focus on Engagement: As you exhale, visualize lifting your pelvic floor muscles upward, like drawing a marble up through your body. This mental imagery can help you engage the muscles effectively.
4. Incorporate Mindful Movements: Perform slow and controlled movements, focusing on how your pelvic floor muscles contract and relax. This slower pace increases your body awareness and control. Yoga pelvic floor exercises can also help slow movements (9).
5. Seek Professional Guidance: If you need help properly cueing your pelvic floor during Pilates exercises, seek guidance from a certified Pilates instructor or physical therapist specializing in pelvic floor health.

What Is the Best Exercise to Strengthen Pelvic Floor?

5 Pilates exercises for pelvic floor muscles include:

• Pelvic Tilts

This exercise involves gently tilting the pelvis forward and backward while lying on your back. It can help strengthen the deep abdominal muscles, including the transversus abdominis, which significantly support the pelvic floor.

To perform this exercise:

1. Lie Down: Begin by lying on your back with your knees bent and feet flat on the floor, hip-width apart. Relax your arms by your sides.
2. Engage Your Core: Gently draw your navel towards your spine to engage your core muscles without lifting your lower back off the floor.
3. Flatten Your Back: Exhale as you gently tilt your pelvis so your lower back flattens against the floor. Imagine bringing your pubic bone up towards your rib cage.
4. Hold: Hold this position for a few seconds, maintaining engagement in your core and pelvic floor muscles without tightening your glutes.
5. Release: Inhale as you release the tilt, allowing your pelvis to return to the neutral position with a slight arch in your lower back.
6. Repeat: Perform this movement 10 to 15 times, focusing on your breathing and controlled core and pelvic floor engagement throughout the exercise.

You can also perform this exercise by doing wall pilates for pelvic floor:

• Simply stand with your back against the wall.
• Tilt your pelvis forward and backward, focusing on engaging the pelvic floor.

• Bridging

Bridging involves lifting your hips off the ground while engaging your core and squeezing your glutes. This movement targets both the pelvic floor and gluteal muscles, helping to improve overall strength and stability.

To perform the bridge pose:

1. Lie Down: Lie on your back with your knees bent and feet flat on the floor, hip-width apart. Place your arms at your sides.
2. Engage Your Core: Inhale as you gently engage your core muscles, drawing your navel towards your spine.
3. Lift Your Hips: Exhale as you lift your hips off the ground, squeezing your glutes and engaging your pelvic floor muscles to maintain stability.
4. Hold: Hold this position for a few seconds, focusing on maintaining engagement in the core and pelvic floor without arching or straining your lower back.
5. Lower Yourself Slowly: Inhale as you lower your hips back to the ground, keeping control of your movement and engaging your core and pelvic floor muscles.
6. Repeat: Perform 10 to 15 repetitions with controlled movements and proper breathing techniques.

• Bird-Dog/Kneeling Arm-Leg Extensions

This exercise targets the transversus abdominis, gluteal muscles, and pelvic floor by challenging stability and coordination.

To perform this exercise:

1. Start on All Fours: Begin on your hands and knees with your wrists directly under your shoulders and your knees below your hips.
2. Engage Your Core: Inhale as you gently engage your core muscles without arching or rounding your back.
3. Extend One Arm and Opposite Leg: As you exhale, extend one arm straight out in front of you while extending the opposite leg behind you, keeping both limbs parallel to the ground.
4. Hold: Hold this position for a few seconds, focusing on maintaining stability and engagement in the core and pelvic floor muscles.
5. Return to Starting Position: Inhale as you slowly lower your arm and leg back to the starting position, keeping control of your movements.
6. Repeat with Opposite Arm and Leg: Perform 10 to 15 repetitions on each side, alternating between arms and legs while maintaining proper form and controlled breathing.

• Side-Lying Leg Lifts

Side-lying leg lifts are excellent for targeting the hips and pelvic region muscles, which can indirectly strengthen the pelvic floor. Side-lying leg lifts help stabilize the pelvis and improve alignment by engaging the abductor muscles. 

This stabilization is crucial in supporting the pelvic floor muscles and maintaining continence and pelvic organ support.

To perform this exercise:

1. Lie on Your Side: Begin by lying on your side with your hips and shoulders stacked and your bottom arm supporting your head.
2. Bend Your Bottom Leg: Bend the leg closest to the ground at a 90-degree angle, keeping it aligned with your body.
3. Position Your Top Leg: Extend the top leg straight out from your hip, resting the foot on top of the bottom foot.
4. Engage Your Core and Lift: Inhale as you gently engage your core muscles without arching or rounding your back. Exhale as you lift the top leg towards the ceiling, keeping it parallel to the ground.
5. Hold: Hold this position for a few seconds, focusing on maintaining stability and engagement in the core and pelvic floor muscles.
6. Lower Slowly: Inhale as you lower your leg back to the starting position.
7. Repeat: Perform 10 to 15 repetitions on each side while maintaining control of your movements and proper breathing techniques.

• Kegels

Kegels are a well-known exercise for strengthening the pelvic floor muscles. These exercises involve repeatedly contracting and relaxing the muscles that control urine flow, known as the pubococcygeus (PC) muscles (10).

To perform Kegels:

1. Identify Your PC Muscles: Try stopping the urine flow while using the bathroom to identify your PC muscles. The muscles you use to do this are your PC muscles.
2. Lie Down or Sit Comfortably: Find a comfortable position to perform Kegels, such as lying down or sitting in a chair with your feet flat on the ground.
3. Contract Your PC Muscles: Inhale as you contract your PC muscles, squeezing as if stopping the urine flow. Imagine pulling these muscles up and in towards your belly button.
4. Hold for a Few Seconds: Hold the contraction for 3 to 5 seconds, making sure to breathe normally throughout.
5. Relax Your Muscles: Exhale as you relax your PC muscles and bring them back to their resting state.
6. Repeat: Perform 10 to 15 repetitions, gradually increasing both the time you hold the contractions and the number of repetitions over time.

Bonus: Standing Ball Squeeze:

• Stand with your feet hip-width apart.
• Place the ball between your thighs.
• Squeeze the ball by engaging your pelvic floor muscles, hold for a few seconds, and then release.
• Repeat 10-15 times.

Doing pelvic floor exercises with a small ball can effectively cue and engage your pelvic floor muscles.

The ball provides a physical target to squeeze, which helps you focus on contracting the right muscles. Adding resistance from the ball can enhance the effectiveness of the exercises, making it easier to identify and strengthen your pelvic floor muscles (11). 

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What Exercises Should You Avoid with Pelvic Floor Problems?

While Pilates is beneficial for building core strength and flexibility, specific exercises can place undue pressure on the pelvic floor, potentially exacerbating pelvic floor problems. You should avoid exercises involving heavy abdominal engagement, intense core contractions, or prolonged inversions if you have pelvic floor dysfunction.

Examples include exercises like the “Hundred,” “Scissors,” “Dead Bugs,” and “Roll Up,” which demand high intra-abdominal pressure and may place stress on weakened pelvic floor muscles.

Additionally, exercises like “Teaser” or “Double Leg Stretch” can challenge pelvic stability, making them unsuitable for individuals with pelvic floor dysfunction.

We recommend cautiously approaching the “Plank” and other advanced abdominal exercises, as they require sustained core engagement and may cause issues for those with weak or strained pelvic floor muscles.

Fortunately, you or a trainer can adjust many Pilates exercises to reduce pressure on the pelvic floor while still fostering strength and stability.

Consult a certified Pilates instructor or physical therapist to learn modifications and find a program tailored to your needs.

We’ve detailed How To Relax Pelvic Floor Muscles by incorporating breathing exercises, gentle stretching, and mindfulness techniques, which can help reduce tension and improve overall pelvic health.

How Long Does It Take to Strengthen the Pelvic Floor?

Strengthening the pelvic floor can vary in time depending on several factors, including the individual’s current muscle strength, consistency of exercise, and overall health. Individuals might start noticing muscle strength and control improvements within 4 to 6 weeks with regular and targeted exercises, such as Kegels or Pilates.

However, significant strengthening and noticeable changes might take about 3 to 6 months of consistent practice. Maintain a regular exercise routine and consult a healthcare professional for personalized advice.

Find out how to Strengthen Pelvic Floor Muscles Without Kegels by exploring alternative techniques that promote core engagement and enhance muscle resilience through mindful movement and posture alignment.

Read more: Can You Lose Weight Doing Pilates Every Day?

What Can Ruin Pelvic Floor Muscle?

Several factors can negatively impact these muscles, leading to dysfunction:

1. Childbirth: The process of childbirth can stretch and weaken the pelvic floor muscles, especially during vaginal delivery. This experience can lead to pelvic floor dysfunction and issues such as urinary incontinence or pelvic organ prolapse (12).
2. Aging: As we age, the pelvic floor muscles naturally weaken. This factor can contribute to incontinence and other pelvic health issues (13).
3. Obesity: Excess weight increases the pressure on the pelvic floor muscles, which can lead to weakening over time and increase the risk of pelvic dysfunction.
4. Chronic Coughing: Conditions that cause chronic coughing, such as asthma or chronic bronchitis, put repeated pressure on the pelvic floor muscles, potentially weakening or damaging them.
5. High-Impact Exercises: Running or heavy lifting can strain the pelvic floor if not performed correctly, potentially leading to muscle weakening and dysfunction.

Dysfunction in the pelvic floor muscles can result in symptoms like urinary or fecal incontinence, pelvic pain, and a feeling of heaviness or pressure in the pelvic area. These symptoms can significantly impact daily life and overall well-being.

Frequently Asked Questions

• Do squats help the pelvic floor?

Yes, squats can help strengthen the pelvic floor muscles when done with proper form. They engage the core and lower body, supporting overall pelvic stability and strength.

• Is walking OK for the pelvic floor?

Walking is an excellent, low-impact exercise for maintaining pelvic floor health. It promotes circulation and can help keep the pelvic floor muscles active without excessive strain.

• Is planking good for the pelvic floor?

For people without pelvic floor dysfunction, planking can benefit the pelvic floor as it strengthens the core muscles, including those supporting the pelvic region. However, for some individuals with current pelvic floor dysfunction, planks may be an exercise that either needs to be modified or worked up to over time. If you have pelvic floor dysfunction, speak to your physician or pelvic floor physical therapist for individual recommendations.

• Can Pilates realign the pelvis?

Pelvic alignment issues can be a result of many potential causes. Pilates may benefit those related to hip, core, and pelvic floor strength. For causes that are anatomical or pathophysiological, consult with your doctor.

The Bottom Line

Pelvic floor health is crucial for overall well-being, and Pilates offers a low-impact yet effective way to strengthen these muscles. Individuals can improve their pelvic floor strength, coordination, and neuromuscular control by incorporating mindful movements, focused breathing techniques, and targeted exercises.

It is essential to consult with a certified Pilates instructor or healthcare professional for personalized guidance and modifications, especially for those who may have pelvic floor dysfunction or are pregnant.