Pilates: How It Can Be Affecting Your Pelvic Floor

Dr. Sasha Speer, PT, DPT
Apr 16
3 min read

Pilates is often praised as one of the “best” forms of exercise for core strength, posture, and body awareness. For many people, it can be incredibly beneficial.

And yet, at Auria Pelvic Health, we’re seeing a growing number of patients whose pelvic floor symptoms are being driven—or worsened—by how they’re doing Pilates.

This doesn’t mean Pilates is bad.

It means that without proper pelvic floor coordination and pressure management, even well-intentioned exercise can create problems.

The Core Isn’t Just the Abs

Pilates places a strong emphasis on core engagement, control, and stability. But the “core” is not just the abdominal muscles.

True core function includes:

The diaphragm (breathing muscle)
Deep abdominal muscles
The pelvic floor
The muscles of the spine and hips

These components must work together. When one part is out of sync, the system compensates—and the pelvic floor often pays the price.

When Pilates Contributes to a Weak or Overloaded Pelvic Floor

We commonly see people who grip their abdominals excessively, hold their breath during exertion, brace instead of coordinating movement, or lack awareness of pelvic floor timing.

Woman in light blue activewear practices Pilates on a reformer in a bright studio, surrounded by plants. Calm and focused mood.

This creates poor pressure management—meaning pressure is directed downward instead of being distributed through the system.

Over time, this can contribute to issues like urinary leakage (especially with exertion), pelvic organ prolapse symptoms, feelings of heaviness or pressure, low back or hip pain, and persistent core fatigue.

Ironically, many people turn to Pilates to fix these problems—without realizing their movement strategy may be reinforcing them.

Tight Pelvic Floor + Pilates = More Pain

On the other end of the spectrum, we also see many people with overactive or tight pelvic floor muscles who gravitate toward Pilates because it feels controlled and “safe.”

However, when constant engagement and holding are layered on top of an already tight pelvic floor, symptoms can escalate.

This may lead to:

Pelvic pain
Pain with intercourse
Tailbone or hip pain
Urinary urgency or frequency
Burning or “UTI-like” symptoms despite negative tests

In these cases, the pelvic floor isn’t weak—it’s overworking.

More tightening doesn’t create strength; it creates irritation.

Why These Patterns Develop

The body is incredibly good at compensating. If someone lacks coordination, stability, or confidence in movement, the nervous system often defaults to:

Holding
Bracing
Over-controlling

Pilates, especially when taught without individualized cueing or pelvic floor assessment, can unintentionally reward these strategies.

The result?

A body that looks strong—but doesn’t move efficiently.

Pilates Isn’t the Problem—Lack of Individualization Is

Woman exercising on a Pilates reformer, illustrating core engagement, breathing, and pelvic floor coordination in a bright studio setting.

Pilates can be a powerful tool when:

The pelvic floor is assessed first
Breathing strategies are appropriate
Pressure is managed rather than forced
Exercises are modified for the individual
Relaxation is valued as much as engagement

What works beautifully for one person can be harmful for another.

This is especially true for:

Postpartum bodies
People with a history of pelvic pain
Those with prolapse or urinary symptoms
People with chronic back or hip pain

How Pelvic Floor Physical Therapy Helps

Pelvic floor physical therapy helps determine:

Whether your pelvic floor needs strengthening, relaxation, or coordination
How you manage pressure during movement
Whether Pilates exercises should be modified—or paused—temporarily
How to integrate breath and movement effectively
When and how to safely return to or progress Pilates

Many people are able to continue Pilates successfully once their pelvic floor is functioning properly and patterns are retrained.

Others discover they need a different approach—or a period of rehab first.

Strong Isn’t the Same as Supported

A strong body is one that can:

Contract when needed
Relax when needed
Adapt to load
Distribute pressure efficiently

If Pilates is leaving you with leaking, pain, pressure, or urinary symptoms, it’s not a personal failure—and it doesn’t mean you should stop moving altogether.

It means your body is asking for better coordination and support.

At Auria Pelvic Health, we help people understand how their movement practices are affecting their pelvic floor—and how to rebuild strength without sacrificing comfort or function.

Because the goal isn’t just to be strong.

It’s to be supported.

Auria Pelvic Health

8929 S Sepulveda Blvd., Ste. 412

Los Angeles, CA 90045

Phone: 310-505-6096

Website: www.theaurialife.com