Does Pilates Help with Pelvic Floor Function?
Pilates is well known for targeting the core and has been used as a method of rehabilitation in the form of clinical Pilates by exercise physiologists and physiotherapists for decades. It has recently enjoyed a boost in popularity with reformer Pilates studios popping up everywhere.
These large group classes are a step away from traditional Pilates in my opinion as they are not individualised and are often fast paced. While I’m no purist and I love a bit of creativity, I do wonder what Joseph Pilates would think.
So, does Pilates help with pelvic floor function? Let’s find out.
In this blog post I’ll cover:
Who needs to consider pelvic floor health?
Pelvic floor health is not something that should only be considered by pregnant and postpartum women. It is super important for women of all ages to have an understanding of what an incredible group of muscles the pelvic floor is, what healthy pelvic floor function means and when to seek help if things aren’t working as well as they should.
Remember, when it comes to the pelvic floor, ‘common’ does not equal normal!
While it might not be common to hear your friends talk about their pelvic floor concerns, it is getting more prevalent to see conversations on social media and in the media. These are most often surrounding pregnancy, exercise and menopause- three very hot topics!
But Pelvic floor health is not just important in relation to leaking, prolapse or childbirth. In fact pelvic floor dysfunction can have widespread impacts on overall health including musculoskeletal pain, mental health, and more.
Pilates as a form of exercise has become hugely popular over the last 5-10 years with Reformer Pilates studios everywhere. They particularly appeal to women who enjoy or want a lower intensity form of exercise including those who may worry about leaking or prolapse with strength training or high intensity cardio.
What is the Pelvic Floor?
Your pelvic floor is a group of muscles and connective tissue, connecting both sides of your pelvis.
It works alongside your deep abdominal and spinal muscles and your diaphragm to support your internal organs, manage intra-abdominal pressure, and assists in bowel and bladder function including voiding and retaining contents.
It also has fascial connections from your head to your toes that together, provide coordination and stability to your body.
What does a well functioning pelvic floor look like?
As an exercise physiologist with a focus on helping women with pelvic health concerns and persistent pain, optimal pelvic floor health and function includes:
Being able to contract and relax the pelvic floor muscles
Coordinated activation both within the pelvic floor and with other muscles and body functions
Having similar muscle strength, length and tone in left and right sides of the pelvic floor
Being able to contract and relax the front pelvic floor muscles
Being able to lengthen and relax the back pelvic floor muscles
An appropriate level of ‘stiffness’ in the pelvic floor connective tissues (ligaments and tendons)
Appropriate amount of muscle strength and bulk
Being able to manage the changes in intra-abdominal pressure when sneezing, laughing, coughing and exercising including walking walking (not just up to the pelvic floor)
Being able to relax to allow easy release of bowel and bladder contents.
Absence of prolapse, urine leaking, bowel incontinence and pelvic pain.
Strong and coordinated adductors, hamstrings, glutes, abdominals and diaphragm to provide support to the pelvic floor for all the above.Your pelvic floor shouldn’t be doing all the work to stabilise the pelvis.
This list is not exhaustive as pelvic floor function can mean many things.
How Pilates targets the pelvic floor and helps optimise function
Pilates is a form of exercise that follows six principles:
Breathing
Concentration
Centering
Control
Precision
Flow
Research has shown that Pilates can be very effective at targeting and improving pelvic floor health when performed correctly. These principles play a big part.
Breathing
Pelvic floor function is intimately connected to the diaphragm muscle and therefore breathing. As we inhale our pelvic floor relaxes and as we exhale our pelvic floor contracts. The timing of exhalation during Pilates exercise to coincide with an increase in load puts the pelvic floor in an optimal position to contract and provide stability to the pelvis and lumbar spine.
Centering
The principle of centring can encompass different aspects of Pilates including centring the mind and centring the body. Centering the body in Pilates involves activating the deep muscles of the core including the pelvic floor, deep abdominals and diaphragm to create strength and stability in the torso including the spine.
Concentration and Precision
While these two principles refer to different things from a Pilates perspective, from a pelvic floor perspective they can be very beneficial. Concentrating and paying attention to the movements and muscle activation patterns as well as ensuring precision in both muscle function and exercise execution is imperative when learning, rehabbing or strengthening the pelvic floor and deep core muscles.
Flow
Who doesn’t love a little flow? Flow is great for the mind and what's great for the mind is great for the pelvic floor. Releasing tension, improving mood and learning to relax when moving can have huge benefits in pelvic floor function.
Other aspects of Pilates that may benefit pelvic floor function can include:
Increased awareness of body alignment and posture which can affect how well the pelvic floor muscles function
Enhanced muscle coordination and endurance
Support for pregnant and postpartum individual
A gentle and supported way to exercise if higher intensity exercises lead to pelvic floor symptoms
When Pilates is not beneficial for Pelvic Floor Health
There are situations when Pilates is not beneficial for your pelvic floor. This can be due to a poorly qualified instructor, large group classes with insufficient correction, fast paced or high intensity classes. Things to consider include:
Contracting the pelvic floor incorrectly can be harmful
Research has shown that 24% of women contract their pelvic floor muscles incorrectly. Doing so can cause an increase in pressure down into the pelvic floor, poor coordination of muscles, lack of improvement or worsening in symptoms. Poor cueing from the instructor such as brace the abdominals or pull the belly button to the spine can be detrimental to the pelvic floor.
Overloading the pelvic floor
Even your pelvic floor needs the correct dose of exercise to be effective. A one hour Pilates class can be a lot if your pelvic floor is weak or you have dysfunction. And if your pelvic floor is already strong and functioning well then focusing too much on contracting it can actually create issues such as a tight pelvic floor and pelvic pain. Too much of a good thing, is well, never a good thing! And this applies to your pelvic floor too.
Poor programming
Everyone likes to feel the burn in a Pilates class! But overworking muscle groups such as abdominals and glutes can lead to pelvic floor dysfunction and overall muscle imbalances.
Are the exercises right for your circumstances?
There are many things to consider when selecting appropriate Pilates exercises for pelvic floor function and health. These include:
Your symptoms
Your current strength and fitness level
Your health status
If you've had children
If you’re in menopause
Your posture and body proportions e.g. femur length
Your genetics
Your past experiences including sports played
Your breathing patterns
Your existing movement patterns
Pilates exercises that are not right for your circumstances can cause or lead to an increase in pelvic floor dysfunction.
Other things that affect your pelvic floor during Pilates
There are other things that can affect your pelvic floor function both during and outside of your Pilates class. These include:
Sucking in your stomach
Gripped muscles can not lengthen and short muscles can not contract.
As women we are taught to be smaller, to take up less space; that thin flat tummies are attractive.
And so we spend all day sucking in our stomachs. Imagine squeezing a blown up balloon in the middle. Where does the pressure go?
The increased pressure goes up (where it can hit a wall with a stiff ribcage) and down, which can lead to prolapse and/or incontinence.
And while your muscles may be able to withstand isolated moments of sucking in, think how tired they’ll be doing this all day- or all through that Pilates class.
Not to mention the long term pressure can lead to chronically lengthened and weak pelvic floor muscles.
And then we need to find stability elsewhere- hello bum cheek clenching!
So instead, let your guts hang out and your butt relax.
Wearing tights with belly compression or pants with a tight waist band
There are a number of reasons why this could be affecting your pelvic floor function and contributing to leaking.
The increased pressure of the waistband on your belly is putting pressure down into the pelvic floor.
Like squeezing the middle of a tube of toothpaste!
When the pants are holding your abdominal muscles in, they are forcing them into a position where they cannot lengthen.
And if they cannot lengthen, they cannot contract to help manage intra-abdominal pressure and support the pelvic floor.
With your abdominals being pulled in by your pants, your brain perceives them to be in a shortened contracted state.
This may lead to a clenched, tight pelvic floor, because as you now know, it’s all connected!
Dysfunctional breathing patterns
Loads of things can contribute to breathing dysfunction such as posture, injury history, pregnancy, stress, sport, exercise and repetitive movements.
But how does breathing affect pelvic floor function?
Your pelvic floor is intimately connected to your diaphragm and together with your abdominal muscles and deep spinal stabilisers, it provides stability to your spine and supports your internal organs (and their contents), through management of intra-abdominal pressure.
Your ability to expand your ribcage on an inhale, will affect how much pressure goes down into your pelvic floor.
On the other hand, your ability to compress your ribcage on exhale will affect how well your pelvic floor and abdominals can contract and manage any increases in pressure through movement or daily function. .
Like when you lift something heavy or forcefully exhale when sneezing or coughing.
Additionally your ribcage may be ‘stuck’ in a state of inhalation (wide and flared rib cage), or exhalation (narrow compressed rib cage), or a combination of the two.
In addition to this, many muscles assisting with breathing and pressure management connect to your ribcage directly or indirectly through fascial connections.
But what does this all mean for your pelvic floor?
Learning to breathe correctly can be a big piece of the puzzle to improving your pelvic floor function.
Poor posture
The ability of the pelvic floor muscles to function well, plays such a big role in their ability to do their job.
And poor posture and joint alignment often leads to some muscle groups being short, tight and unable to lengthen. And other (often opposing) muscle groups to be long, weak and unable to contract.
It can also mean your pelvic floor and diaphragm don't line up optimally to function well together.
So, how do you change your posture?
Hint: it’s NOT by ‘standing up straight’ or using posture correctors. It does take time, consistent effort and sometimes some expert guidance.
But a great place to start is by:
Learning to contract your pelvic floor and abdominals correctly,
Perform targeted breathing exercises
Aiming to create a ‘stack’ between your ribcage and pelvis.
Key Pilates exercises beneficial for pelvic floor health
There are so many Pilates exercises that are beneficial for pelvic floor health, but if you’ve read everything that comes before this topic, you’ll know that the most beneficial Pilates exercises for your pelvic floor are the ones that you need and that suit your circumstances.
How to know if your class is helping or harming your Pelvic floor?
Yes, your Pilates class could actually be harming your pelvic floor. Things to watch out for include:
An instructor who cannot provide correct cueing to engage and relax the pelvic floor. A variety of cues is a bonus as different people respond to different cues.
A class that focuses purely on bum’s and tum’s- or similar
A class that includes a lot of clams, bridges and other glute shortening exercises to get a good glute burn. Your pelvic floor loves to have room and not be compressed by short tight glutes- which also causes a short tight back pelvic floor.
A high energy class that doesn’t take the time to focus on the precision of Pilates and setting up the exercise well
A class where no modifications are given or consideration for different levels.
A Pilates class that isn’t actually Pilates- there are plenty of classes that use reformers in all different ways- creativity is amazing, until it isn’t.
How to incorporate Pilates into pelvic floor rehabilitation
If you are a beginner then it is best to start with a one-one Pilates session with a suitably qualified instructor. This will not only ensure you understand Pilates methodology, but also familiarise you with using Pilates equipment such as a reformer.
If you have pelvic floor dysfunction, then I highly recommend attending a clinical Pilates class with a Pilates qualified Exercise Physiologist or physiotherapist. They will have a deep understanding of Pilates but also the ability to assess you and identify the Pilates exercises that will be most effective.
If you live in or near the city of Toowoomba, you can access Clinical Pilates in my clinic, Ebb & Flow Exercise Physiology.
Conclusion
So, does Pilates help with pelvic floor function? Absolutely! However it is important to ensure that your instructor is well qualified, you are appropriately assessed before starting, the class is the right level for you and that it is actually Pilates- not a bastardised high intensity version of Pilates.
Where to next:
Read my blogs:
Read more about my clinical Pilates Toowoomba services
Disclaimer: The information provided in this blog is intended for educational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare professional before starting any exercise or health program. By using this content, you agree that EBB & FLOW EXERCISE PHYSIOLOGY is not responsible for any injuries or health issues that may arise from your use of the exercises or advice provided.