5 Findings About Pilates for Bladder Leaks

One Pilates trial deliberately included pelvic-floor contractions

A 2024 trial¹ assigned 40 postmenopausal women to pelvic-floor muscle training or Pilates, three times weekly for 12 weeks. Its abstract reports improvements in pad-test leakage, diary-recorded losses and symptom scores in both groups, without demonstrating superior continence results for Pilates.¹

The trial record specifies that participants were reminded to contract the pelvic floor during each strengthening repetition, but not during stretches. Equipment included a reformer and other Pilates apparatus.²

This tested a specific program incorporating pelvic-floor work. It cannot show that any mat class or video produces the same outcome.¹²

Better abdominal strength did not mean better bladder control

Another 2024 trial³ included 34 women with stress incontinence, 17 per group, comparing pelvic-floor training with modified Pilates twice weekly for 12 weeks.³

Symptoms and their impact improved within both groups. Several measurements of pelvic-floor electrical activity favored pelvic-floor training; deep abdominal muscle strength favored Pilates. The published abstract does not report superior symptom relief with Pilates.³

An abdominal strength measurement and a bladder-symptom score answer different questions. Neither should be substituted for the other when a class is advertised as treatment for leaks.³

Enjoying a class did not establish an added treatment benefit

A 2018 UK pilot randomized 73 women to usual physiotherapy or physiotherapy plus six weekly, hour-long modified Pilates classes. Both groups received pelvic-floor care; this was an add-on comparison.⁴

Only 49 women contributed complete follow-up data. The main questionnaire comparisons found no significant differences between groups. Some subgroup results favored Pilates for self-esteem, embarrassment or relationships, and interviews described positive experiences.⁴

The study was too small for firm treatment conclusions. Extra group contact also made it difficult to separate the exercises from the experience of attending a class.⁴

The 2026 breathing trial compared two breathing programs

This trial included 46 women with stress or mixed incontinence. Yoga-based or Pilates-based breathing exercises were practiced for six weeks, five days weekly, in two 20-minute daily sessions. A physiotherapist taught and corrected technique initially and at weeks three and five.⁵

Both groups improved on symptom and quality-of-life scores. Some quality-of-life and resting muscle-activity results favored yoga. There was no standard pelvic-floor-training comparison group.⁵

These findings concern coached breathing programs. They do not demonstrate that Pilates classes outperform pelvic-floor training. The abstract provides no numerical between-group symptom-effect estimate.⁵

Current guidance still calls for a supervised pelvic-floor program

NICE recommends at least three months of supervised pelvic-floor muscle training for stress or mixed urinary incontinence. Supervision includes checking contraction and relaxation, then adapting training to ability, discomfort and individual goals. Group or individual sessions should be offered, with progress and end-of-program reviews.⁶

Before paying for a class promoted for leakage, ask who will assess your pelvic-floor technique, how exercises will be adapted, and how improvement will be reviewed. Bring the class description to a pelvic-health physiotherapist.⁶

The “Check It” section of Laugh, Sneeze, Jump explains why breath-holding, pushing down and substituting other muscles can make a squeeze difficult to judge. Our questions before an internal pelvic-floor exam cover the assessment conversation separately.