The Truth About Pilates and Pelvic Floor Health, According to Doctors and Experts
SARAH PERCY LOUNGES against a pillow in the soft glow of a lamp, blonde hair in a messy bun, yellow T-shirt rumpled. She speaks directly into the phone that she’s holding up in front of her face. “Hello, hi! Let’s stop scrolling,” she says as soon as the video starts.
Percy raises her right hand, cupping it upside down with her fingertips together as though pulling up on an invisible string, then relaxes it a second later, palm open, fingers splayed. “On, off, 2, off, 3, off...” she says in time with her hand movements. She’ll count up from zero to 10, 12, and then 15, holding her hand in that cupped position until she hits her targeted number. “Almost there, keep going!” she says as she nears the end of each count-up.
The video has over 24,600 likes and nearly 1,000 comments. Another pinned video, in which Percy (who goes by @femalephysiosarah on TikTok and Instagram) does the exercises clad in glasses and cozy blue pajamas, has racked up 21.1 million views and 2.1 million likes. In yet another post, supermodel Ashley Graham sits in a car with one of Percy’s videos visibly playing on her phone. She follows along, a cheeky smile on her face. “Are you squeezing? Releasing?” Graham says to the camera.
Ask a group of women over the age of 18 what exactly Percy is doing and they’ll probably laugh in recognition of the absurd-looking movement. Kegels, obviously. The hand gestures are meant to mimic what your pelvic floor does as you clench and then release the hammock of muscles that spreads through your pelvis. With Percy, it’s a covert signal in a language only women speak, a perky reminder to protect and strengthen that vital muscle network while lying in bed or brushing your teeth.
I was at my friend’s bachelorette party this summer when I saw one of Percy’s videos pop up. Realizing I had a perfect panel at my disposal, I posed the question. “Do you all know this woman? Are you targeted by these posts too? Do you know what she’s doing?”
About half the women immediately said yes. Some actually followed Percy. One said she does the exercises every time she scrolls past, while another had no idea what the hand signals meant or how to do a Kegel. “Wait, how do I know if I’m doing it right? I don’t know how to do this,” she said, panicked that she’d potentially missed an essential memo about her anatomy. And in some ways, she had.
The women in that room perfectly illustrated an emerging trend: Thanks to a host of social media–fueled attention (and other forces), a crucial element of women’s health and women’s bodies is now fodder for party conversation after centuries of ignorance and silence.
In recent years, rectifying the knowledge gap around the pelvic floor has felt particularly urgent, bringing it out of obscurity and into a new era of recognition. The main target? Moms, moms-to-be, and increasingly, any woman thinking about her pelvic floor. Because while we’re all being made acutely aware of just how important this muscle group will be when the time comes to get pregnant and give birth, strengthening it is also a boon before, beyond, and regardless of those periods.
A healthy pelvic floor supports things like sexual health and bladder and bowel continence. If the comments on Percy’s videos are any indication, we can make use of the tips and tricks regardless of age or maternal status.
“I just would love to shout it from the rooftops about pelvic health,” Percy says when we chat. And indeed, that’s exactly what she and other physical therapists on social media are doing.
Trend Starters
This newfound focus on pelvic floor health is a microcosm of a much larger movement that aims to demystify pregnancy and postpartum. In 2026, mamas-to-be have never had more access to endless wisdom (some factual, some not so much), exercises, and tools. For that, we can thank not only a flourishing social media environment that seeks to break the silence around these major transitions, but also an older generation of moms and grandmothers who bore the brunt of the physical and mental consequences with very few—if any—pointers or other information.
“The expecting mom of 2026 is so unique,” says Erica Paulson, who has worked as a labor doula for 20 years and is cofounder and CEO of Nurture, which provides health and wellness services for pregnant and postpartum women. “Today’s parents are much more curious about their options. They want to practice wellness—not just treat something after it’s a problem, but invest in the health of their body, especially their pregnant body, and their baby as well.”
From her perspective, moms of today are asking what childbirth and postpartum will look like, how they will define that for themselves, and who will be there to help them. They want to be prepared, Paulson says, and that often means looking to social and traditional media, people in their communities, and experts.
The increased interest around the pregnancy and postpartum window is also leading to curiosity about and awareness of the pelvic floor in general. And despite what social media may tell you, maintaining a healthy pelvic floor is a whole lot more complex than following along as someone does Kegel exercises in an 80-second Instagram video. (Percy, for her part, includes a disclaimer on her physio-related videos about consulting a women’s health physiotherapist or physical therapist before doing the exercises, and she advises women to seek out professional help for their own care plan.) Still, experts say it’s high time we all started paying more attention to those muscles—even if you’re not pregnant or postpartum. And if social media helps boost that message? Great.
“Unfortunately, in the United States, the majority of women don’t learn about their pelvic floor,” says Larissa Rodriguez, MD, a urologist at Weill Cornell Medicine with expertise in the surgical treatment of pelvic floor conditions. “We don’t do a great job educating women on many health-related things, and this is one of them.”
In her experience, most women learn about it only when they have an issue.
Pelvis Anatomy 101
Think of your pelvis—that bowl-like bony structure at the base of your spine—as the anchor of your skeleton. It’s responsible for supporting the weight of your upper body, helping you do basic functions like sitting, standing, walking, and running. It consists of several bones, including your sacrum, tailbone, pubis, “sit bones,” and hip bones, and it houses everything from your bladder, urethra, uterus, and ovaries to your rectum and anus. It’s also the structure the baby pushes through on its trip into the big wide world.
The pelvic floor, then, describes the group of muscles that lies at the base of the pelvis, supporting the internal pelvic organs. “Imagine the pelvic floor like a hammock between two trees,” says Percy. It’s the unsung hero of some of the most basic and vital functions you do every day: peeing, pooping, and having sex. Without it, all three would likely be painful, uncontrolled, or impossible. “They’re voluntary muscles, meaning we have control over them, unlike smooth muscles,” says Dr. Rodriguez. “We can be taught to utilize them.” (That’s where pelvic floor therapy comes in, but more on that in a sec.)
When you’re pregnant, new and different pelvic floor challenges are introduced. That growing fetus is akin to “adding a massive bowling ball, and then another one, to that hammock,” says Percy, who recently gave birth to her second child. She’s referring, of course, to the baby, the enlarged uterus, the growth of a brand-new organ (hello, placenta!), and overall weight gain during pregnancy. So it’s no wonder that about 50 percent of pregnant women experience symptoms of pelvic floor disorders—from constipation to urinary incontinence—even before giving birth. That little muscle hammock is working overtime to keep things in place.
Plus, the pelvic floor is especially sensitive to changes in our hormones postpartum and in menopause, says Sara Koehl, DPT, who specializes in pelvic floor health at Wave Physical Therapy & Pilates in Cincinnati. During pregnancy, there’s a big influx of estrogen. Afterward, estrogen takes a dive, especially if you’re breastfeeding. That makes your pelvic floor tissues less flexible and pliable, interrupting normal functions. During childbirth, you have to know how to both relax your pelvic floor and also bear down properly. “We want our muscles to be viable and moving well,” Koehl says. “We want trees to bend so they don’t break.”
For that reason, cultivating a healthy, strong pelvic floor before getting pregnant is a great idea. It helps women stay healthy and pain-free during pregnancy and can aid them during childbirth, experts say. It’s also connected to shorter pushing phases, fewer cases of tearing, and improved postpartum recovery, per Paulson. “We want to be able to lengthen and fully contract the muscles to accommodate a vaginal birth,” Percy explains. But you can’t do that if you barely know what your pelvic floor is or how to connect with it.
Of course, this is easier said than done. Historically, the pelvic floor has not received the attention it deserves during prenatal appointments. At these appointments, “you’re talking about a million other things [related to pregnancy],” says Maral Malekzadeh, DO, a clinician specializing in gynecology at the Well Westlake and Advanced Women’s Health & Surgery in Westlake, Ohio. “Pelvic floor seems to fall to the very bottom of that list.”
But it shouldn’t. Pelvic floor muscle training during pregnancy was effective in reducing urinary incontinence risk and third- or fourth-degree perineal tears during vaginal birth, found one meta-analysis published in Acta Obstetricia et Gynecologica Scandinavica. Of course, everyone’s risk factors for tearing and other complications are “very, very different, depending on their birth and anatomy,” says Percy. “But there are so many benefits to optimizing the pelvic floor as early as you can in pregnancy.”
Dr. Malekzadeh typically sees a lot of postpartum women experiencing urinary leakage and the sensation that something is pulling down in their pelvic area (not necessarily full uterine prolapse—where the uterus drops down or into the vagina—but ligament laxity). And considering the fact that, each year, 10 percent of U.S. women who give birth vaginally end up with pelvic floor disorders that require surgery, it would make sense to encourage women to learn how to keep it strong and healthy before childbirth.
We’re not talking about Kegels, Kegels, and more Kegels here. That exercise has its time and place and is definitely important in learning how to engage your pelvic floor, strengthen it, and help prevent incontinence. But different women have different needs. And a healthy pelvic floor is actually not about making it as strong as possible. It’s more about coordination and the ability to control those muscles.
Experts say you need to be able to contract and relax the muscles, as you do in a Kegel, which naturally results in building pelvic strength. Some women already have an overly tight pelvic floor and are unable to relax the muscles, which causes its own set of issues, from painful sex to vaginismus. “Most of the women that we work with are holding too much tension,” says Janelle Frederick, a pelvic floor physical therapist who is known on Instagram as @vaginarehabdoctor.
Plus, “if your pelvic floor is rock hard, then that might increase your chances of a prolonged second stage of labor,” Percy says. (That’s when the mother is 10 centimeters dilated and ready to push.) But all women need to work on strengthening and learning how to engage their pelvic floor—to connect with the muscles there and learn how to appropriately use them. The goal, then, is to work with a women’s health physical therapist to find the perfect recipe for you and your body.
Unfortunately, unlike other forms of exercise that are more DIY-able, pelvic floor exercises really require you to work with an expert. You won’t know what your needs are—and what your treatment should look like—until you’re assessed. (FYI, to get a complete and accurate picture of your pelvic floor health and coordination, pelvic floor therapists or women’s health physical therapists usually have to do an internal vaginal exam, like one you might get at your yearly gyno appointment.)
After meeting with a therapist, your pelvic floor program might involve learning breathing techniques (the pelvic floor and diaphragm work together, per Paulson) and core-strengthening or hip-opening exercises. It might mean improving posture, which can have “a big impact on how intra-abdominal pressure works,” says Koehl.
It’s also not a one-and-done deal. A strong, optimal pelvic floor takes active, intentional work. “Physical therapy is a lifelong commitment,” says Dr. Rodriguez. “I tell my patients that it’s no different than exercising any other part of your body. It’s not that I exercise for a month and I’m done for life. It doesn’t work that way.”
Here Come the Pilates Moms
It all started as a joke in Sonia Djafri’s labor and delivery unit: “Oh, there’s another pilates mom doing her thing!”
Over the past 12 months, Djafri, a labor and delivery physician assistant at a hospital in New York, has seen more women sailing through their pushing stage in less time and with minimal tearing. They seem more tuned in to their core, pelvic floor, and breathing techniques. Almost every time, they tell Djafri they’ve been doing lots of pilates.
One day last September, after coaching three “pilates moms” back-to-back through efficient and quick births, Djafri couldn’t stop thinking about it. She pulled out her phone and recorded a video about her observations, posting it to TikTok. “Pilates revolution has created baby-delivering machines,” the text over the video reads. It completely blew up. With 1.3 million views and over 120,000 comments, it was clear that women had alot to say.
When Djafri mentioned her observation to some of the maternal fetal medicine doctors at her hospital, they told her they’d seen the same trend. “A lot of moms commented on [my video] how their labor was so much better if they had done pilates during their pregnancy,” says Djafri.
A small surge in media centering on pelvic floor health and exercise seems to be at least one contributing factor in this pilates mom trend. One woman will post about her fantastic labor and postpartum experience, attributing it to pilates, and that makes other moms-to-be want the same for themselves, Djafri says. Other times, it’s just word of mouth. (Of course, it’s worth noting that, while there are no studies yet, a socioeconomic factor is at play here: Affluent women giving birth in New York City hospitals who can afford nine-plus months of pilates are more likely to experience positive birth outcomes with fewer complications.) But moms across the country posted comments about their similar experiences on Djafri’s video.
To be clear, pilates is not—and never will be—a replacement for pelvic floor therapy. And it’s not a miracle workout that promises a quick, easy delivery. Not even close. “Obviously, there are certain factors you can’t control that might lead to C-sections and other outcomes,” Djafri says. “Patients should always consult their health care provider and attend pregnancy-specific classes to understand the potential risks of childbirth.” But the trendy workout, which has seen a mighty resurgence over the past few years, does seem to provide key core strength and breathing techniques that help women better connect with their pelvic floor.
Any doctor or physical therapist who deals with the pelvic floor will tell you that your core is key. If your abs are weak, your pelvic floor has to compensate by doing more of the heavy lifting. That’s why core exercises are often a big part of physical therapy. For younger patients in their late teens or early 20s, Dr. Malekzadeh actually tells them to focus first on their core strength. “Core health supports overall pelvic muscle function—the diaphragm, abdominals, back, pelvic floor—and is what makes pelvic health strong,” she says. “You don’t have to wait until you’re pregnant to do that.”
It’s a muscle group like any other in your body, Frederick adds. One “that needs nourishment, that needs care. It can be trained to function better and support your life goals.”
In some ways, you can think about caring for your pelvic floor the same way you do training for a marathon. You don’t just show up on race day expecting to crush 26.2 miles. “I always tell [moms], this is about to be the biggest workout of your life thus far,” Djafri says. “It’s a big birthday party, and it’s so exciting.”
Beyond the Babies
Of course, that pelvic floor party continues throughout your life, coming into play during postpartum, menopause, and your regular day-to-day activities.
As a pelvic floor therapist, Frederick does a lot of work with clients who experience painful sex or are unable to have sex, often the result of overly tight pelvic floor muscles, which can have a seriously negative impact on their relationships and self-image. (FYI, painful sex isn’t the only consequence—a tight pelvic floor can also cause bladder leakage and painful bowel movements.)
Frederick frequently ends up teaching clients about their basic reproductive anatomy during sessions. She’ll have them hold up a mirror to their parts to help “visually connect” with their vagina, clitoris, and labia for the first time. “It’s an area that a lot of us are thirsty for, in a sense, especially if sex education wasn’t part of your background, or open conversation wasn’t welcomed in your household,” she says. “Your pelvis, that’s where love is made. So many important things and intimate things are happening in the pelvic region.”
In true health journalist fashion, I booked myself an appointment with a pelvic floor physical therapist while reporting this story. A few years back, I found myself frequently blaming my “small bladder” for the many pee breaks I required on road trips and airplanes. It was annoying but didn’t interrupt my life enough for me to seek medical help. However, my conversations with these doctors and PTs totally changed my perspective. For one, I didn’t have to live in discomfort just because it wasn’t a medical emergency. My body was sending me signals, so I should listen. And secondly, if I was struggling with this now, the chances were that it would only get exponentially worse when I had kids someday.
At my appointment, I told the PT I was writing a story about pelvic floor health. She knew all about Sarah Percy and even recommended some other social media PTs to follow. During my pelvic floor exam, she checked my breathing and core. As she coached me through the correct way to do a Kegel, I realized I’d been doing them wrong my whole life. We came up with a plan that included a few, yes, Kegel exercises, but also a few other techniques and practices. I wished I’d gone sooner.
Passing It On
“Women have been having babies for millennia,” says Dr. Rodriguez. “But every woman feels they’re the first one going [through it].”
Thankfully, this has started to change. The older women who come into her office—usually for more difficult dysfunctional issues like pelvic organ prolapse—seem more open to talking about it than women did a decade ago. “They want their children, their daughters, not to go through this. So they are the ones saying, ‘What can my daughter do? She’s thinking of having a baby.’ And they are talking to their daughters about it.”
Paulson sees it in her practice too. It was one of the reasons she became a doula in the first place. After working with a doula for her second child’s birth, she realized just how important that mind-body connection and awareness was and what a positive difference it made in her childbirth experience. “It just lit this fire in me. I need to do this for other women. I need to spread the word,” she says. “Having a baby isn’t just something that you just do one time. It changes your body. It changes you inside and out.”
The women who come into Nurture are starting to ask Paulson more about their pelvic floor “because they hear about it from their friends.”
When I started working at Women’s Health four years ago, one of my mom’s best friends called me and urged me to write a story on this topic. “I wish I’d known more about my pelvic floor,” she said. “No one ever talks about it. Now, I’m struggling with it.”
Perhaps the larger message here is that we should all be talking more about everything even remotely related to the pelvic floor. “Even before 16, start talking about what’s normal and what’s not normal in terms of bladder health, bowel health, periods. I always encourage my clients, ‘Talk to your daughters about their periods,’ ” Percy says.
She’s right. These kinds of conversations can have ripple effects. “I really think we’ll see the next few generations, hopefully, having less pelvic floor concerns because they’re being proactive,” says Percy. And that will be due, in part, to the women who came—and dealt in silence—before us.
But we’re not quite there yet. There are so many women who are still just learning the basics. In a recent video Percy posted, “11 things I will teach my daughters about pelvic health as they grow up,” the comments are filled with women surprised to learn that it shouldn’t hurt to put a tampon in, or that you can fix urinary leakage, or that a “small bladder” isn’t a real thing. And several women pledge to pass along the knowledge to their own daughters.
As one commenter so aptly put it, “The conversation is well overdue—not just with young girls but with ourselves.”️
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