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You feel it coming, but you can’t stop it; that twitch in your pelvic floor perfectly timed to your sudden cough or sneeze, or the confirmation you’ve pushed that pigeon pose a little too far. Stress Urinary Incontinence (SUI) – involuntary leakage that occurs with increases in intra-abdominal pressure – is one of the more frustrating and embarrassing hallmarks of womanhood, the inescapable tradeoff for motherhood or a satisfying workout.

As a women’s health professional, I’ve spent years dispelling that myth. You don’t need to put on your (specially designed) big girl panties and deal with it; pelvic floor therapy can help you vanquish incontinence. But the best experts can admit they don’t have all the answers. You may be surprised to learn something that has come up in more recent research about Stress Urinary Incontinence that I’m passing on to my patients (and to you):

A weak pelvic floor may not be the culprit!

For a long time, pelvic floor muscle training has been the recommended treatment for many forms of incontinence. There’s a good reason for that; many patients – including mine – see dramatic results. But this past year, during a larger study, a group of researchers in New England collected data that is changing the way physical therapists think about, and treat Stress Urinary Incontinence.

Not all the study participants had Stress Urinary Incontinence; and the researchers were expecting to see significantly weaker pelvic floor muscles in those who did. As it turns out, there was a difference in muscle strength and mobility between the two groups; but it was in their hips, not their pelvic floors. They even found limited evidence to suggest hip strength and flexibility may serve as a coping mechanism for women with pelvic floor weakness who don’t experience Stress Urinary Incontinence.

What does that mean for you? First, if you’re already on top of your pelvic floor health, good for you. It’s still central to bladder control; so keep doing what you’re doing.

Think Beyond Kegels

  • Prioritize hip stretches and strengthening exercises (and watch your form!)
  • Work your IT band (foam rollers are a big help-check out which ones I recommend here)
  • Avoid sitting for long periods of time (take regular breaks during work)

And if you suffer from Stress Urinary Incontinence, ask your medical professional to follow the researcher’s recommendation to broaden your examination and treatment to include your hips – especially if pelvic floor exercises alone aren’t helping.

And if you’re still just dealing with the stress of Stress Urinary Incontinence? Make an appointment with a Femina PT therapist today. Fortunately, our philosophy has always been to treat the whole patient; and we’ve included hip, low back and whole body assessment and treatment (when necessary) in our pelvic floor therapy from the beginning. We’re glad to know we’re ahead of the game this time; but we are constantly reviewing the latest medical research – including the follow up to this study – as part of our ongoing commitment to patient care.


Hartigan, E., McAuley, J-A., Lawrence, M., et al. Pelvic Floor Muscle Performance, Hip Mobility, and Hip Strength in Women With and Without Self-Reported Stress Urinary Incontinence. Journal Of Women’s Health Physical Therapy. 2019. 43:4  160-169.

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    • Testimonial by R.M., Age 40

      I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor...

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    • Testimonial by Amanda W.

      Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and...

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