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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.

What Our Patients Have to Say


Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

Read more: Testimonial by S.B.

Testimonial by T.C.

While pregnant with my twins, Heather took care with keeping me on my feet and pain free. She saved my back, my sanity and the holidays! I would recommend her to every “mom” looking to stay on her feet during pregnancy and post-partum.

-- T.C.

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

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