Why Strong Hips May Be the Missing Link to a Stronger Pelvic Floor
When most women think about improving their pelvic floor, they immediately think of Kegel exercises. While pelvic floor muscle training remains the gold standard for treating stress urinary incontinence, exciting new research suggests there may be another important piece of the puzzle: strong hips.
Your pelvic floor doesn't work alone
Your pelvic floor is part of a remarkable team of muscles that work together every day. Along with your diaphragm, deep abdominal muscles, back muscles, and hip muscles, it helps to:
Support your bladder, bowel and pelvic organs
Maintain continence
Stabilise your pelvis and spine
Manage pressure inside your abdomen when you lift, cough or exercise
Every time you stand up from a chair, climb stairs, carry shopping, lift your grandchildren or squat down to pick something up, these muscles work together to keep you stable and supported.
So, what do your hips have to do with it?
The large muscles around your hips—particularly your gluteus maximus (your bottom), gluteus medius (the muscles on the side of your hips), and the deep hip muscles—are attached to the pelvis and help control its movement.
Researchers have found that women with stress urinary incontinence often have weaker hip muscles than women without bladder leakage. This has led scientists to view the pelvic floor as part of an integrated lumbopelvic-hip system, rather than a group of muscles that work in isolation.
When your hips are stronger, your pelvis is more stable, movement is more efficient, and the pelvic floor has a better foundation from which to do its job.
What does the research show?
A randomised clinical trial published in the Journal of Manipulative and Physiological Therapeutics compared two groups of women with stress urinary incontinence.
One group completed pelvic floor muscle exercises.
The second group completed the same pelvic floor exercises plus strengthening exercises for the gluteal and hip muscles.
The women who added hip strengthening experienced greater improvements in urinary leakage, supporting the idea that strengthening the muscles around the pelvis may enhance pelvic floor rehabilitation. While larger studies are still needed, these findings are encouraging and fit with what we know about how the body moves.
More recent systematic reviews have also concluded that:
Pelvic floor muscle training remains the most effective first-line treatment for stress urinary incontinence.
Whole-body strength training can support pelvic floor function by improving strength, stability and coordination.
Resistance training is not inherently harmful to the pelvic floor when exercises are appropriately prescribed and progressed.
It's about teamwork, not just Kegels
One of the most important messages from current research is that the pelvic floor is designed to work with the rest of your body.
Strength training helps improve the coordination between your:
Pelvic floor
Gluteal muscles
Core muscles
Diaphragm
This coordination is especially important during everyday activities such as lifting, carrying, climbing stairs and getting up from the floor.
Strength training offers even more benefits after menopause
As we age, and particularly after menopause, women naturally lose muscle mass and strength. Building stronger hips and legs doesn't just support pelvic floor health—it can also:
Improve balance and reduce the risk of falls
Strengthen bones and help prevent osteoporosis
Make everyday activities easier
Increase confidence in movement
Improve overall strength and independence
That's why a well-designed strength program can deliver benefits that extend far beyond the gym.
The bottom line
If you're experiencing bladder leakage or are concerned about your pelvic floor, don't think of it as "just" a pelvic floor problem.
The best results often come from treating the whole system. A combination of targeted pelvic floor muscle training and progressive strength training for the hips, legs and core can help your body move more efficiently and provide better support for your pelvic floor.
Strong hips don't replace pelvic floor exercises—but they may be one of the missing pieces that help your pelvic floor work at its best.
References
Marques, S. A. A., da Silveira, S. R. B., Pássaro, A. C., Haddad, J. M., Baracat, E. C., & Ferreira, E. A. G. (2020). Effect of pelvic floor and hip muscle strengthening in the treatment of stress urinary incontinence: A randomized clinical trial. Journal of Manipulative and Physiological Therapeutics, 43(3), 247–256.
Piernicka, M., Labun, J., & Szumilewicz, A. (2025). Training interventions used in postmenopausal women to improve pelvic floor muscle function related to urinary continence: A systematic review. Journal of Clinical Medicine, 14(13), 4800.
Marcellou, E. G., Stasi, S., Giannopapas, V., Bø, K., Bakalidou, D., Konstadoulakis, M., & Papathanasiou, G. (2025). Effect of pelvic floor muscle training on urinary incontinence symptoms in postmenopausal women: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 304, 134–140.