Some patients tell her a doctor has recommended pelvic floor or "Kegel" exercises. "They tell me they've been doing them for years but they're not helping." The problem in that case, she said, is that patients are doing them wrong, which actually makes the problem worse rather than correcting it.

To determine how strong the muscles are, McLaughlin uses a one-finger exam to assess the strength of pelvic floor muscle contraction and to see how long patients can maintain the contraction. She then teaches them how to build muscle endurance, working two different parts of the muscle system.

She also uses a bio-feedback system, which senses the activity of the muscles so patients can see on a screen how well they are contracting and can make adjustments accordingly. "It's a good tool to help re-educate them about how to use their muscles correctly."

Patients build muscle strength and endurance at home as they do daily exercises, usually from 60 to 80 repetitions per day.

Generally patients see the therapist once a week for two or three weeks, then the visits are spaced further apart. McLaughlin said most people require a total of six visits but must maintain their exercise schedule for several weeks or months to see real improvement, just as with any other muscle group, she said.

"It's easier to take a pill because this takes commitment, and people will only improve if they are doing the exercises." Young mothers with children sometimes opt for surgery even if they know about physical therapy, she said, because they can't find time to do the exercises.

Yet surgery "doesn't permanently repair" the problem. "The muscles and connective tissue become weak again over time, and going through menopause thins out the tissue."

McLaughlin is hopeful that patients thinking about medication or surgery will learn they have another option.

"People come in all the time and say 'I didn't know you could do physical therapy for this.' The whole pelvic area has been kind of a no-no to talk about," despite the fact that physical therapists have been treating incontinence since the 1980s, she said. "We need to do a better job of educating people."