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Sprouting knowledge in Pelvic Health

How To Get "The Knack" and Control Your Bladder!


How many times have you heard people say they leak when they sneeze, laugh, or cough? Or even, with all the above?

For many generations it’s been common to assume that leaking with daily activities is normal, or something that results from childbirth, aging, or just a part of life. This type of bladder leakage is known as stress incontinence. Luckily, the word is getting out that leaking with any action, , is a sign or symptom of dysfunction in our bodies and is extremely treatable.


There is an abundance of evidence that supports pelvic floor muscle training can as one of the most effective ways of treating incontinence. Yet, what does that look like in practice? Do we just need to do kegels to stop leaking? Or, is there a missing link to training our pelvic floor to keep our underwear dry and to stop having to pack extra pads during allergy season?


As mentioned in our previous post, for the pelvic floor muscles to function properly they need to have a strong contraction and be able to relax and release tension fully. However, the timing of how these muscles engage is equally important to their ability to move through their full range of motion.


When you perform activities that increase your intra-abdominal pressure, such as sneezing, coughing, laughing, running, and jumping, our pelvic floor muscles should be automatically engaging before these actions.


This reflexive contraction helps to close off the opening of the urethra and prevents the increase in abdominal pressure from pushing on the bladder and causing urine to leak out. For many people, this well-timed and automatic contraction of the pelvic floor is missing, causing them to leak with some or all of these activities.


The Technique ...


In order to regain this function, we need to consciously re-teach our pelvic floor muscles to contract PRIOR to things we’ve experienced leakage with. In the pelvic floor world, this is called “The Knack”, Originally coined by researchers over 20 years ago who were studying stress incontinence in older women, the Knack is now commonly known as the timely contraction of the pelvic floor before a leakage-causing event. The technique has since been documented in research showing its efficacy and effectiveness in treating stress incontinence.


Over time, as we teach our pelvic floor to contract with symptomatic activities, the reflex will become automatic again and will no longer require conscious activation to prevent leakage.


Let's Test It Out!


🍉 Sit up tall on a firm chair

🍉 Bring your elbow up to your mouth and cough into your elbow


What did your pelvic floor do when you coughed? Did it move up, go down, do nothing?


🍉 Next, let’s repeat but this time try and perform a kegel first

🍉 Hold the contraction and then cough again.


How did doing a kegel change the response of your pelvic floor compared to the first time you coughed? Did you notice there was less pressure in the pelvis the second time?


Did you feel any leakage the first time, and did that change after engaging the pelvic floor first? If so, you might want to start practicing The Knack throughout your day until you regain that automatic contraction again.


Have you ever experienced stress incontinence? Did you ever practice the Knack at home to help prevent leaking?


Let us know in the comments, we would love to hear from you!


🍉 Savanna Rowe, MPT

Registered Interim Physiotherapist


Bump Physio & Co is a community of health care providers dedicated to changing the way pelvic health and obstetrical services are delivered. Our two clinics locations are Port Moody and Langley BC, where we treat beyond the Bump and welcome clients from all stages and phases of life! Our team has advanced training in Pelvic Health, Orthopedics, Obstetrics, Clinical Pilates, Active Rehabilitation and More!


Please follow us along on our socials @bumpphysio to keep updated on all that is going on and for more information about how the Bump Community can help YOU!


Citations


Dumoulin, C., Cacciari, L., Hay-Smith, E.C. Pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018; Issue 10.


Miller, J.M., Ashton-Miller, J.A., DeLancey, J.O. A pelvic muscle precontraction can reduce cough-related urine loss in selected women with mild SUI. J Am Geriatr Soc. 1998 Jul;46(7):870-4.


​​Miller, J. M., Sampselle, C., Ashton-Miller, J., Hong, G. R., & DeLancey, J. O. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. International urogynecology journal and pelvic floor dysfunction, 2008. 19(6), 773–782.


2021. What is urinary incontinence. The Canadian Continence Foundation. Retrieved from

https://www.canadiancontinence.ca/EN/what-is-urinary-incontinence.php