The Knack
‘What? A well-timed pelvic floor contraction is all it takes to stop urine leakage during a sneeze!’
The Knack is a well-timed voluntary pelvic floor muscle contraction that is performed right before an activity that causes leakage.
The Knack technique is used for managing stress urinary incontinence (SUI) to counteract intra-abdominal pressure increases in women who experience urine leakage.
To make The Knack successful, there are two very key components:
The strength of the pelvic floor muscle contraction
The timing of the contraction
Let’s quickly review Stress Urinary Incontinence (SUI):
Essentially, SUI occurs when the intra-abdominal pressure exceeds the ability for our continence systems to maintain and leakage of urine occurs. Pelvic floor dysfunction is part of the continence system, due to muscles which are too tight, too weak or have reduced coordination or motor control.
During a cough, sneeze or laugh, the intra-abdominal pressure increase creates a bearing down on pelvic organs and pelvic floor muscles:
With a functional pelvic floor, your body automatically contracts the pelvic floor muscles immediately before you cough, sneeze or laugh - this will mean as you increase your intra-abdominal pressure, it will create a closing on the urethra onto the pelvic floor muscles and you remain continent
With a dysfunctional pelvic floor, your body doesn’t automatically contract the pelvic floor - this will mean there is nothing to push the urethra against when you increase your intra-abdominal pressure. The urethra doesn’t have closure and you will leak urine
An Analogy for The Knack:
In the analogy, the urethra is the garden hose, the pelvic floor is the ground or the trampoline and urine leakage is the water from the hose
If you had a garden hose running along the ground and you wanted to stop the flow of water - it can be easily stopped by stepping on the hose. You have pinched the hose shut by the force of the foot onto the ground. You have stopped the flow of water
Now, picture the same hose running on top of a trampoline, if you step on the hose now - it wouldn’t be pinched shut. The trampoline and the hose would move underneath the weight of your foot. The water would continue to flow
