Getting the “Knack” of Controlling Urinary Incontinence

A lot of us have been there.

We laugh on a full bladder and leak. We sneeze and oopsy—urinary incontinence. We walk down the street and have to stop (or even cross our legs) to sneeze so we don’t leak.

Is there another strategy we can use?

Yes! It’s called the Knack!

Leak no more with the Knack

The Knack, coined by James Ashton-Miller, refers to the strategy of doing a pelvic floor muscle contraction (commonly known as a Kegel) prior to loading the pelvic floor with an event that could potentially cause urinary incontinence, such as coughing or sneezing.

This means that as you feel a sneeze or cough come on, you pull your pelvic floor muscles up and in. You can do this before lifting, too.

Why does this work?

As you may know, the pelvic floor has three layers of muscles.

The outermost layer acts to close around the terminal aspects of the urinary, reproductive (for ciswomen), and digestive systems. This first layer, along with help from the second layer, act as sphincters to “clamp down on the hoses.”

First layer of the pelvic floor muscles

The third layer, which helps support the pelvic organs and contributes to lumbopelvic stability, also helps elevate and support the urethra.

Third layer of the pelvic floor muscles

Research shows women who contract the outer first layer before the deepest third layer leak less urine. The coordination and timing of these muscle layers creates the optimal force closure at the urethra. This means that the pressure on the outside of the pelvic floor is higher than the pressure on the inside of the pelvic floor.

An easy and portable exercise you can do is cough with the Knack:

• pull your pelvic floor up and in
• fake a cough
• relax your pelvic floor

You can repeat 10 times a few times a day. You can make the Knack more difficult by doing it while balancing on one leg or when your bladder is fairly full.

The goal is to integrate the Knack into your daily life so it becomes automatic. Practice increasing intra-abdominal pressure while maintaining a pelvic floor muscle contraction to help it become more automatic during your daily life.

Your abs matter

Don’t forget about the abdominal wall!

Your deepest layer of abdominal muscles, the transverse abdominals, co-contract with the pelvic floor muscles.

Image courtesy of Pelvic Guru

This means, in an optimal system, when you contract your pelvic floor muscles, you turn on your abdominal wall and vice versa. You can use the two muscle groups together by imagining you are “zipping up” from the pelvic floor up to the lower abdomen.

To do the core zip:

• Pull your pelvic floor up and in
• Compress your low belly, zipping between your two hip points
• Extra credit: pair this with an exhalation

Sit better to prevent leakage

Just a reminder about posture: studies show slouched sitting is associated with urinary incontinence and pelvic organ prolapse.

Resources

M Miller, Janis & M. Sampselle, Carolyn & Ashton-Miller, James & Hong, Gwi-Ryung & DeLancey, John. (2008). 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. 19. 773-82.