The "Knack" - The Missing Link to Urinary Incontinence

Do you leak when you cough, sneeze, lift, bend over, laugh, or with quick and sudden movements? If you answered yes to any of the above, then learning about and practicing the “knack” reflex may be for you!

What is the “Knack” Reflex?

Most of us have heard of the “kegel” exercise, but maybe not the “knack” reflex. A kegel is a contraction of the muscles of the pelvic floor that when performed properly helps to keep the pelvic floor strong. Whereas the “Knack” reflex is a strong and well timed contraction of the pelvic floor muscles. The proper timing of the pelvic floor contraction is a reflexive reaction. However, if there is any pelvic floor dysfunction or imbalance, this reflexive contraction has likely been lost or diminished. Pelvic Floor Physiotherapist, Lauren Sutherland, sates that “your pelvic floor should be able to reflexively turn on just before an increase in intra-abdominal pressure such as a cough, sneeze, laugh or jump etc”. Sutherland explains that this reflex, is diminished in women (and men) who deal with stress urinary incontinence and that it is particularly common in women postpartum.

Do you Still Have the “Knack” Reflex?

If you are curious if you still have the “knack” reflex, test yourself! First go ahead and do a strong cough. Did you feel your pelvic floor contract automatically just before your cough? If your answer is NO, you need to practice the “knack” exercise by working on the coordination and timing of the pelvic floor muscles.

Sutherland encourages you to practice re-training the knack reflex by doing the following exercise; in a relaxed position such as lying on your back with your knees bent and legs lying open on pillows (butterfly), or if this is a difficult or uncomfortable position for you, an alternative way to practice this exercise is in a seated position. Begin by inhaling to relax the pelvic floor. Then think of gently picking up a blueberry at your urethral opening and zipping up a zipper in your lower abdomen as you let out a forceful cough. Sutherland explains that the “strength of the cough should come from the bottom of your torso (pelvic floor and abdominals). You can imagine a very low Heimlich maneuver that is pushing the force up from the bottom of your pelvis and out of your mouth”. Completely release and relax you pelvic floor following the forced cough and try again. Sutherland recommends practicing this exercise in different positions throughout the day and states that the more you practice the more automatic it will become when a real cough, sneeze or laugh comes on.

How does the “Knack” Reflex help control Bladder Leaks?

By contracting the pelvic floor muscles, specifically the urethral sphincters, when the pelvic floor is stressed, the “knack” reflex helps to close the urine tube more

effectively. This assists in controlling bladder leaks. When the pelvic floor muscles

are working properly, they contract automatically before and during any increase in pressure from within the abdomen. Therefore, if you suffer from leaks when you laugh, cough, sneeze or stress your pelvic floor, consciously contracting these muscles prior to can often help to overcome the bladder leakage. Pelvic Health Solutions recommends that “Every time you get a dribble of urine because of stress incontinence, STOP, and repeat the activity that just caused you to leak (ie. coughing) THREE times, using the “Knack” exercise just before each practice activity (ie. a cough). Doing so will assist in retraining the reflexive reaction of using your pelvic floor during activities that cause increased intra-abdominal pressure”.

If you suffer from leaks when you laugh, cough or sneeze, practicing the “knack” reflex is a quick and effective way to improve bladder control during episodes of increased intrabdominal and pelvic floor stress.

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