The Knack


“Getting the Knack”…


is a decidedly Australian term, that our friends “down under” created to give us some rhythm or timing to the pelvic floor. It is all well and good if we spend our time and energy strengthening the pelvic floor muscles by exercising them. However, the timing of how we use those muscles is a key part to success in providing support to the “prolapsed” organs and to stop stress incontinence.


In healthy pelvic floor muscles, not only do we need strong muscles, but they need to contract at the right time. This is a reflexive reaction, one in which, under normal circumstances, we do not have to consciously think about. However, in dysfunction, or in an unhealthy pelvic floor, this reflexive contraction has likely been lost.


Test yourself first. Do a strong cough, and see if you can feel your pelvic floor contract automatically just before you cough. If not, you need to practice “The Knack”. You have to work on timing and coordination of the pelvic floor muscles.


This is how you do it. First, make sure that you have been practicing your “quickies”. These are quick, strong contractions that you hold for 2 seconds and release quickly. Use this quick strong pelvic floor contraction just before you cough, sneeze, bend, lift, or in any way increase the pressure in your stomach (even laughing will cause this, hence, the term, “I laughed so hard I peed my pants”). You need to consciously and repetitively practice the Knack until it becomes a reflexive contraction again. If the reflex never gets retrained, you must continue the Knack for the rest of your life to maintain good support and control of the pelvic floor muscles when you increase the pressure in your abdomen.


Another term that comes from our Aussie friends that helps you practice getting the Knack is “Leak and Three-peat”. 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 just before each practice activity (ie. a cough). This will help to retrain the reflexive reaction of using your pelvic floor during activities that cause increased intra-abdominal pressure. Once again, the types of activities that you will need to practice this with can be coughing, sneezing, lifting, bending over, laughing and quick sudden movements.