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The term “The Knack” was coined by Ashton-Miller as the learned pre-contracting of the pelvic floor muscles before activities that cause leakage such as coughing, sneezing, laughing, or jumping. It can also be used during activities that aggravate prolapse symptoms, causing bulging in the vagina or pelvic pressure.
It is all well and good if we spend our time and energy strengthening the pelvic floor muscles by exercising them. However, the functional application and timing of how we use those muscles is imperative. Essentially, “The Knack” is timing a pelvic floor contraction before the moment of expected leakage or pelvic bulge/pressure.
Not only do we need strong pelvic floor 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, if you experience stress incontinence or have prolapse symptoms associated with certain activities, it may be because this reflexive contraction is lost. Luckily, we can re-instate this reflex with practice.
You can have a pelvic health physiotherapist check to see if your reflex is in place. This is done by observing your perineum during a cough. If this is not an option, you can test yourself. Do a strong cough, and see if you can feel your pelvic floor contract automatically just before your cough? If not, you need to practice “The Knack” prior to coughing. You can implement “The Knack” with any activity that brings on your symptoms of leakage or pelvic bulge/pressure. It is also a very useful technique to help women protect their prolapse.
How to do “The Knack”
First, make sure that you have been practicing your “quick flicks.” These are quick, strong contractions that you release quickly. Use this quick, strong pelvic floor contraction just before the activity that causes your symptoms. You need to consciously and repetitively practice “The Knack” until it becomes a reflexive contraction again. If the reflex is not retrained, meaning you still experience symptoms or there is an observable descent during an increase in abdominal pressure, you should continue to implement “The Knack” or seek out help from a physiotherapist.