Mastering the KNACK: A Technique for Minimizing Stress Urinary Incontinence

In this episode, I'll discuss the KNACK technique, a pelvic floor contraction method designed to help minimize stress urinary incontinence. I explain how this technique, also known as 'squeeze before you sneeze,' can reduce leakage by up to 80% in pregnant and non-pregnant women. 

This episode details the benefits of coordinating pelvic floor contractions with breathing and showcases the effectiveness of the KNACK through the paper towel test. Listeners are encouraged to try the technique and, if needed, improve the strength and coordination of their pelvic floor muscles. 

For more information, visit Dr. Janis Miller's website, MyConfidentBladder.com, "Bladder101" course available on my website at thewomensbladderdoctor.com, or my blog post the "KNACK" at https://thewomensbladderdoctor.com/?s=knack

00:28 Introduction to KNACK

00:54 Understanding Stress Urinary Incontinence

01:38 The Knac Technique Explained

04:58 Scientific Validation of the Knac

05:20 Paper Towel Test Demonstration

06:32 Effectiveness in Pregnant and Non-Pregnant Women

07:41 Challenges and Considerations

09:07 Additional Resources and Final Thoughts

Transcript

Hi there. Today, I'm going to be talking to you about the NAC. So the knack is a technique to help minimize stress urinary incontinence. One of my goals with this podcast is to give you additional tools to help you manage your own leaking. And you can find a lot of these tools in my course, bladder 101.

But if you just need a little bit of help, I want to make sure that you have the tools that you need to get better. So The NAC is a pelvic floor contraction that you perform before an activity and it has been shown to decrease leaking by up to 80 percent in both pregnant and non pregnant women. So this may sound a little bit too good to be true.

I'm going to go into it in a lot more detail in a second. But if you think about it, this is probably something that you do on your own without even realizing it. So, a lot of women will kind of cross their legs or bring their legs together before they sneeze or laugh or cough. And what you're really doing here is you're doing a pelvic floor contraction without really thinking about it or planning to do it.

So the knack is called lots of different things. So some people refer to it as squeeze before you sneeze. I've also seen it called bracing, perineal lock, pelvic clutch, Kegel when you cough, quick Kegel, muscle clenching, or What it really is, is just a voluntary pelvic floor contraction in response to a specific situation. 

So, this is what a lot of practitioners call it. A lot of patients, women, who are walking around, will think of it as just kind of holding back, right? When we talk to women about it, that's, that's How they describe it is holding back and the knack is a counterbracing technique. The knack is a counterbracing technique.

And once again, this technique works for stress urinary incontinence. So stress urinary incontinence is when you leak with a Valsalva maneuver. So you leak with Coughing, sneezing, laughing, you leak with exercise, running, and it's because the pressure in your abdominal cavity is higher than the pressure in your sphincter and it pushes the urine out.

So, if you can contract your pelvic floor. Before you do the activity that makes you leak, what will happen, you increase the pressure at your sphincter and then you are much less likely to leak. So this works best if you have a strong pelvic floor. And so that's one of the reasons that we tell you to do pelvic floor strengthening, pelvic floor muscle training.

Um, That's one of the reasons that it is always the first thing that we recommend for stress urinary incontinence. The stronger your pelvic floor is, the better this will work. So it's not enough to just have a strong pelvic floor. You also have to use your pelvic floor at the right time. This works best if you're exhaling when you do the contraction.

So you want to coordinate your breathing. Um, with the contraction. And the reason for that is that when you fill your lungs with air, your diaphragm, which is the main breathing muscle, it's shaped like a dome and it separates your lungs from your belly. When you breathe in, your lungs fill and your diaphragm presses down.

Presses down, and this flattens the diaphragm, and it also lengthens your abs, and it lengthens the pelvic floor. When you exhale, the opposite happens. The diaphragm lifts, your organs move up, and the pelvic floor contracts. So if you're exhaling, your pelvic floor is contracting on its own, and then if you're squeezing on top of that, then you're You're doing, um, you're maximizing your contraction.

So if you have trouble kind of coordinating your breath and a pelvic floor contraction, it's best to try it while you're lying down. That just minimizes the stress on the pelvic floor. Pelvic floor exercises are always harder if you're sitting and even harder if you're standing. So you want to practice the exercise lying down with your breath if you're having trouble coordinating all of that.

So this may all sound very simple and you may be thinking to yourself, my goodness, there is no way that this is going to work, but this technique has actually been pretty well studied. It's been studied at the University of Michigan. A PhD nurse practitioner by the name of Janice Miller did kind of the initial investigation, um, on this technique.

And what she recommends doing is she recommends doing a paper towel test where you take a paper towel, you take a brown paper towel, you fold it in thirds, you place it on the perineum, and then you cough three times. And you don't want to press up. You don't want to do anything that might change the pressure, but you Cough three times, right?

And then, assuming you leak, then you would take a sharpie and you would mark the circle of the leak, right? Because there would be some moisture on that paper towel. And then you would do the same test again. You would take a new paper towel. Place it on the perineum and cough three times again. But before you cough, contract your pelvic floor.

Um, and then if you leak again, you want to mark the amount. Um, so again, take a sharpie and just kind of circle around the leakage spot. And then you can compare those two spots and see how much leakage you have. Or you may have no leakage at all. And so that's what That's the way to kind of prove to yourself that this techniques works.

If you want to prove it to yourself in the security and the privacy of your own bathroom. So they actually did this paper towel test, and they tested it on women. They tested it on both non pregnant women and pregnant women. And what they found in the non pregnant women is that 80 percent of women leaked much less when they contracted their pelvic floor, right?

So when they did the NAC. And of those 80 percent of women, about 20 percent of them were completely dry. So, for most women, it made it better for some women. It completely got rid of the leaking. Um, and this is without any strengthening of the pelvic floor. This is just kind of taking women where they were at in pregnant women.

They found that 80 percent of women leaked much less, and of these women, 55 percent were totally dry. The one thing about the pregnant women is that this technique did work much better if it was your first pregnancy. In this group, it worked much better. Um, less well in women who are on a subsequent pregnancy.

So there's thersecond or third pregnancy. And when the authors talked about why they thought it might not work, right? So it didn't work in about 20 percent of women. And they gave these three reasons why they thought it might not work. So the first is that there might be some underlying muscle damage, right?

So you can have a congenital problem with your muscles where they don't contract very well. You can have a medical reason. You can have muscle damage after a delivery. That's probably the most common reason. And then those muscles don't work quite as well. And so the knack, Wouldn't work as well for you either.

The second reason was they said, well, maybe some of these women need more training, um, to make sure that they're contracting their pelvic floor correctly. So they didn't do any initial training. And we all know that it is difficult to learn to contract your pelvic floor on your own. And a lot of people need some guidance and learning how to do that.

And then the third reason was that. Some women did the NAC at baseline, so they did it when they weren't supposed to be doing it. And so then they can contract more later, right? So, without meaning to, they're already contracting their pelvic floor. And that is kind of like reason two, right? Where you're just not quite as aware of your pelvic floor when you're contracting it when you're not contracting it. 

If you're interested in learning more from Dr. Miller, she has a website called My confident bladder.com, and she talks about this paper towel test. She talks about the NAC and there's some other education, um, some more information, uh, about the bladder and about different techniques that you can use to help stay dry. 

So one of the reasons that they called it the knack is because once you get the knack of it, once you get the hang of it, it becomes pretty easy and it's something that you can do  without really thinking about it, with a little bit of practice. This is a small technique. Once again, it is a technique to help with stress urinary incontinence.

Does not help with urgency urinary incontinence. And it has shown to be very helpful in women with stress incontinence. And you can check it out on your own with that paper. Towel test, or it's something that you can just, um, incorporate in your life. And if you do do that paper towel test, and you find that you're someone that's having less leaking, but still some like leaking, if you strengthen your pelvic floor and those muscles get even stronger, you may be able to get to a point where you're having no leaking at all, or you may want to work on your breathing so that those muscles are just a little bit more.

coordinated for you. So if you need additional help, you can always check out my course bladder 101 and that's available on my website, the womensbladder. com. Um, but I hope that this little technique helps you don't poo poo it, take the time to try it. Sometimes, these small things can make a huge difference in controlling your leaking.

So let's go ahead and get started.