Getting Back “The Knack”: Muscle Retraining for Stress Urinary Incontinence

In a previous blog we talked about Stress Urinary Incontinence. SUI is leakage of urine that occurs during times of increased abdominal pressure because of weak pelvic floor muscles. It can happen during everyday activities like coughing, sneezing, laughing, lifting your child or even standing from a chair. Some women find ways to manage SUI by avoiding the activities that cause it, wearing incontinence pads, or by constantly going to the toilet to ensure their bladder never gets too full. However, over time SUI can worsen and may become harder to avoid and can also lead to other bladder problems like frequency and urgency.Fortunately the pelvic floor muscles can be retrained to work properly again and stop SUI. At times of increased pressure an extra strong squeeze by the pelvic floor is needed. This is called “The Knack” and requires co-ordination as well as strength of the pelvic floor.

The pelvic floor is made up of a superficial layer and a deep layer, which perform separate actions. The superficial layer performs a squeezing action around the urethra to keep it closed. The deep layer performs a lift forwards and up action. For the pelvic floor to work properly it needs to do both of these actions.

Using the following imagery can help to train both actions:

“Imagine you drop a pebble into a puddle of water and watch the ripples travel outwards. Now imagine that in reverse – the ripples moving in (this is the squeeze) and the pebble lifting up (this is the lift).”   

To really get the hang of The Knack you also need to be able to perform the action quickly and at the right time. After practising the squeeze and lift you should practise doing it as fast and strong as you can. You then need to be able to use the Knack at the times of increased pressure. So every time you cough or sneeze or bend and lift etc, squeeze and lift the pelvic floor just before doing the action.

In someone who does not suffer from SUI the Knack is an inbuilt natural reflex. But in a dysfunctional pelvic floor this reflex has likely been lost. So the Knack will need to be consciously and repetitively practised until it starts to become automatic again.

It may sound like a bit of work but it is worth it because the Knack has been shown to be very effective at reducing and even curing SUI symptoms. If you need help with this, then book in for a Women’s Health Assessment with Tori or Bonnie at our Sydney CBD Physio and Pilates clinic.

So get lifting ladies!

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