Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence
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The aim of the study was to determine the immediate effect of timing a pelvic muscle contraction with the moment of expected leakage (the Knack maneuver) to preempt cough-related stress incontinence. Women performed a standing stress test using three hard coughs without and then with the Knack maneuver. Volume of urine loss under both conditions was quantified with paper-towel test. Two groups of women were tested: nonpregnant women (n = 64) and pregnant women (n = 29). In nonpregnant women, wetted area decreased from a median (range) of 43.2 (0.2–183.7) cm2 without the Knack maneuver to 6.9 (range of 0 to 183.7 cm2) with it (p < 0.0001); while in pregnant women it decreased from 14.8 (0–169.7) cm2 to 0 (0–96.5) cm2, respectively (p = 0.001). This study confirms the effect from the Knack maneuver as immediate and provides a partial explanation for early response to widely applied pelvic muscle training regimens in women with stress incontinence.
KeywordsUrinary incontinence Pelvic muscle training Stress incontinence Pelvic muscle education Kegel Pregnancy
The study was supported by the National Institutes of Health/National Institute for Nursing Research, Grant # R01 NR04007 (PI Carolyn Sampselle, PhD) and National Institutes of Health/National Institute for Child Health and Human Development, Grant #P50 HD044406 (Director John DeLancey, MD).
Conflicts of interest
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