Clarification and Confirmation of the Effect of Volitional Pelvic Floor Muscle Contraction to Preempt Urine Loss (The Knack Maneuver) in Stress Incontinent Women

摘要

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.