Dynamic Pelvic Floor Bracing (The Knack)
When you move a downward pressure is created in your abdomen onto your bladder and organs.
Your pelvic floor and inner stomach muscles contract to support your bladder and organs.
Your pelvic floor works before and throughout movement.
They work gently as you do gentle activities and brace to lift your bladder strongly and quickly as you do strong activities such as coughing, sneezing, laughing, jumping or lifting heavy objects.
Leakage, urgency and prolapse happen when you do not lift as you move.
Pressure in your abdomen makes you leak.
Pelvic floor muscle exercises are used to improve your ability to dynamically lift your bladder and the outlet pipe (urethra) whilst doing daily activities.
This is called dynamic bracing.
You need to learn to master basic pelvic floor contractions before commencing dynamic bracing.
Your physiotherapist will tell you when to commence dynamic bracing.
It is done in stages and the activity is changed as you master each one. Do 3 or more sessions of 10 each day.
How to brace
Start slowly
Lift strongly for 1 second as you say the letter SSS (“essss”) or "Yes."
Do 10.
When you have mastered this………………
Speed it up
Lift quickly as you say SSS or "Yes."
Do 10.
When you have mastered this………………
Make it stronger
Stronger lift as you say SSS or "Yes louder.
Do 10.
When you have mastered this………………
Progress to other activities
for example
Lift as you slowly clear your throat/cough. (10)
Lift quickly as you clear your throat/cough. (10)
Lift strongly as you clear your throat/cough. (10)
Brace and clear your throat/cough. (10)
Practice whilst doing anything that might make you leak, feel a bulge or heavy.
Go through the process of bracing slowly at first, then speed it up and then do it stronger. Do 10 at each stage.
Select the relevant activities to practice.
Saying the word ID (if you leak with sneezing.)
Blow
Lifting something
Walking on the spot
Getting out of a chair or car
Rolling in Bed
Getting out of bed
Getting off the floor
Stepping down a step
Jumping
Starting a mower
Hitting a tennis, cricket, squash ball
Golf swing
Getting off a bicycle
Bowling
Do exercises that are similar to leakage activities
Your physiotherapist will set up gym, pilates or home exercises that simulate relevant activities that make you leak.
Leak and Repeat
You could start the regime of Leak and Repeat where each time you have a bladder accident doing an activity you then repeat the activity with your pelvic floor lifted.
Repeat this until your leakage ceases.