Guide The Knack: squeeze before you sneeze, cough or lift
The Knack is a quick pelvic floor squeeze just before a cough, sneeze or lift. How to do it, what the research found, and how it fits with Kegel exercises.
The Knack is a pelvic floor contraction you make on purpose a moment before a cough, sneeze, laugh or lift, and hold through it. It braces the urethra against the jump in belly pressure that causes stress urinary incontinence, the leaks that come with effort.
In a small 1998 study of older women with mild to moderate stress incontinence, a week after they learned it, the women leaked on average about 98% less on a medium cough and 73% less on a deep cough when they used the Knack than when they didn't. Miller et al., 1998.
How to do the Knack
- Learn the lift first. Sitting or lying down, squeeze as if holding in wind and urine at the same time, then lift up and in. Let go completely. Keep your buttocks, thighs and belly soft.
- Time it. When you feel a cough coming, squeeze and lift first, cough, keep holding through the cough, then let go.
- Start small. Practice with a light, deliberate cough, then a harder one, then a cough while standing.
- Take it into the day. Use the same squeeze before a sneeze, a laugh, standing up from a chair, lifting a child or a bag, and jumping. If you have a prolapse, avoid heavy lifting and high-impact activities such as jumping.
- Keep breathing. Don't hold your breath or bear down during the effort.
Why a well-timed squeeze reduces leaks
A cough or sneeze sends a sudden spike of pressure down onto the bladder and urethra. A healthy pelvic floor tightens a split second before that spike without you thinking about it. After childbirth, that automatic response can be weaker or missing. In people with stress leaks, including men after prostate surgery, it has been measured as starting later.
The Knack does that timing on purpose. In the 1998 study, the drop in leakage was not significantly linked to a manual test of pelvic floor strength, and it showed up within a week, earlier than you would expect from muscle growth.
The Knack and Kegel exercises do different jobs
The Knack is a skill of timing. Kegel exercises, or pelvic floor muscle training, build the strength and endurance behind it. NICE recommends at least three months of supervised pelvic floor training as the first treatment for women with stress incontinence, and the Knack is often taught as part of that program. NICE quality standard QS77.
Quick contractions are useful training here: a fast lift up and in, then a full release, repeated. They are the same movement as the Knack, practiced when nothing is at stake. Kegel exercises for leaks.
Where the Kegelia app fits
The Kegelia app trains the movement behind the Knack. In Quick Flicks sessions, a jellyfish's bell draws up and in for each quick lift and opens for each release, with a haptic tap on every lift; Long Hold sessions build endurance. Sessions run 1, 3 or 5 minutes and work the same way for women and men.
No app can tell when a sneeze is coming, and the Kegelia app doesn't measure your muscle. The Knack itself is yours to use in the moment; the app makes the daily practice behind it easier to keep. Kegel exercises for bladder control.
Practice the lift before you need it
Start with the free 1-minute Beginner session. Stopping early still counts.
iPhone (iOS only for now)
When the Knack isn't enough
The Knack is for stress leaks, the ones that come with effort. If you leak on the way to the toilet with a sudden, strong urge, that is urge incontinence, and bladder training usually comes first. Exercises for an overactive bladder.
If leaks are getting worse, come with pain, or you find it hard to let the pelvic floor go after squeezing, see a pelvic floor physical therapist. A tight pelvic floor often needs to learn to release, and adding more squeezing is not the first step. Tight or weak pelvic floor?
Questions about the Knack
What is the Knack in pelvic floor exercises?
The Knack is a pelvic floor squeeze made just before a cough, sneeze, laugh or lift and held through it. It braces the urethra against the sudden pressure that causes stress leaks. Physical therapists also call it a pelvic floor precontraction, or "squeeze before you sneeze". Kegel exercises for leaks.
Does the Knack work for sneezing too?
The original study measured coughs, but a sneeze, a laugh and a lift also raise pressure on the pelvic floor, so physical therapists often teach the Knack for all of them. A sneeze gives less warning, which is why practicing quick lifts helps. How to do Kegel exercises.
Is the Knack the same as a Kegel exercise?
The Knack uses the same muscle and the same lift, but it is a skill of timing, not a training routine. Kegel exercises build the strength behind it. The Kegelia app covers the training side, with Quick Flicks sessions for fast lifts and Long Hold sessions for endurance. What are Kegel exercises?
Can men use the Knack?
Yes. Men who leak when they cough or lift, for example after prostate surgery, are taught the same squeeze before the effort. The Kegelia app works the same way for men and women, with no device. Do Kegel exercises work for men?
Does the Knack help with urge incontinence?
Partly. The Knack as described here is for leaks that come with effort, but the same well-timed squeeze is also used to hold back a sudden urge. For urge or mixed incontinence, bladder training is usually the first step. The Kegelia app trains the pelvic floor but is not a bladder training tool. Exercises for an overactive bladder.
Can an app remind me to use the Knack?
No app can tell that a sneeze is coming. What helps is daily practice of quick lifts, so the squeeze is ready when you need it. The Kegelia app's reminders arrive on the days and times you choose and never name the exercise. How to stick with Kegel exercises.
Read next
This guide is based on published research and clinical how-to references. See sources →
Kegelia is a general wellbeing app, not a medical device, and this page is not medical advice. Kegel exercises strengthen and support the pelvic floor; the research cited here is about pelvic floor muscle training and the Knack, not about any app. If you have leaks that worry you, pain, or symptoms that are getting worse, see a doctor or a pelvic floor physical therapist.
