• J M Miller, J A Ashton-Miller, and J O DeLancey.
• Institute of Gerontology, University of Michigan, Ann Arbor 48109-2125, USA.
• J Am Geriatr Soc. 1998 Jul 1; 46 (7): 870-4.

ObjectivesTo test the hypothesis that selected older women with mild-to-moderate stress urinary incontinence (SUI) can learn to demonstrate significantly reduced urine loss in 1 week by intentionally contracting the pelvic floor muscles before and during a cough (a skill we have termed "The Knack").DesignA prospective, randomized, single-blind interventional study.SettingThe Older American Independence Center, a federally sponsored research program affiliated with the University of Michigan in Ann Arbor, Michigan.ParticipantsTwenty-seven women with a mean (SD) age of 68.0 (5.5) years, self-reported SUI, and demonstrable urine loss during a deep cough.InterventionWomen were randomized to an immediate intervention group (Group I: n=13) who were taught the Knack after their first clinic visit, or a wait-listed control group (Group II: n=14) who were taught the Knack after 1 month.MeasurementsAt 1 week after instruction, we tested the efficacy of the Knack in a standing stress test by (1) comparing the volumes of cough-related urine loss leaked by all subjects, with and without use of the Knack, and (2) comparing the volumes of cough-related urine loss leaked by Group I, using the Knack, with Group II, which had not yet been taught the Knack.ResultsIntra-individual results showed that at 1-week follow-up, the Knack was used to reduce urine loss resulting from a medium cough by an average of 98.2%, compared with that of a similar cough performed 1 minute before without the Knack (P=.009); likewise urine loss was reduced by an average of 73.3% (P=.003) in a deep cough. Reduction in urine loss was not significantly correlated with a digital measure of pelvic floor muscle strength.ConclusionWithin 1 week, selected older women with mild-to-moderate SUI can acquire the skill of using a properly-timed pelvic floor muscle contraction to significantly reduce urine leakage during a cough.

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