Pelvic floor rehabilitation in multiple sclerosis.

Area of Science:

• Urology
• Neurology
• Rehabilitation Medicine

Background:

• Pelvic floor rehabilitation is primarily used for stress incontinence but shows potential for detrusor instability and urgency.
• Neurogenic bladder dysfunction in Multiple Sclerosis (MS) may benefit from pelvic floor rehabilitation.
• Limited research exists on pelvic floor rehabilitation's efficacy in MS-related voiding dysfunction.

Purpose of the Study:

• To investigate the role of pelvic floor rehabilitation in treating voiding dysfunction in female MS patients.
• To evaluate clinical and neurological parameters in relation to treatment outcomes.
• To introduce a new scoring system for pelvic floor dysfunction.

Main Methods:

• An open prospective trial involving 30 female MS patients.
• Assessment of pelvic floor strength, endurance, exhaustibility, and relaxation using a new scoring system.
• Cystometric analysis and voiding charts to measure functional bladder capacity and urinary frequency.
• Evaluation of neurological status using the Kurtzke score.

Main Results:

• Significant improvements were observed in pelvic floor strength (p < 0.001), endurance (p < 0.001), and exhaustibility (p = 0.01).
• Functional bladder capacity increased significantly (p = 0.005), while urinary frequency (p < 0.01) and daily incontinent episodes (p < 0.01) decreased.
• Pelvic floor relaxation scores did not show significant improvement. Cystometric findings remained largely unchanged.

Conclusions:

• Pelvic floor rehabilitation is an effective treatment for voiding dysfunction in female MS patients with low Kurtzke scores and no pelvic floor spasticity.
• The treatment improves key functional parameters like bladder capacity and reduces urinary symptoms.
• Further research may explore optimizing relaxation training within pelvic floor rehabilitation protocols for MS.