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Pelvic floor rehabilitation is effective in patients with multiple sclerosis
T Vahtera1, M Haaranen, A L Viramo-Koskela
1Masku Neurological Rehabilitation Centre, Finland.
Objective:
To determine the effect of pelvic floor muscle exercises combined with electrical stimulation of pelvic floor on lower urinary tract dysfunction in multiple sclerosis (MS) patients with near normal (< 100 ml) postvoid residual volumes.
Design:
Open, controlled, randomized study in two parallel groups.
Setting:
Rehabilitation centre for MS patients.
Subjects:
Fifty women and 30 men with definite MS and current symptoms of lower urinary tract dysfunction.
Outcome:
The muscle activity of the pelvic floor muscles was tested using surface EMG. Subjective urinary symptoms were assessed using a questionnaire.
Interventions:
Pelvic floor muscles were stimulated using electrical stimulation at six sessions. During and after the final session the patients were taught to exercise their pelvic floor muscles and advised to continue these exercises regularly for at least six months. The control group was not treated.
Results:
The maximal contraction power and endurance of the pelvic floor muscles increased after six sessions of electrical stimulation with interferential currents. Symptoms of urinary urgency, frequency and incontinence were significantly less frequent in the treated group than in the untreated subjects. Male patients appeared to respond better to the treatment than female patients. Compliance with the pelvic floor exercises was over 60% at the end of a follow-up for six months. Most drop-outs were due to the disappearance of urinary tract symptoms or to severe relapses in MS.
Conclusions:
The present study indicates that pelvic floor muscle exercises combined with electrical stimulation of the pelvic floor constitute an effective treatment for lower urinary tract dysfunction at least in male patients with MS.