Lower urinary tract dysfunction (LUTD) is common in patients with multiple sclerosis (MS), with neurogenic overactive bladder (OAB) symptoms to be usually present.  This situation usually affects patients’ quality of life (QoL), forcing them to explore for suitable treatments. Apart from invasive therapies, such as the appropriate drugs or any kind of surgical procedures, pelvic floor muscle training (PMFT) seems to be an effective conservative way to cope with lower urinary tract dysfunction in patients with MS. The aim of this study is to examine the effectiveness of PFMT in a selective group of patients with MS and OAB symptoms and compare it with percutaneous posterior tibial nerve stimulation (PTSN).

This is a prospective observational study over the efficacy of PFMT on patients with MS and OAB, with a parallel comparison to percutaneous PTSN. The participants were pooled up from the Urodynamics and Neuro-urology Unit of our Hospital and they were advised a treatment program of 12 weeks, under the guidance of a specialized physiotherapist. Patients eligible for the study were those with Expanded Disability Status Scale (EDSS) less than 6. All patients were complaining for lower urinary tract symptoms implying OAB and they were either naive of any other treatment or with a clean period of at least 3 months. Patients with a recent history of urinary tract infection, intra-detrusor Botolinum toxin A injections in the last year, pregnancy and underlying disease relapsing during the study were excluded. The treatment program included 30 minutes sessions once a week, with pelvic floor muscle exercises with biofeedback (Group A) or percutaneous posterior tibial nerve stimulation, 20 Hz and 200 cycles/sec (Group B). The primary outcome was to determine the real effect of both therapies on the symptoms of overactive bladder, using the Overactive Bladder Symptoms Score (OABSS). The secondary outcome was the efficacy of this treatment strategy on QoL, with the use of ICIQ-SF questionnaire. The adequate sample size for a valid power of the study over 90% has been estimated according to specific power calculator. All patients were totally informed about the study, signed an informed consent and data have been statistically analyzed with SPSS v.23.

A total of 20 patients have been enrolled and finally 18 of them were eligible, as the rest two have had a urinary tract infection. More specifically, 6 men and 12 women have been included, with a mean age of 44.5 years old and a mean EDSS of 4.5. All of them reported at least one urine leakage episode in their recent medical history. The power of the study has been estimated at 91%. Patients were equally allocated in Groups A and B and each of them included 3 men and 6 women. No statistical difference between the two Groups has been detected at baseline, regarding OABS and ICIQ-SF total scores. (p= 0.784 and p= 0.632 respectively). These parameters were re-evaluated after the end of each program, showing a significant change in both Groups. For OABS score, p value was 0.02 for Group A and 0.018 for Group B, while for ISIQ-SF p value was 0.006 for Group A an 0.009 for Group B, respectively. A separate analysis between the two Groups has been performed, proving no difference in their effectiveness (p= 0.129). More specifically and evaluating the effect of PFMT on QoL, an analysis focused on the interfering of leaking episodes in everyday life, showed that PFMT was absolutely effective with a strong statistical difference before and after treatment (p= 0.002).

Physiotherapy, as a treatment strategy for neurogenic overactive bladder for patients with MS, seems to be quite effective; the results prove that pelvic floor exercises have similar and adequate impact on patients’ symptoms and quality of life, comparing to percutaneous posterior tibial nerve stimulation.

Pelvic floor muscle training seems to be efficient for overactive bladder symptoms in patients with MS and mild disability.

Pérez DC, Chao CW, Jiménez LL, Fernández IM, de la Llave Rincón AI. Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial. Int Urogynecol J. 2020 Feb;31(2):267-275. doi: 10.1007/s00192-019-03993-y
Lúcio A, D'ancona CA, Perissinotto MC, McLean L, Damasceno BP, de Moraes Lopes MH. Pelvic Floor Muscle Training With and Without Electrical Stimulation in the Treatment of Lower Urinary Tract Symptoms in Women With Multiple Sclerosis. J Wound Ostomy Continence Nurs. 2016 Jul-Aug;43(4):414-9. doi: 10.1097/WON.0000000000000223
Gaspard L, Tombal B, Opsomer RJ, Castille Y, Van Pesch V, Detrembleur C. [Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial]. Prog Urol. 2014 Sep;24(11):697-707. doi: 10.1016/j.purol.2014.05.003