Aims: Multiple sclerosis (MS) is a demyelinating disease characterized by the presence of multiple demyelination plaques in white matter of the brain and spinal cord, these lesions damage the information conductions among neurons causing disabilities including urinary symptoms. It is known that urinary incontinence negatively affect the quality of life (QoL) when presented making its treatment necessary and conservative managements are the first line treatment. For this reason, the aim of this study was to evaluate the effect of Transcutaneous electrostimulation of the Tibial Nerve on urinary symptons and quality of life in women with Multiple Sclerosis.

Material and methods: Twenty women participated of this randomized controlled trial were the included women were over 18 years old, with relapsing remitting form of MS (EDSS up to 6.5) presenting LUTS for at least 6 months (relating at least three of the following symptoms: urgency, urge urinary incontinence, urinary frequency, nocturia and nocturnal enuresis). Pregnant women, those with pelvic prolapse and those submitted to gynecological surgery in the last six months were excluded. Participants were randomized into two groups: treatment group (G1,N=13) and control group (G2, N=16), the G1 underwent sessions of treatment twice a week during six months performing PFM training and transcutaneous tibial electrostimulation with frequency of 02Hz, pulse width 1000 µs and intensity according to patients’tolerance. The G2 was instructed to perform PFM training, also during 6 months, at home twice a week and to register by themselves in a schedule the days and time the exercises were performed. The assessment tool were: OAB-V8 questionnaire and Qualiveen SF questionnaire was used for Quality of Life assessment. Statistical analysis was performed using mean and standard deviation to characterize the data and sample size comparison was performed using the chi-square test. The age and Expanded Illness Scale (EDSS) were evaluated by the Student t test independent. The effects of therapies on OAB-V8 were carried out by testing of Analysis of Variance for Repeated Measures. Significance was admitted at 5% and effect size (ƞ 2 p) were reported when there was a significant difference between groups.

Results: Groups were homogeneous at baseline. After the treatment, G1 showed improvement in the OAB-V8 questionnaire, and it was significant between groups (p=0.001). Regarding the assessment of quality of life in general, G1 showed a significant improvement (p=0.001) in its global score, and also in its domains of concern with limitations (p=0.001) and negative feelings (p=0.02) caused by urinary incontinence. There was no difference between the groups in relation to the other domains (fear and frequency of limitations).

Interpretation of the results: In this study the intervention group showed better results when compared with a PFM training protocol performed with no professional assistance at home. The difference in the findings of both groups leads to two assumptions: Probably tdue to neurological damages in these population causes difficulties in the conscious of their muscles and a supervised program would benefit neurological population better than performing exercises alone.
Second, previous studies showed that the treatment of LUTS with PFM training is greater when added electrostimulation therapy, so the fact that G1 presented better results in both assessment tools can be associated to the use of electrostimulation, as the presence of the electrical current enhances detrusor inhibition.

Conclusion: The results of this research reinforce the benefits of EETT in reducing lower urinary tract symptoms and improving quality of life in terms of concerns about limitations and associated negative feelings in women with multiple sclerosis. The data also reinforces the importance of physiotherapist supervision for the correct execution of pelvic floor training for this population.

MARZOUK, M. H.; DARWISH, M. H.; EL-TAMAWY, M. S.; MORSY, S.; ABBAS, R. L.; ALI, A. S. Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study. Mult Scler Relat Disord. 2022; 68:104252.
KHARAJI, G.; SHAHALI, S.; EBRAHIMI-TAKAMJANI, I.; SARRAFZADEH, J.; SANAEI, F.; SHANBEHZADEH, S. Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis. Int Urogynecol J. 2023;34(7):1339-1349.
JIANG, Y.; LI, X.; GUO, S.; WEI, Z.; XU, S.; QIN, H.; XU, J. Transcutaneous Electrical Stimulation for Neurogenic Bladder After Spinal Cord Injury: A Systematic Review and Meta-Analysis, Neuromodulation: Technology at the Neural Interface, 2023; 06:02.