MS and pelvic floor dysfunction: What to know
Fact-checked by Living with multiple sclerosis (MS) can bring a range of challenges, including pelvic floor dysfunction, which occurs when the muscles and connective tissues at the base of the pelvis don’t work in coordination, potentially affecting bladder, bowel, and sexual function.
Understanding how MS may impact pelvic floor function can help you recognize early signs, seek timely guidance, and explore strategies to maintain your independence and well-being.
How MS can affect the pelvic floor
The pelvic floor muscles, which support the bladder, bowel, and internal reproductive organs, rely on clear signals from the brain and spinal cord to function properly. In MS, inflammation and nerve damage can interfere with those signals, leaving the pelvic floor muscles poorly coordinated.
People with pelvic floor dysfunction may experience:
- Bladder issues: These are among the most common pelvic floor symptoms and can include needing to go urgently or more often, urinary incontinence (leaking urine), or difficulty fully emptying the bladder.
- Bowel problems: The most common issues are constipation or fecal incontinence, which affect as many as 70% of patients.
- Sexual dysfunction: You may notice changes in sensation, have more difficulty with arousal, and experience decreased lubrication or erectile dysfunction.
Risk factors and who is most affected
Pelvic floor dysfunction can develop at any stage of MS, though certain factors may increase your risk, including how severe your MS is, your sex, and how other MS symptoms affect you daily.
MS severity
As MS progresses and nerve damage becomes more widespread, you may notice more changes in how your pelvic floor works.
Research suggests that people who have lived with MS for longer periods of time or who have greater levels of disability may be more likely to experience bladder and bowel symptoms.
Sex
Women in the general population tend to face a higher risk of pelvic floor dysfunction. This is partly due to pregnancy and childbirth, which can stretch or weaken pelvic floor muscles, as well as hormonal changes during menopause that may affect muscle tone and tissue support.
In MS, pelvic floor symptoms can affect both men and women, though they may look different. For example, women with MS may be more likely to experience urinary incontinence, while men may more commonly report sexual symptoms such as erectile dysfunction.
Common MS symptoms
Other MS symptoms can also play a role in pelvic floor issues. Fatigue, spasticity, and cognitive changes may make it harder to keep up with routines that support pelvic health or to respond quickly when symptoms arise.
Diagnosis and assessment
Your doctor will likely start by asking detailed questions about your symptoms, including how often they happen and how they affect your daily life. Your physician may also do a physical exam to assess how your pelvic floor muscles are working.
If your bladder symptoms are more complex, your doctor may recommend urodynamic testing. This series of tests looks at how your bladder and urethra store and release urine. They assess factors such as bladder pressure, urine flow, and muscle activity to pinpoint the specific type of dysfunction.
Your care team may also suggest other tests, such as measuring how your anal sphincters work or how well you can start a bowel movement. Keeping a detailed journal of your bladder and bowel habits may be helpful.
Treatment options
The goal of pelvic floor dysfunction treatment is to improve muscle function so that your symptoms interfere less with your daily life.
Pelvic floor therapy
Pelvic floor therapy for MS, a type of physical therapy that helps strengthen or relax the pelvic muscles, can be an important part of care. A pelvic floor physical therapist can assess how your muscles are working and develop a program based on your needs.
Your therapist or care team may recommend pelvic floor exercises, relaxation techniques, or manual therapy, which uses gentle pressure and massage techniques to help relax muscles.
Biofeedback, which uses sensors to monitor your pelvic floor muscles as you exercise them, is also commonly used alongside physical therapy to treat pelvic floor dysfunction.
Bladder and bowel training
Bladder training is a form of behavior therapy that uses planned bathroom visits to improve control and reduce urgency. Bowel training uses a similar approach, often combined with dietary changes to address bowel-related symptoms.
Medications
Certain classes of medications can help calm an overactive bladder or support bowel function. Your doctor can discuss possible treatment options with you.
Self-care and daily management
In addition to medical treatments, lifestyle changes can help support pelvic floor health in those with MS.
For instance, staying well-hydrated supports bladder and bowel function, while limiting caffeine and alcohol may help reduce bladder irritation.
Additionally, practical planning can reduce some of the unpredictability that often makes pelvic floor symptoms so disruptive. Here are a few strategies that may help:
- Map out restroom locations before you leave home so you know where you can stop if you need to go quickly.
- Adjust your fluid intake by spreading drinks throughout the day and cutting back shortly before long outings or bedtime, based on your doctor’s guidance.
- Build in regular bathroom breaks rather than waiting for a strong urgency, which can help reduce leaks and accidents.
- Wear absorbent products or carry a change of clothes when you plan to be out for longer periods.
- Plan around your typical symptom patterns, such as scheduling important activities at times of day when your symptoms tend to be more manageable.
Finally, take advantage of MS support resources, including disease-specific nonprofits and peer communities, such as the Multiple Sclerosis News Today forums and Facebook group.
Connecting with others facing similar challenges can help you learn practical tips, share experiences, and find emotional support as you manage pelvic floor symptoms alongside other aspects of life with MS.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
