Incontinence in MS Affects Walking Ability, Negatively Impacts Patients’ Quality of Life, Study Finds

Urinary incontinence,  associated with poor functioning of the muscles in the pelvic area, was found to have a negative impact on daily activities like walking and overall quality of life in people with multiple sclerosis (MS), a study shows.

Adding pelvic floor muscle training to an MS treatment program may help to improve overall function, the researchers suggest, which could improve patient performance of daily life activities, especially in those with moderate or severe dependence on others.

The study, “Pelvic floor dysfunction negatively impacts general functional performance in patients with multiple sclerosis,” was published in the journal Neurology and Urodynamics.

People with MS can often experience fatigue, numbness and tingling, muscle spasms, walking difficulties, pain, and bowel or bladder problems. Urinary symptoms such as urgency, frequency,  excessive urination at night, called nocturia, dysuria, or pain or discomfort when urinating, and incontinence are indicative of an overactive bladder, and can affect patients’ quality of life considerably.

Studies have indicated that the improvement of the pelvic floor muscles’ function is directly associated with an improvement in gait or balance.

“Pelvic floor musculature is responsible for supporting the pelvic organs, as well as for providing stability to the trunk. The coordinated action of this musculature with the abdominal wall is fundamental to achieving the correct control of body stability in static activities and/or during those that require dynamic postural control, as in the case of gait,” the researchers said.

However, there is not much evidence on whether gait functionality — a person’s ability to walk — can be affected by the status of the pelvic floor musculature in MS patients.

Thus, researchers from the Universidad Antónoma de Madrid, in Spain, sought to evaluate the relationship between pelvic floor function and general functional performance in people with MS, and how the patients’ dependence on others correlated with that.

A total of 43 MS patients — 24 women and 19 men; mean age of 50.3 years — were included in the study. The researchers took into consideration that giving birth can stretch the muscles of the pelvic floor, noting that 11 (25.6%) of the women included in the study had never given birth.

To assess the participants’ pelvic floor musculature functionality, the researchers took into account each individual’s urinary incontinence (UI), fecal incontinence, and constipation history. The team also assessed the patients’ general functional performance and gait using validated clinical tools.

The results showed that urinary incontinence had a significant and negative impact on the patients’ quality of life and general functional performance.

People with more severe urinary incontinence performed worse in the Timed Up and Go (TUG) test — a test to assess walking and balance abilities. In this test, researchers count the time it takes a person, who starts by sitting down on a chair, to rise from that chair, walk three meters, turn around, walk back to the chair, and sit down.

This result suggested that MS patients with urinary incontinence had more trouble walking. Importantly, these patients also were the ones who were more dependent on others — rated as moderate-to-severe dependence — for daily activities.

The participants with greater constipation also had lower quality of life scores, the data showed. In addition, those with more severe fecal incontinence presented a higher degree of urinary incontinence and constipation. Those findings suggest a relation between the variables of pelvic floor function, the researchers said.

Those with MS who reported better quality of life based on their physical abilities were found to be more independent, and had better gait functionality.

“The most significant relationship was obtained between the degree of dependence and gait functionality, showing a strong inverse correlation,” the scientists said.

The data suggest that MS patients’ functional dependence on others for carrying out day-to-day activities has a correlation with the improper workings of the pelvic floor muscles, emphasizing the importance of this musculature in the activities of daily life.

The scientists concluded that urinary incontinence “appears to have a negative impact on the performance of daily living activities, walking, and the physical dimension of quality of life in patients with MS.”

“In addition, patients with moderate or severe dependence showed higher UI and gait disturbance compared with those with mild dependence or independence,” they said.

Based on these results, the team suggested that “it could be relevant to add pelvic floor muscle training to interventions aimed at improving overall functionality in patients with MS.”