Training of pelvic floor muscles in MS found to help urinary symptoms

Training of the pelvic muscles, provided alongside lifestyle advice via telerehabilitation — tailored exercise instruction delivered via an online video call — significantly reduced urinary symptoms in women with multiple sclerosis (MS), a controlled study showed.

The use of pelvic floor muscle training or PFMT, which are exercises designed to strengthen the muscles that support the bladder and other organs, also were found to improve several quality of life measures among the women taking part in the therapy.

The researchers noted that “the telemedicine group was very satisfied with the use of video conferencing” for working weekly with the physiotherapists providing the training.

“We suggest that PFMT applied via telerehabilitation can be considered as an alternative method in MS patients with lower urinary tract symptoms who have problems in accessing rehabilitation services for various reasons,” the team wrote.

The study, “Effects of pelvic floor muscle training applied with telerehabilitation in patients with multiple sclerosis having lower urinary track symptoms: A randomized controlled trial,” was published in the journal Health Care for Women International.

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People with MS often experience bladder-related problems such as urgent or frequent urination. Such symptoms develop from abnormal signals between nerves and pelvic floor muscles that support the bladder, uterus or prostate, and rectum.

PFMT is often recommended for both men and women with urinary problems, including MS patients with such symptoms. The exercises applied to bladder problems involve actively tightening and relaxing muscles that control urine flow.

Telerehabilitation is an alternative rehabilitation approach for patients, including those with MS, made possible through advances in communication technology.

Rehabilitation services — from evaluation and diagnosis to treatment with tailored exercises — can be delivered to patients in their homes without traditional face-to-face meetings. Less travel and lower costs make telerehabilitation a preferred option for a broader range of patients.

However, whether telerehabilitation can be used to deliver PFMT has not been assessed.

Now, researchers in Turkey recruited 42 women with MS, with lower urinary tract symptoms, to assess PFMT delivered via an online video call. The participants, ranging in age from 18 to 65, were randomly assigned to either PFMT plus lifestyle advice, or lifestyle advice alone as a control intervention.

PFMT was performed with a physiotherapist for about 20 minutes weekly for eight weeks, or about two months. Patients were initially taught to contract and relax the pelvic floor muscles combined with breathing. Exercises were performed in various positions, such as lying, sitting, and standing.

For strength, patients contracted muscles strongly for 1-2 seconds, repeated 8-12 times. Repetitive endurance exercises involved moderate muscle contraction, repeated 15-20 times. Timed endurance exercises were similar, but contractions were held for a certain period. Rest intervals were included to minimize fatigue.

Lifestyle advice involved recommendations to reduce urinary symptoms, and included suggestions regarding fluid intake, diet, constipation, defecation position, weight control, and smoking and alcohol consumption.

Compared with before treatment, the severity of overactive bladder symptoms was significantly reduced among those who underwent PFMT, as indicated by lower total scores on the overactive bladder-version8 (OAB-V8) scale.

Likewise, urinary incontinence was significantly lessened with PFMT, as assessed with the international consultation on incontinence questionnaire-short form (ICIQ-SF). Urination frequency, urinating at night, and the number of urinary incontinence events also improved.

A decrease in lower urinary tract symptoms and an increase in [quality of life] were observed in the PFMT group, who received training via telerehabilitation; however, these parameters did not change in the control group.

Quality of life assessments using the King’s Health Questionnaire (KHQ) found PFMT significantly lessened the impact of incontinence on quality of life. The treatment also helped with physical and social limitations, emotional problems, role (task) limitation, and complaint severity scores.

By comparison, no such changes in OAB-V8, ICIQ-SF, or KHQ were observed in the control group participants who received lifestyle advice only.

Additional measures of participants’ subjective perception of improvement and satisfaction were significantly better with PFMT versus controls.

“A decrease in lower urinary tract symptoms and an increase in [quality of life] were observed in the PFMT group, who received training via telerehabilitation; however, these parameters did not change in the control group,” the researchers wrote.

While further study into the longterm effects of such treatment is needed, these findings support the use of PFMT through telerehabilitation, according to the team.

“PFMT applied via telerehabilitation in the management of lower urinary tract symptoms in MS patients is a useful method, especially in certain conditions such as pandemic and limited rehabilitation services/resources,” they concluded.