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Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial


Introduction and hypothesis

Lower urinary tract symptoms (LUTS) affect up to 80% of patients with multiple sclerosis (MS). The present randomized, open-label, clinical trial examines the effectiveness, as a conservative treatment for LUTS, of a physiotherapist-guided pelvic floor muscle training (PFMT) program adapted for patients with relapsing-remitting multiple sclerosis (RRMS) and urinary incontinence (UI).


Forty-eight patients with RRMS were randomly assigned to a 12-week PFMT program with or without physiotherapist guidance. The primary endpoint was the reduction in urinary leakages after 12 weeks of following the program. The secondary variables assessed were quality of life (QoL), UI severity, LUTS, and treatment adherence.


Forty patients completed the program. No significant differences in baseline characteristics were seen between the two treatment groups. At 12 weeks, both groups reported a significantly reduced number of leakages compared with baseline (P < 0.001), with no significant differences seen between groups (P = 0.210). In the physiotherapist-guided group, significant differences were found in QoL, UI severity, and LUTS between baseline and 12 weeks, for both male and female subjects. No significant differences in adherence were seen between the two treatment groups.


No difference in leakage reduction was seen between physiotherapist-guided and unguided PFMT. However, the physiotherapist-guided program was associated with improvements in UI severity, QoL, and LUTS in women and men. The guided PFMT group also showed a trend towards better adherence to treatment.

Clinical trial registration

No. NCT03000647; Title: “Guided Versus Non-Guided Pelvic Floor Exercises for Urinary Incontinence in Relapsing-Remitting Multiple Sclerosis.”

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This research was possible thanks to the collaboration of Dr. Carmelo Fernández García, Head of the Rehabilitation Service of the HGV and HURJC, the HGV physiotherapy team, and the supervisor of the HURJC Rehabilitation Service. The authors also thank the HURJC and HGV neurologists for their input, the MS patient associations who assisted in publicizing the study, and Adrian Burton for translation and editing services.

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Correspondence to Denise Cuevas Pérez.

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Pérez, D.C., Chao, C.W., Jiménez, L.L. et al. Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial. Int Urogynecol J 31, 267–275 (2020). https://doi.org/10.1007/s00192-019-03993-y

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  • Multiple sclerosis
  • Pelvic floor exercise
  • Physiotherapy
  • Quality of life
  • Supervision
  • Urinary incontinence