Skip to main content

Advertisement

Log in

The effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the central nervous system that involves different neurological areas. In addition to lower urinary tract symptoms (LUTS), sexual dysfunction (SD), and psychopathological effects, MS sometimes seriously impairs the quality of life (QoL). We hypothesize that the pelvic floor exercise program (PFEP) could improve bladder, sexual function, depression, and QoL in MS patients.

Methods

Patients diagnosed with MS completed the Incontinence Questionnaire Short Form (ICIQ-SF), the Beck Depression Inventory (BDI), the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire, and either the Female Sexual Function Index (FSFI) or the Sexual Health Inventory for Men (SHIM). Maximum bladder volumes (MBV) and post-voiding residual (PVR) volumes were measured using ultrasonography. The patients who regularly completed the PFEP for 12 weeks were asked to fill out the questionnaires again, and their MBV and PVR were remeasured.

Results

Seventy-two patients with relapsing–remitting multiple sclerosis (RRMS) were included in the study. Forty-two (58.3%) RRMS patients reached the end of the study. The patients’ post-PFEP average MBV statistically increased (p = 0.01). In contrast, no statistically significant difference was found in the PVR (p = 0.2). After exercise, the FSFI values in women increased (p = 0.02), and ICIQ-SF and BDI values in all the RRMS patients statistically decreased (p = 0.004, p = 0.01, respectively), but there was no improvement in the MSQoL-54 score (p > 0.05).

Conclusion

PFEP, which causes a reduction in LUTS by enhancing the MBV of RRMS patients, can be seen as an investment in the future in terms of reducing depression in MS patients and preventing or delaying SD in women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Nazari F, Shaygannejad V, Sichani MM et al (2020) The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis. BMC Neurol 20:24

    Article  Google Scholar 

  2. Abello A, Badin J, Das AK (2020) Worsening disability status in multiple sclerosis predicts urologic complications. Int Urol Nephrol 52:859–863

    Article  CAS  Google Scholar 

  3. Tornic J, Panicker JN (2018) The management of lower urinary tract dysfunction in multiple sclerosis. Curr Neurol Neurosci Rep 18:54

    Article  Google Scholar 

  4. Pérez DC, Chao CW, Jiménez LL et al (2020) Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial. Int Urogynecol J 31:267–275

    Article  Google Scholar 

  5. Calabrò RS, Russo M, Dattola V et al (2018) Sexual function in young individuals with multiple sclerosis: does disability matter? J Neurosci Nurs 50:161–166

    Article  Google Scholar 

  6. Sobhgol SS, Priddis H, Smith CA, Dahlen HG (2019) The effect of pelvic floor muscle exercise on female sexual function during pregnancy and postpartum: a systematic review. Sex Med Rev 7:13–28

    Article  Google Scholar 

  7. Drulovic J, Kisic-Tepavcevic D, Pekmezovic T (2020) Epidemiology, diagnosis and management of sexual dysfunction in multiple sclerosis. Acta Neurol Belg 120:791–797

    Article  Google Scholar 

  8. Tomé ALF, Miranda EP, de Bessa JJ et al (2019) Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis. Clinics (Sao Paulo) 74:713

    Article  Google Scholar 

  9. Price N, Dawood R, Jackson SR (2010) Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas 67:309–315

    Article  Google Scholar 

  10. Silva Ferreira AP, de Souza Pegorare ABG, Miotto A Jr et al (2019) A controlled clinical trial on the effects of exercise on lower urinary tract symptoms in women with multiple sclerosis. Am J Phys Med Rehabil 98:777–782

    Article  Google Scholar 

  11. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    Article  CAS  Google Scholar 

  12. Avery K, Donovan J, Peters TJ et al (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23:322–330

    Article  Google Scholar 

  13. Cetinel B, Demirkesen O, Tarcan T et al (2007) Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior? Int Urogynecol J Pelvic Floor Dysfunct 18:659–664

    Article  Google Scholar 

  14. Kendall PC, Hollon SD, Beck AT et al (1987) Issues and recommendations regarding use of the Beck Depression Inventory. Cognit Ther Res 11:289–299

    Article  Google Scholar 

  15. Idiman E, Uzunel F, Ozakbas S et al (2006) Cross-cultural adaptation and validation of multiple sclerosis quality of life questionnaire (MSQOL-54) in a Turkish multiple sclerosis sample. J Neurol Sci 240:77–80

    Article  Google Scholar 

  16. Tepavcevic DK, Kostic J, Basuroski ID et al (2008) The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler 14:1131–1136

    Article  CAS  Google Scholar 

  17. Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31:1–20

    Article  Google Scholar 

  18. Cappelleri JC, Rosen RC (2005) The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res 17:307–319

    Article  CAS  Google Scholar 

  19. Mainprize TC, Drutz HP (1989) Accuracy of total bladder volume and residual urine measurements: comparison between real-time ultrasonography and catheterization. Am J Obstet Gynecol 160:1013–1016

    Article  CAS  Google Scholar 

  20. Vahtera T, Haaranen M, Viramo-Koskela AL, Ruutiainen J (1997) Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin Rehabil 11:211–219

    Article  CAS  Google Scholar 

  21. Sangsawang B, Sangsawang N (2016) Is a 6-week supervised pelvic floor muscle exercise program effective in preventing stress urinary incontinence in late pregnancy in primigravid women?: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 197:103–110

    Article  Google Scholar 

  22. Dorey G, Speakman MJ, Feneley RC et al (2005) Pelvic floor exercises for erectile dysfunction. BJU Int 96:595–597

    Article  Google Scholar 

  23. Ferreira AP, Pegorare AB, Salgado PR et al (2016) Impact of a pelvic floor training program among women with multiple sclerosis: a controlled clinical trial. Am J Phys Med Rehabil 95:1–8

    Article  Google Scholar 

  24. Gaspard L, Tombal B, Opsomer RJ et al (2014) Kinésithérapie et symptômes du bas appareil urinaire chez des patients atteints de la sclérose en plaques : étude contrôlée randomisée. Prog Urol 24:697–707

    Article  CAS  Google Scholar 

  25. Lúcio AC, Campos RM, Perissinotto MC et al (2010) Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis. Neurourol Urodyn 29:1410–1413

    Article  Google Scholar 

  26. Esteve-Ríos A, Garcia-Sanjuan S, Oliver-Roig A et al (2020) Effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis: a systematic review. Clin Rehabil 34:438–449

    Article  Google Scholar 

  27. Lúcio AC, D’Ancona CA, Lopes MH et al (2014) The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis. Mult Scler 20:1761–1768

    Article  Google Scholar 

  28. Mosalanejad F, Afrasiabifar A, Zoladl M (2018) Investigating the combined effect of pelvic floor muscle exercise and mindfulness on sexual function in women with multiple sclerosis: a randomized controlled trial. Clin Rehabil 32:1340–1347

    Article  Google Scholar 

  29. Sobhgol SS, Priddis H, Smith CA, Dahlen HG (2019) Evaluation of the effect of an antenatal pelvic floor muscle exercise programme on female sexual function during pregnancy and the first 3 months following birth: study protocol for a pragmatic randomised controlled trial. Trials 20:144

    Article  Google Scholar 

  30. Gava G, Visconti M, Salvi F et al (2019) Prevalence and psychopathological determinants of sexual dysfunction and related distress in women with and without multiple sclerosis. J Sex Med 16:833–842

    Article  Google Scholar 

  31. Nortvedt MW, Riise T, Myhr KM et al (2001) (2001) Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler 7:231–235

    Article  CAS  Google Scholar 

  32. Zecca C, Riccitelli GC, Disanto G et al (2016) Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients’ quality of life. Eur J Neurol 23:1228–1234

    Article  CAS  Google Scholar 

  33. Dehghan-Nayeri N, Khakbazan Z, Ghafoori F, Nabavi SM (2017) Sexual dysfunction levels in iranian women suffering from multiple sclerosis. Mult Scler Relat Disord 12:49–53

    Article  Google Scholar 

  34. Marck CH, Jelinek PL, Weiland TJ et al (2016) Sexual function in multiple sclerosis and associations with demographic, disease, and lifestyle characteristics: an international cross-sectional study. BMC Neurol 16:210

    Article  Google Scholar 

  35. Delaney KE, Donovan J (2017) Multiple sclerosis and sexual dysfunction: a need for further education and interdisciplinary care. NeuroRehabilitation 41:317–329

    Article  Google Scholar 

  36. Persson R, Lee S, Yood MU et al (2020) Incident depression in patients diagnosed with multiple sclerosis: a multi-database study. Eur J Neurol 27:1556–1560

    Article  CAS  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

Authors

Contributions

BA: project development, data collection, data analysis, manuscript writing. AAG: project development, data collection. TIKO: data collection, manuscript editing. AU: project development, manuscript editing. NT: data collection.

Corresponding author

Correspondence to Bengu Altunan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work with a smaller number of patients has been presented at the 6th EAN Congress as Virtual Congress, on 23–26 May 2020.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Altunan, B., Gundogdu, A.A., Ozcaglayan, T.I.K. et al. The effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients. Int Urol Nephrol 53, 1059–1065 (2021). https://doi.org/10.1007/s11255-021-02804-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-021-02804-y

Keywords

Navigation