Pelvic floor rehabilitation in multiple sclerosis

Although primarily used for treatment of stress incontinence, pelvic floor rehabilitation has been reported to have some value in the treatment of det rusor instability and urgency. In neurogenic bladder dysfunction due to Multiple Sclerosis, many authors h ave suggested the possible use of pelvic floor rehabilitation as a treatmen t modality. Therefore, we designed an open prospective trial to look at the possible role of pelvic floor rehabilitation in voiding dysfunction due to MS, concentrating upon the clinical and neurological parameters in relatio n to the outcome. A new scoring system for pelvic floor dysfunction is intr oduced. Thirty female patients were evaluated. In 25, the strength of the pelvic fl oor was significantly improved after one month (p < 0.001). In all patients but one the endurance score improved significantly (p < 0.001) as did the exhaustibility score (p = 0.01). The relaxation score on the other hand did not show any significant evolution despite intensive training. Cystometric findings after one month did not significantly differ from the initial cystometric findings. There was a significant increase in the mean functional bladder capacity as read from the voiding charts from 173.8 cc /- 53.9 cc to 208.5 cc +/- 57.6 cc (p = 0.005). Also the mean urinary frequency decreased significantly from 12.7 +/- 3.6 t o 9.1 +/- 2.6 (p < 0.01) as did the mean number of daily incontinent episod es from 2.8 +/- 1.3 to 1.5 +/- 1.5 (p < 0.01). Pelvic floor rehabilitation has a place in the treatment of MS patients wit h a low Kurtzke score and without pelvic floor spasticity.