Pelvic Floor & Multiple Sclerosis

Proper functioning of the pelvic floor contributes significantly to the quality of life. In this article we will deal with improving the function of the pelvic floor and sphincters.

What is a pelvic floor?

A significant proportion of people living with multiple sclerosis face difficulties in controlling the sphincters: difficulty holding back or evacuating 1 . The sphincters, which are responsible for our ability to hold back and release, are part of a structure known as the pelvic floor. The pelvic floor, as it is called – a system of muscles and ligaments, in the shape of a hammock, located in the lower part of the female and male pelvis and “padded” it from the inside.

The abdominal organs are located on these muscles, and three systems are directly there:

  • The lower urinary tract – bladder and urethra.
  • The female reproductive system – uterus, fallopian tubes and ovaries. The cervix connects to the vagina.
  • The lower digestive tract – rectum and the anus

In this muscular system, three openings are located in the female body: the urethra, the vulva and the anus. In the floor of the male pelvis – two openings: the urethra and the anus.

Pelvic floor has several functions:

  1. Support the internal organs.
  2. Control of the voluntary sphincters (pelvic floor muscles surrounding the vagina and anus).
  3. Part of sexual function.

The control of the sphincters is complex and involves many areas of the nervous system: from the peripheral nervous system, which includes the spinal cord and its branches, to the central nervous system, which includes various areas of the brain.

Multiple sclerosis and pelvic floor function

Multiple sclerosis is a disease that affects different areas of the nervous system, and for this reason a significant number of patients will experience deficiencies in controlling the sphincters. The nature of the defects and their severity are a result of the areas that are affected and the extent of the damage. Deficiencies in urinary control can manifest in storage difficulties such as difficulty holding back, urgency and frequency, and loss of urine. In addition, there may also be difficulties in emptying and retaining urine. Deficiencies in the urinary system are reported in 37%-99% of patients 2 . Deficiencies in the digestive system can manifest in constipation and emptying difficulties and/or loss of bowel contents 3 .

Pelvic floor muscles surround the vagina in a circular fashion, and are therefore closely related to sexual function. Sexual dysfunction in multiple sclerosis is reported among 40%-80% of women and 50%-90% of men .

A muscle is an elastic tissue, which can contract in order to perform a movement, but to the extent that it must know how to release and stretch. If one of the actions is not carried out fully, a problem arises that can lead to a malfunction.

Excessive contraction of the muscles may lead to difficulties in voiding and pain during intercourse. Pelvic floor muscles also weaken as a result of pregnancy, childbirth, hormonal processes such as the cessation of menstruation, and natural aging.

Since multiple sclerosis is three times more common in women aged 20-40, which is the childbearing age, the weakness accompanying the disease is additional to the weakness caused by pregnancy and childbirth. This is why women can experience more control difficulties. Men will face more difficulties in emptying themselves .

Pelvic floor treatment in multiple sclerosis

It is important to know that pelvic floor rehabilitation in multiple sclerosis can help reduce symptoms related to the urinary system, improve quality of life, reduce anxiety and depression, and improve sexual function 2 .

So what can be done:

Strengthening exercises

Strengthening exercises for the weakened pelvic floor is the first line of treatment. The exercises help to improve control and the ability to hold back. Exercise may lead to an improvement in symptoms at a rate of 56%-70% among the patients 2. The practice should be adapted to the patient’s ability, and should be carried out under different instructors. Practice can be as part of physical therapy or independent practice 1 . Practice in a therapeutic setting can be between six weeks and six months, and in any case, independent practice, adjusted to the patient’s lifestyle, must be continued.

Relaxation practice

Increased tone in the pelvic floor muscles may manifest itself in pain during intercourse and difficulty emptying 3. For this reason a significant part of the practice is not only contraction, but also relaxation.

Biofeedback

is a tool that provides feedback on muscle activity. The patient is connected to an electrode, which reads the function of the muscles during action, and provides feedback on their function 2. With the development of technology, there are different types of biofeedback on the market today, also adapted for home practice using apps and a wireless electrode. Also, chairs are also coming into use today, which give feedback from external use – without the need to insert an electrode.

Electrical stimulation

using a vaginal or anal electrode, electrical stimulation (gentle and painless) can be given, which allows the patient to better identify the muscle action. The electrical stimulation directly activates the weakened muscle, and helps build muscle volume. This is a treatment that has been found to be effective for multiple sclerosis patients for both urinary and fecal leaks 2.

Nutrition

A diet rich in fiber and including drinking in an appropriate amount can improve bowel movements 2.

Exercise

to improve mobility, endurance, and speed of getting to the bathroom. It is recommended to use a physical therapist to obtain a prescription for physical activity, adapted to the specific abilities and needs of each patient. The exercises are designed to strengthen the limbs and improve endurance, the purpose of which is to improve the speed of walking to the bathroom, the ability to maintain balance and take off clothes at the required speed.

Adaptation of auxiliary accessories

both for mobility – by physiotherapists, and for dressing and undressing quickly – by occupational clinics. These will help to arrive and get organized at the desired speed in the bathroom.

Conclusion

The secret to successful pelvic floor treatment is a multi-system treatment which includes: medical treatment (diagnosis and medication), nursing care, occupational therapy and of course physiotherapy. If there are difficulties, it is important to contact the attending physician for further clarification and receiving appropriate treatment.

The author: Liat Shik-Nova, BPT, MPH
pelvic floor rehabilitation and women’s health physiotherapist.
Coordinates and lectures in training courses for physiotherapists for pelvic floor rehabilitation and sexuality.
Member of the steering committee for women’s health – the association for the promotion of physiotherapy.

Sources:

  1. Kajbafvala et al. MSRD, 2022;59:103559
    2. Sparaco & Bonavita. J Clin Med, 2022;11:1941
    3. Kovari et al. NeuroRehabil, 2022;50:89–99

Video: “Rehabilitation of the patients with Multiple Sclerosis”

MULTIPLE SCLEROSIS. EXERCISES FOR STRETCHING AND IMPROVING BODY FLEXIBILITY AND JOINT MOBILITY, REDUCING TONE

For additional information about Rehabilitation of the patients with Multiple Sclerosis you can watch a video demonstrating exercises and rehabilitation recommendations.

Check out the demo version of our sets of exercises for Multiple Sclerosis on YouTube

Check out the demo version of our sets of exercises for Multiple Sclerosis on YouTube

You can find more information about  Multiple Sclerosis in our Library of Articles.

Our website presents the following sets of exercises for the rehabilitation of the patients with Multiple Sclerosis:

  1. MULTIPLE SCLEROSIS. EXERCISES FOR STRETCHING AND IMPROVING BODY FLEXIBILITY AND JOINT MOBILITY, REDUCING TONE
  2. MULTIPLE SCLEROSIS. EXERCISES TO STRENGTHEN THE MUSCULOSKELETAL AND MUSCULAR SYSTEM, ENDURANCE
  3. MULTIPLE SCLEROSIS. EXERCISES TO IMPROVE COORDINATION, BALANCE AND GAIT
  4. MULTIPLE SCLEROSIS. STRETCHING AND WORKING WITH A MASSAGE ROLLER. ADVANCED STAGE OF REHABILITATION
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