Symptom Management

A person’s ability to maintain urinary and bowel continence significantly affects that person’s potential to be able to engage in activities outside their home. According to an article published in 2019 by the Public Library of Science, researchers determined more than 50 percent people with multiple sclerosis suffer from some form of bowel and bladder incontinence. These researchers found, “positive correlation between the severity of fatigue and bladder and bowel problems in our surveyed MS population.”

In an article by Fatemeh Nazari, of Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, published in 2020 in BMC Neurology, “the prevalence rate of lower urinary tract symptoms was 87.6 percent among all the subjects” which is a substantial percentage. The International Continence Society website defines lower urinary tract symptoms as “a symptom related to the lower urinary tract. It may originate from the bladder, urethra, prostate (men) and/or adjacent pelvic floor or pelvic organs, or at times be referred from similarly innervated anatomy e.g. lower ureter.”

In everyday language, this means there is a dysfunction in a person’s ability to maintain urinary continence because of a dysfunction in the person’s physical anatomy. Many of the same muscles that assist with urinary control also contribute to bowel control.

Just like any muscle in the body, the group of muscles that make up the pelvic floor are muscles that can show improvements in strength, endurance, and coordination. This group of muscles aid in bowel and bladder control as well as organ support. With MS, fatigue is a huge issue that affects a person’s ability to participate in daily activities including functional management and control of their bowel and bladder. Finding a physical therapist who is knowledgeable in both the physical limitations and considerations of a person with MS as well as experienced in retraining and strengthening the pelvic floor muscles is crucial for the greatest improvements in functional management of bowel and bladder continence.

When assessing a person’s bowel and bladder control, it is important to look at that individual’s diet, breathing, posture, past medical history, family support and psychosocial environment while always considering how each person’s body responds to a given therapeutic intervention. This is where the experience and expertise of your therapist is critical. With the MS population, it is imperative that a sufficient amount of recovery time is given between therapeutic interventions to ensure that the muscles recover adequately. This is true with all forms of exercise but especially true within the MS population. When treating the pelvic floor, it is equally critical that a therapist recheck the patient’s ability to accurately contract and relax the pelvic floor muscle group to ensure that accurate motor learning is occurring. This will also minimize the risk of developing unintended complications associated with poor pelvic floor motor control.

While in an ideal world, every person would be able to participate in a pelvic floor retraining via a therapeutic relationship with someone who has experience in both the neurology and pelvic floor worlds, sometimes this is not always possible for various reasons. There are many resources available to help people reach their health and wellness goals. As with any comprehensive wellness and/or health care program, you should always consult with your physician before beginning any type of new exercise program.