[Pelvic floor muscles training, electrical stimulation, bladder training and lifestyle interventions to manage lower urinary tract dysfunction in multiple sclerosis: a systematic review]

Abstract

Aim: To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population.

Material: Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy.

Results: Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P≤0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P=0.035 to P<0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials.

Conclusions: The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.

Keywords: Behavioral treatment; Bladder training; Entraînement vésical; Exercice du plancher pelvien; Kinésithérapie; Lifestyle interventions; Lower urinary tract symptoms; Modification des habitudes de vie; Multiple sclerosis; Nerf tibial postérieur; Pelvic floor muscle training; Physical therapy; Posterior tibial nerve; Sclérose en plaques; Traitement comportemental; Troubles du bas appareil urinaire.