Physical Therapy Improves Urinary Symptoms in Patients With Multiple Sclerosis

Jim Kling

June 08, 2010

June 8, 2010 (San Antonio, Texas) — A physical therapy regimen improves both urinary incontinence and urinary retention in patients with multiple sclerosis (MS), according to a study presented here at the Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis.

Many patients with MS experience urinary dysfunction at some time during the disease course, which can have a significant effect on quality of life. Pharmacotherapy is available, but patients may choose against it because of adverse effects. As a result, Maria Lopes de Carvalho, MD, PhD, and colleagues from the Italian MS Society Rehabilitation Center in Genova, Italy, developed a physical therapy approach designed to improve symptoms of urinary dysfunction and conducted a study to test its effectiveness.

The investigators enrolled 62 patients (54 women, 8 men) with MS and urinary symptoms who had been referred for the first time to the rehabilitation center. Each patient was assigned an individualized rehabilitation program.

Mean age ± standard deviation was 52.67 ± 13.14 years. Mean time since disease onset was 13.78 ± 9.38 years. The patients had a mean Expanded Disability Status Scale score of 5.39 ± 1.39.

Dr. Lopes de Carvalho's team measured Expanded Disability Status Scale score, course and duration of disease, mobility status, symptoms (urgency, retention, hesitation, incontinence, frequency), postvoid residual volume on bladder ultrasound, Wagner Test of urinary incontinence, visual analogue scale, urodynamic investigation, pelvic floor muscle evaluation (Pubo-Coccygeal Grading Test and muscle coordination evaluation), and current pharmacologic therapies. Patients also completed a 5-day bladder diary.

On the basis of the information collected, the researchers developed an individualized urinary rehabilitation program. Mean duration of the program was 12 sessions.

At the end of the rehabilitation program, patients repeated the same evaluation conducted at baseline, without the urodynamic investigation. Primary outcomes included urinary incontinence (Wagner Test), mean number of episodes of leakage (bladder diary), mean number of episodes of urinary frequency in 5 days (bladder diary), nocturia and urgency, and urinary retention (postvoid residual). Secondary outcomes included change in visual analogue scale and Pubo-Coccygeal Grading Test.

At pretreatment, the mean Wagner Test score of urinary incontinence was 67.77. The mean score was 75.95 at the end of the rehabilitation program (P < .001).

Patients had a mean postvoid residual volume, measured with bladder ultrasound, of 113.39 mL at pretreatment and 97.93 mL at the end of the rehabilitation program (P = .010).

The rehabilitation effort was undertaken because "too many people were asking us to do something for their bladder and bowel problems," Dr. Lopes de Carvalho, who presented the study findings, told Medscape Neurology. "Everybody knows this is a big problem, but we have only pharmacological therapies," she added.

It was surprising that the team reported improvements in urinary retention, according to Ted Brown, MD, MPH, a physiatrist at the Multiple Sclerosis Center at Evergreen College in Kirkland, Washington. "People have looked at pelvic floor rehabilitation for urinary incontinence and bowel incontinence, but not retention. We've been concerned that if you strengthen the pelvic floor muscles, which is generally what we do with urinary incontinence, that it could make retention worse. [Dr. Lopes de Carvalho] showed you could actually help urinary retention with her techniques, which I found very interesting," Dr. Brown, who attended the session, told Medscape Neurology.

Dr. Brown noted that Dr. Lopes de Carvalho did not present specifics on the rehabilitation program. "It's novel. It would be interesting to learn how they came up with it."

The study did not receive commercial support. Dr. Lopes de Carvalho and Dr. Brown have disclosed no relevant financial relationships.

Consortium of Multiple Sclerosis Centers (CMSC) 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS): Abstract P24. Presented June 4, 2010.


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