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How Can Multiple Sclerosis (MS) Affect My Pelvic Floor?

Hi friends!  This week we’re going to talk about a condition called Multiple sclerosis (MS)because it commonly impacts our pelvic floor muscles, bowel, bladder, and sexual function.

 

MS is a chronic nervous system autoimmune and inflammatory disease that affects the brain and spinal cord (Nguyen, 2019; Compston, 2008, Dendrou, 2015).  The symptoms that present with MS depend on where lesions are located in the brain and spinal cord.   This means that two individuals with MS can present with completely different symptoms.  While this is true, there are some common symptoms that affect the pelvic floor muscles.

 

Let’s first talk about how MS can affect the bladder.  Individuals with MS are seven times more likely to report symptoms of overactive bladder than those without MS (McGrother, 2006).  More than half of individuals report moderate to severe urinary symptoms with urinary urgency the most common (Mahajan, 2010). 

 

Another common symptom is urinary retention, meaning difficulty emptying the bladder (Milleman, 2004).  This is often caused by the pelvic floor muscles doing the wrong thing at the wrong time—they need to relax as we try to pee to allow urine to exit the body.  When the muscles have spasticity, they may have a hard time relaxing making it difficult for urine to leave the bladder (DeRidder, 1998).  The good news is that pelvic floor therapy can help teach these muscles coordination while also making sure they are strong and flexible!

 

 

Similar to the bladder, MS can cause issues with our bowels.  This can be either constipation (difficulty getting poop out) or fecal incontinence (leakage of gas or poop). Pelvic floor muscle training can often treat the symptoms of both constipation and leakage.  If you are experiencing these symptoms, it’s important to discuss them with your healthcare provider.

 


 

Sexual dysfunction is common in individuals with MS.  Almost half of men reported erectile dysfunction (Haensch, 2006).  While one third of women report difficulty achieving orgasm (Haensch, 2006).  Sensation with intercourse can often be impacted by MS (Der Walt, 2019).  This can be due to the functioning of the sexual organs (including the pelvic floor muscles) as well as the side effects from commonly prescribed anti-depressant medications.

 

It can be scary to be diagnosed with MS and you may feel hopeless.  Getting proper care is one of the most important things in managing the disease.  Speak with your healthcare providers about any symptoms you have so that you can get the help you need.  For bowel, bladder, and sexual dysfunction ask your provider for a referral to a pelvic floor PT or OT near you.  Many people live happy lives while managing MS because they are in control of their symptoms!

 

Ready to learn more about pelvic health? Here are some helpful resources:


For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources.  At myPFM Academy you’ll find courses like: 

  • Multiple Sclerosis and the Pelvic Floor with Dr. Emily Reul, PT, DPT

  • Treatments for OAB with Dr. Sarah Boyles, MD, MPH, FACOG, FPMRS

  • An Overview of Female Sexual Function and Dysfunction with Dr. Heather Jeffcoat, PT, DPT

  • Sexual Health and Pelvic Pain: Navigating care for cisgender men with Dr. Susie Gronski, BPT, PRPC, WCS

 

Written by Emily Reul, PT, DPT

 

References

  1. Compston A, Coles A. Multiple sclerosis. Lancet 2008; 372:1502.

  2. Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol 2015; 15:545.

  3. DeRidder D et al.  Clinical assessment of pelvic floor dysfunction in multiple sclerosis. Neurourol Urodyn.1998;17:337-542.

  4. Der Walt et al. Family Planning, Antenatal and Postpartum Care in Multiple Sclerosis: A Review and Update. Med Journ Australia. March 2019;211(5):230-236.

  5. Haensch CA, Jorg J.  Autunomic dysfunction in multiple sclerosis. J Neurol. 2006;253 Suppl 1:I3-9.

  6. Mahajan ST, Patel PB, Marrie RA.  Under treatment of overactive bladder symptoms in patietns with multiple sclerosis: an ancillary analysis of the NARCOMS patient registry. J Urol. 2010;183:14432-7.

  7. McGrother CW, Donaldson MK, Hayward T, Matthews R, Dallosso HM, Hyde C. Urinary storage symptoms and comorbidities: a prospective population cohort study in middle-aged and older women.  Age Ageing.2006;35(1):16-24.

  8. Milleman M, Langenstroer P, Guralnick ML.  Post-void residual urine volume in women with overactive bladder symptoms. J Urol. 2004;172(5):1911-4.

  9. Nguyen et al. Pregnancy and Multiple Sclerosis: Clinical Effects Across the Lifespan. Autoimmun Rev. October 2019;18(10):102360.

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