Multiple Sclerosis (MS) is a disease that affects the central nervous system. When the immune system attacks the myelin, which is the protective coating around the nerves, it results in a process called demyelination. The exact cause is unknown, but is believed to be contributed by a combination of genetics, environmental factors and immune system deficiencies. Common symptoms include fatigue, weakness, blurred or double vision, changes in balance or coordination, pain, and impaired attention or concentration. How does this relate to the pelvis? Unfortunately, with this patient population, up to 80% have bladder dysfunction, more than 40% experience constipation, and 91% of men and 72% of women report sexual dysfunction, according to some studies. Most common bladder dysfunctions include urinary urgency, frequency and incontinence. This happens because the demyelination process affects telling the bladder muscle and pelvic floor muscles what to do. Constipation is a common result not only from changes in nerve function, but also due to a lack of inactivity as weakness and fatigue worsen. Sexual function changes include decrease in sensation, vaginal dryness, erectile dysfunction, and reduced libido.
Research in this patient population is limited, but shows that the best candidates for pelvic floor therapy are those who get treated in the early stages of MS. Pelvic floor physical therapy, with or without the use of biofeedback, has been shown to improve urinary incontinence, nocturia (nighttime voiding), and bladder emptying. Patient education for behavioral modifications including timed voiding, bladder training, and fluid and dietary management assist with improved bladder storage. Conversely, improved bladder emptying can be improved by techniques for triggered reflex voiding, muscle training for both the pelvic floor and abdomen, and positioning. Extensive research has been performed for managing constipation utilizing abdominal massage; this massage helps facilitate fecal matter through the colon. A pelvic floor therapist can provide education on direction, pressure, intensity and frequency of massage routine for optimal results. In regards to sexual function, a skilled physical therapist can assess pelvic floor muscle tone, flexibility and ability to relax for optimum function in both men and women. It may also be important to look positioning, lubricant, mindfulness and fatigability for improved intimacy. With this in mind, please speak up to your provider regarding pelvic health as symptoms may change over time.