Urogynecological physiotherapy for strengthening the pelvic floor: Prevention and rehabilitation of urinary incontinence in patients with multiple sclerosis
DOI:
https://doi.org/10.55892/jrg.v8i18.2027Keywords:
Demyelinating Disease, Urinary Incontinence, Pelvic Floor Physical Therapy, Urodynamic TestingAbstract
Multiple Sclerosis (MS) is a chronic demyelinating disease that affects the Central Nervous System (CNS). Lesions can occur in various regions, leading to diverse symptoms, including visual, motor, sensory, and urinary problems. Physiotherapy plays a key role in improving aerobic capacity, functional independence, fatigue resistance, muscle strength, gait speed, proprioceptive sensitivity, balance, and reducing spasticity. The objective of this study is to guide physiotherapy toward techniques capable of alleviating lower urinary tract symptoms in individuals diagnosed with multiple sclerosis associated with urinary incontinence, and to highlight physiotherapeutic treatment as an essential and innovative tool—not only in symptom management but also in promoting patient autonomy and social reintegration. The search for publications from the current decade (2014–2024) was conducted using Health Science Descriptors (DeCS) with the terms: “urinary incontinence” AND “multiple sclerosis” AND “physiotherapy”, combined according to the specificities of each consulted database. The databases included the BVS Regional Portal (Virtual Health Library), PubMed (developed by the National Center for Biotechnology Information, NCBI), and the PEDro Platform (Physiotherapy Evidence Database).The importance of urogynecological physiotherapy in managing urinary symptoms in MS patients is well-supported by evidence, particularly when combined with pelvic floor muscle training, electrotherapy, and posterior tibial nerve stimulation. The integration of new technologies and innovative approaches, such as guided rehabilitation and neural stimulation, can expand therapeutic options and improve treatment adherence. Personalized treatment, tailored to individual patient needs, is crucial for maximizing clinical outcomes.
Downloads
References
ABAKAY, H. et al. The effects of incontinence on functionality, disability, and quality of life in male and female patients with multiple sclerosis. Multiple Sclerosis and Related Disorders, v. 66, 104010, 2022. https://doi.org/10.1016/j.msard.2022.104010.
BAPIR, R. et al. Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials. Archivio Italiano di Urologia e Andrologia, v. 94, n. 4, p. 492-506, 2022. https://doi.org/10.4081/aiua.2022.4.492.
BLOCK, V. et al. Do physical therapy interventions affect urinary incontinence and quality of life in people with multiple sclerosis?: An Evidence-Based Review. International journal of MS care, v. 17, n. 4, 172-80, 2015. doi:10.7224/1537-2073.2014-031
BLOCK, V. J. et al. Underutilization of physical therapy for symptomatic women with MS during and following pregnancy, Multiple Sclerosis and Related Disorders, v. 48, 2021, 102703, Disponível em: https://doi.org/10.1016/j.msard.2020.102703.
BOTTINI, D. A. M. C. et al. Treinamento do assoalho pélvico com ou sem eletroterapia no tratamento dos sintomas da hiperatividade do detrusor em mulheres com esclerose múltipla e mielopatia associada ao HTLV-I (HAM/TSP): um ensaio clínico randomizado. Fisioterapia Brasil, v. 20, n. 4: 500-508, 2019. https://doi.org/10.33233/fb.v20i4.2555
DAMASCENO, A. et al. Epidemiological study on multiple sclerosis in Brazil: demographic and clinical characteristics according to geographic distribution – a BRANDO study. Arquivos de Neuro-Psiquiatria, v. 82 (S 01): S1-S52, 2024. DOI: 10.1055/s-0044-1789352
DECLEMY, I. et al. Prevalence of comorbidities in multiple sclerosis patients with neurogenic bladder. Progrès en Urologie, v. 31, p. 732-738, 2021. https://doi.org/10.1016/j.purol.2021.05.003.
DUFOUR, S.; WU, M. “No. 397 - Conservative Care of Urinary Incontinence in Women.” Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC v. 42, n. 4, 510-522. 2020. doi:10.1016/j.jogc.2019.04.009
GASPARD, L. et al. Kinésithérapie et symptômes du bas appareil urinaire chez des patients atteints de la sclérose en plaques: Étude contrôlée randomisée [Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial]. Progres en Urologie, v. 24, n. 11, 697-707, 2014. doi:10.1016/j.purol.2014.05.003
GIANNOPAPAS, V. et al. Sexual dysfunction therapeutic approaches in patients with multiple sclerosis: A Systematic Review. Neurological Sciences. v. 44. 2022. https://doi.org/10.1007/s10072-022-06572-0.
GUSTAVSEN, S. et al. The association of selected multiple sclerosis symptoms with disability and quality of life: A large Danish self-report survey. BMC Neurology, [S.l.], v. 21, n. 317, 2021. https://doi.org/10.1186/s12883-021-02344-z.
GUTIERREZ, D. et al. The type of exercise most beneficial for quality of life in people with multiple sclerosis: A network meta-analysis. Annals of Physical Medicine and Rehabilitation, v. 65, p. 101578, 2022. https://doi.org/10.1016/j.rehab.2022.101578.
HAKI, M. et al. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine, v. 103, n. 8, p. e37297, 2024. Disponível em: https://doi.org/10.1097/MD.0000000000037297.
HAY-SMITH, E. J. C. et al. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women. The Cochrane Database of Systematic Reviews v. 12, n. 12 CD009508, 2024, doi:10.1002/14651858.CD009508.pub2
LAKIN, L. et al. Comprehensive approach to management of multiple sclerosis: Addressing invisible symptoms - A Narrative Review. Neurology and Therapy. 2021;10(1):75-98. doi:10.1007/s40120-021-00239-2.
LASA, I. et al. Effects of hippotherapy in multiple sclerosis: pilot study on quality of life, spasticity, gait, pelvic floor, depression and fatigue. Clínica Médica (Barc), v. 152, n. 2, p. 55-58, 2019. https://doi.org/10.1016/j.medcli.2018.06.023.
LI, S. et al. Effect of pelvic floor muscle training combined with electrical stimulation therapy on stress urinary incontinence: A Meta-Analysis. Urologia Internationalis, v. 1, n. 11, 2025, doi:10.1159/000543133
KAJDAFVALA, M. et al. Pelvic floor muscle training in multiple sclerosis patients with lower urinary tract dysfunction: A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, v. 59, p. 103559, 2022. Disponível em: https://doi.org/10.1016/j.msard.2022.103559.
PÉREZ, D. C. et al. Pelvic floor muscle training adapted for urinary incontinence in multiple sclerosis: a randomized clinical trial. International Urogynecology Journal, v. 31, n. 2, p. 267-275, 2020. https://doi.org/10.1007/s00192-019-04099-1.
PIZZOL, D. et al. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clinical and Experimental Research, v. 33, n. 1, p. 25-35, 2021. https://doi.org/10.1007/s40520-020-01710-0.
REINA-GUTIÉRREZ, S. et al. “The type of exercise most beneficial for quality of life in people with multiple sclerosis: A network meta-analysis.” Annals of Physical and Rehabilitation Medicine, v. 65, n. 3, 101578, 2022. doi:10.1016/j.rehab.2021.101578
SAVIO, M.; KEARNEY, H.; GIUNTI, G. Evaluating the evidence behind multidisciplinary roles for a multiple sclerosis unit: A systematic literature review, Multiple Sclerosis and Related Disorders, v. 95, 106342, 2025. https://doi.org/10.1016/j.msard.2025.106342.
SEDDONE, S. et al. Lower urinary tract disorders in multiple sclerosis patients: prevalence, clinical features, and response to treatments. Neurourology and Urodynamics, v. 40, n. 6, 1500–1508, 2021. https://doi.org/10.1002/nau.24687
TORNIC, I. et al. The management of lower urinary tract dysfunction in multiple sclerosis. Current Neurology and Neuroscience Reports, v. 18, p. 54, 2018. https://doi.org/10.1007/s11910-018-0858-y.
VAINAUSKIENÉ, V.; VAITKIENÉ, R. Enablers of patient knowledge empowerment for self-management of chronic disease: An Integrative Review. International Journal of Environmental Research and Public Health, v. 18, n. 5, 2247, 2021. https://doi.org/10.3390/ijerph18052247
YAVAS, I. et al. Feasibility of telerehabilitation-based pelvic floor muscle training for urinary incontinence in people with multiple sclerosis: A randomized, controlled, assessor-blinded study. Journal of Neurologic Physical Therapy, v. 47, n. 4, p. 217-226, 2023. https://doi.org/10.1097/NPT.0000000000000432.
