Pelvic floor muscle training on urinary incontinence and sexual function in people with multiple sclerosis: A systematic review

Objective: This systematic review evaluates and summarizes the effects of pelvic floor muscle training on urinary incontinence and sexual function in people with multiple sclerosis.

Data sources: PubMed, Scopus, PEDro, CINAHL, Web of Science, and ULAKBIM databases with keywords multiple sclerosis, urinary incontinence, sexual function, and pelvic floor muscle training were screened for randomized controlled studies and clinical trials from the beginning until July 2020 (updated in August 2021).

Review methods: Two authors independently made the study selection. Turkish and English publications were taken into consideration. The risk of bias for the included studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEXT) was used to assess the methodological quality of studies. Data extraction was performed by two researchers independently.

Results: Initial search identified a total of 2831 studies, after removing duplicates, 2180 records were screened and 7 studies with 248 participants [mean age (years): 50.0 ± 11.11 and range: 20-67; mean Expanded Disability Status Scale score: 4.2 ± 1.64 and range: 1.5-7.5] met the inclusion criteria. Only one study included male people with multiple sclerosis. Five studies were judged as being of some concerns and two studies were judged as being of high risk of bias. The TESTEXT scores ranged from 5 to 9 out of 15. The outcome measures were the health-related quality of life (6 studies), severity of overactive bladder (5 studies), leakage episodes (4 studies), severity of urinary incontinence (3 studies), 24-h pad test (2 studies), pad usage, sexual function, and anxiety and depression (1 study). Significant improvements were observed in all specified outcome measures in the groups that received pelvic floor muscle training in majority of the studies.

Conclusion: Current evidence suggests that pelvic floor muscle training seems to be an effective treatment modality for improving health-related quality of life and reducing the severity of urinary incontinence and overactive bladder symptoms in people with multiple sclerosis. It also can reduce leakage episodes, pad usage, anxiety, and depression and improve sexual function. However, it should be noted that all included studies had some concerns or a high risk of bias in at least one domain of risk of bias assessment, and most of the studies did not have high quality.