Physiotherapy and Rehabilitation Approaches in the Evaluation of Lower Urinary Tract Dysfunction in Multiple Sclerosis
DOI:
https://doi.org/10.5281/zenodo.20613709Keywords:
Lower urinary tract dysfunction, Multiple sclerosis, Pelvic floor muscle training, Physiotherapy and rehabilitationAbstract
Objective: Multiple sclerosis (MS) is a chronic neurological disease frequently associated with lower urinary tract dysfunction (LUTD), which negatively affects quality of life and may worsen with disease progression. This review aimed to evaluate current methods used in the assessment of lower urinary tract symptoms and to summarize the effectiveness of physiotherapy-based interventions in individuals with MS.
Materials and Methods: Current evidence regarding the evaluation and rehabilitation of LUTD in MS was reviewed. Assessment methods included detailed medical history, symptom and quality-of-life questionnaires, bladder diaries, pad tests, and objective evaluation of pelvic floor muscle function using digital palpation, manometry, electromyography (EMG), and ultrasonography. Urodynamic studies were considered when required for diagnosis and treatment planning. Physiotherapy interventions including pelvic floor muscle training (PFMT), biofeedback, electrotherapy, core stabilization (CS), dynamic neuromuscular stabilization (DNS), and tele-rehabilitation approaches were examined.
Results: Comprehensive assessment combining subjective and objective measures was found to be essential for accurate diagnosis and individualized treatment planning. Pelvic floor muscle training represents the cornerstone of LUTD rehabilitation in MS and has consistently demonstrated improvements in urinary symptoms and quality of life. Appropriate muscle activation, pre-contraction ability, and feedback mechanisms enhance treatment effectiveness. Adjunctive modalities such as biofeedback and electrotherapy provide additional benefits in selected patients. Emerging evidence suggests that core stabilization and dynamic neuromuscular stabilization approaches may positively influence pelvic floor function, although evidence specific to MS remains limited. Tele-rehabilitation has been shown to facilitate remote delivery of PFMT and yields short-term outcomes comparable to conventional face-to-face interventions.
Conclusion: Management of LUTD in individuals with MS requires a multidisciplinary and individualized approach. Physiotherapy plays a central role in symptom management and quality-of-life improvement. Although current evidence supports the effectiveness of PFMT and adjunctive therapies, further high-quality studies with standardized protocols and long-term follow-up are needed to optimize rehabilitation strategies in this population
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