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Urinary rehabilitation effective in Multiple Sclerosis

Urinary Problems Individualised rehabilitation can improve urinary dysfunction in multiple sclerosis (MS) patients independent of disease duration or disability, according to a study presented here.

Over the study's 10-week course of treatment, post-void residual (PVR) fell from 160 mL to approximately 95 mL (p=0.010). "This is the first study that has shown that MS patients could reduce their post void residual," said lead author Maria Lopes de Carvalho, MD, of the AISM Rehabilitation Center in Genova, Italy.

Strength and coordination of the pelvic floor muscles was also increased -- "also a first," she said. Significant improvements were also seen in incontinence as recorded in patient diaries, as well as urge. Frequency was not improved, she said at the meeting of the Joint Consortium of Multiple Sclerosis Centers and America's Committee on Treatment and Research in Multiple Sclerosis.

"Over 80% of MS patients have symptoms of urinary dysfunction during the disease course," Lopes de Carvalho noted. Urinary symptoms, including urge, retention, hesitation, frequency, and incontinence, "can have a significant impact on patient quality of life."

Although rehabilitation has been recommended in expert guidelines, there are few studies about its effectiveness in MS, no studies on retention, and no studies examining whether effectiveness of therapy is dependent on disease duration or level of disability, she said.

To determine the potential of an individualised rehabilitation program to improve symptoms, the researchers enrolled 82 consecutive MS patients (mean age 52 years, mean disease duration 14 years) with urinary symptoms who were referred for the first time to their center. Patients had either been diagnosed with the progressive form of the disease, or had had no relapses in the past six months.

Patients were evaluated for post-void residual (PVR) with bladder ultrasound, pelvic floor muscle function, and other disease aspects with numerous other measures, including the Wagner test of urinary dysfunction-related quality of life and the Expanded Disability Status Scale (EDSS).

Based on the results of the urinary exams, an individualised rehabilitation program was designed for each patient, and delivered for an average of 20 sessions over the course of 10 weeks. Components included counseling for all patients, intermittent catheterization for PVR> 80 mL, pelvic floor muscle rehabilitation using biofeedback, functional electrical stimulation, and other techniques. Patients kept a bladder diary during the follow-up period.

There was no correlation between improvement and age, EDSS score, disease duration, or urinary symptom duration.

"We can say that rehabilitation is effective in the treatment of urinary disorders in MS," Lopes de Carvalho said. Based on the independence of improvement from duration of disease or symptoms, "rehabilitation could be performed throughout the disease course."

The study is important, according to George Kraft, MD, director of the Western Multiple Sclerosis Center at the University of Washington School of Medicine in Seattle. "We have very little else to offer these patients," he said, and these results show that rehabilitation can improve this aspect of the disease.

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