Friday, 6 March 2015

ClinicSpeak: pelvic floor excercises

I won the debate; all MSers should do pelvic floor exercises. #MSBlog #MSResearch #ClinicSpeak

Urgent survey needed for a public debate. #MSBlog #MSResearch #ClinicSpeak

Did you know pelvic floor exercises help with sexual dysfunction? #MSBlog #MSResearch #ClinicSpeak

THANK YOU, I WON THE DEBATE! 


"I won the debate and made the argument that as part of routine MS practice all MSers should be informed of the benefits of exercise and pelvic floor exercises. This recommendation is based on evidence and the fact that pelvic floor exercises are cheap and can be included as part of a self-management programme."

Debate: Pelvic floor exercises should be recommended to all patients with bladder and/or sexual dysfunction. 

For: Prof Gavin Giovannoni /  Against: Dr James Overell.

"There is an emerging literature on the subject. Do any of you have experience with this form or therapy? I would appreciate it if you could let me know via this short survey if you have heard of this treatment or not? Have you been offered it or not? If you have has it been of benefit or not? I have been researching the issue and it occurred to me that everyone with MS should be made aware of this topic and sex, a form of exercise, could be defined as part of a pelvic floor exercise programme. This topic falls into my holistic approach to MS very well. "





Aims: Evaluate the role of Pelvic Floor Muscle Training (PFMT) on the treatment of Lower Urinary Tract Dysfunction (LUTD) in Multiple Sclerosis (MS) patients.

Methods: In this randomized controlled trial, twenty seven female patients with a diagnosis of MS and LUTD complaints were randomized, in two groups: Treatment group (GI) (N = 13) and Sham group (GII) (N = 14). Evaluation included urodynamic study, 24-hr Pad testing, three day voiding diary and pelvic floor evaluation according to PERFECT scheme. Intervention was performed twice a week for 12 weeks in both groups. GI intervention consisted of PFMT with assistance of a vaginal perineometer. GII received a sham treatment consisted on the introduction of a perineometer inside the vagina with no contraction required.

Results: At the end of the treatment GI was complaining less about storage and voiding symptoms than GII. Furthermore, differences found between groups were: reduction of pad weight (P = 0.00) (Mean: 87,51 grams initial and 6,03 grams final in GI. 69,46 grams initial and 75,88 grams final in GII), number of pads (P = 0.01) (Mean: 3,61 initial and 2,15 final in GI. 3,42 initial and 3,28 final in GII) and nocturia events (P < 0.00) (Mean: 2,38 initial and 0,46 final in GI. 2,55 initial and 2,47 final in GII) and improvements of muscle power (P = 0.00), endurance (P < 0.00), resistance (P < 0.00) and fast contractions (P < 0.00), domains of PERFECT scheme.

Conclusions: PFMT is an effective approach to treat LUTD in female with MS.

Paper 2


OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. 

METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. 

RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. 

CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.

Paper 3

Vahtera et al. Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin Rehabil August 1997 vol. 11 no. 3 211-219.

Objective: To determine the effect of pelvic floor muscle exercises combined with electrical stimulation of pelvic floor on lower urinary tract dysfunction in MSers with near normal (<100 ml) postvoid residual volumes.

Design: Open, controlled, randomized study in two parallel groups.

Setting: Rehabilitation centre for MSers.

Subjects: Fifty women and 30 men with definite MS and current symptoms of lower urinary tract dysfunction.

Outcome: The muscle activity of the pelvic floor muscles was tested using surface EMG. Subjective urinary symptoms were assessed using a questionnaire.

Interventions: Pelvic floor muscles were stimulated using electrical stimulation at six sessions. During and after the final session the MSers were taught to exercise their pelvic floor muscles and advised to continue these exercises regularly for at least six months. The control group was not treated.

Results: The maximal contraction power and endurance of the pelvic floor muscles increased after six sessions of electrical stimulation with interferential currents. Symptoms of urinary urgency, frequency and incontinence were significantly less frequent in the treated group than in the untreated subjects. Male MSers appeared to respond better to the treatment than female MSers. Compliance with the pelvic floor exercises was over 60% at the end of a follow-up for six months. Most drop-outs were due to the disappearance of urinary tract symptoms or to severe relapses in MS.

Conclusions: The present study indicates that pelvic floor muscle exercises combined with electrical stimulation of the pelvic floor constitute an effective treatment for lower urinary tract dysfunction at least in male MSers with MS.

7 comments:

  1. I can't see the survey. I understand pelvic floor exercises can improve core strength and improve balance and control. This has got to be good for my MS since I have some balance issues. I have begun my own routine of pelvic floor exercises as I have had bowel and bladder issues before. I do get urinary urgency with UTI's. So I just researched about it on the web and started doing the exercises. I think it's working but results may take a few months apparently. I also picked up a few relevant exercises from physio sessions some months ago. I'm female with RRMS.

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    1. I would be interested in finding out how pelvic floor exercises improve balance. I'm due to start the Pelvicore pelvic floor exercise technique programme for stress urinary incontinence but this is through my own research/ own motivation.

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  2. my husband likes it....

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  3. It was one of the first exercises my physiotherapist showed me upon diagnosis. I still do it. Great fun.

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  4. There's no survey on this post.

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  5. Pelvic floor exercises are _essential_ for all women. Any GP will be able to tell you that any woman, even young women who have not had children, can lose pelvic floor strength. A tendency to weakness in the pelvic floor is also thought to be inherited in some cases. Of course, pelvic floor exercises are particularly crucial in women who have gone through pregnancy and childbirth. And in women who have MS, or any other condition which can affect muscle tone. Without a strong pelvic floor, urinary and bowel continence suffer, and in severe cases, prolapse results - which can become irreversible. And less essential to life but to some no doubt unthinkable - inability to orgasm is also a possible consequence. This is a no-brainer. All women should do pelvic floor exercises.

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  6. Something that I think is VITAL, and which I omitted from my survey response was that many women may be doing pelvic floor exercises wrongly, thus seeing no benefit. Until you learn how to do them properly, you may actually be bearing down, rather than lifting the pelvic floor muscle. A simple plastic indicator device, inserted into the vagina, can provide the necessary feedback in order to learn how to do them. A GP, continence nurse or physiotherapist will be able to advise on this.

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