The Missing Link in the Treatment of Patients with Multiple Sclerosis

Multiple Sclerosis (MS) is an autoimmune inflammatory disease where the immune system causes demyelination of the central nervous system. MS is x 3 more common in women and is usually diagnosed between the ages of 20-50 years old. The disease course can vary in individuals with the most common being the relapsing-remitting course, where the body will have phases of functional recovery in between episodic flares.1

Symptoms of MS vary but commonly include fatigue, sensory changes, visual impairments, cognitive decline, and weakness. A 2019 systematic review evaluated data from multiple countries and estimated that 55% of women with MS suffer from some form of sexual dysfunction.2 Additionally, studies show that there are significant incidences of urinary incontinence (UI) in these populations. A 2016 study found that 35% of patients with MS reported experiencing UI3 in addition to a high prevalence of Urinary Tract Infections (UTIs). Despite these numbers, there is an alarmingly low referral rate to pelvic floor therapy. A 2020 study retrospectively analyzed the medical records of 142 women with MS before conception, during pregnancy, and 1 year postpartum. However, less than 5% of women who reported urinary incontinence were referred to a pelvic floor therapist.4 The under-utilization of physical therapy services within this population is especially egregious when considering the profound impact pelvic floor therapy has on improving the quality of life for patients with MS that suffer from pelvic conditions such as urinary incontinence.5

These patients fill countless life roles. They are mothers, professionals, wives, community members, athletes and more. For those given this life-changing diagnosis, it becomes increasingly difficult to participate in these life-roles as the disease process unfolds. Pelvic floor symptoms exacerbate this issue due to the often-severe issues with continence. This effect on participation is especially egregious when you consider the relationship this progressive illness has with psychological issues such as depression.

There is a strong need for pelvic floor therapy in this patient population. Pelvic floor therapy has grown tremendously as a field in the past few decades. However, there is always room for improvement. For those in the field, and for those of us who are working toward it, we need to advocate for our services and our patients. MS is just one of the many patient populations that is both in need of and underutilizing pelvic floor therapy. I hope this blog post will encourage all of us to strive towards life-long learning as we aim to help to expand our profession!

References

1. Who gets ms? National Multiple Sclerosis Society. Available at: https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS (Accessed: January 11, 2023). 
2. Azimi A, Hanaei S, Sahraian MA, Mohammadifar M, Ramagopalan SV, Ghajarzadeh M. Prevalence of Sexual Dysfunction in Women with Multiple Sclerosis: a Systematic Review and Meta-Analysis. Maedica (Bucur). 2019;14(4):408-412. doi:10.26574/maedica.2019.14.4.408
3. Zecca C, Riccitelli GC, Disanto G, et al. Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients’ quality of life. Eur J Neurol. 2016;23(7):1228-1234. doi:10.1111/ene.13010
4. Block VJ, Mestas O, Anderson A, et al. Underutilization of physical therapy for symptomatic women with MS during and following pregnancy. Mult Scler Relat Disord. 2021;48:102703. doi:10.1016/j.msard.2020.102703
5. Block V, Rivera M, Melnick M, Allen DD. Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis?: An Evidence-Based Review. Int J MS Care. 2015;17(4):172-180. doi:10.7224/1537-2073.2014-031

Author: Raquelle Geneviève Hafen, SPT

Author Bio: Raquelle is a second year SPT at California State University, Long Beach (Class of 2024.) She has strong interests in pelvic floor therapy as it relates to sexual dysfunction in pregnant, post-partum, and oncological populations.