Background/Purpose MS is a progressive disease that is characterized by lesions causing loss of myelin in the central nervous system (Umphred, 1995). Among the many symptoms that can occur, bowel, bladder, and sexual dysfunctions have been found to occur in as many as 75% of the cases of men and women with the disease. Previous studies have shown statistically significant improvements for patients with urinary incontinence if pelvic floor muscle training is incorporated in treatment (Greer, Smith, & Arya, 2012) (Lucio, Perissionto, Natalin, Prudente, Damasceno, & D'ancona, 2011) (Tibaek, Gard, & Jensen, 2005). Several studies have also found correlations between low back pain and pelvic floor dysfunction (Beales, O'Sullivan, & Briffa, 2009) (O'Sullivan & Beales, 2007) (Pel, C., Pool-Goudzwaard, G., & Snijders, 2008) (Smith, Russell, & Hodges, 2006). This case study seeks to blend the two interventions, pelvic floor muscle training and low back treatment to help a patient with multiple sclerosis and urinary incontinence. This case study prompted the PICO question: Can a patient with MS demonstrate improved urinary continence with postural interventions coupled with pelvic floor muscle training? Case Description This case study looked at a 40 year old woman diagnosed with MS in 2007. She had been experiencing increased urinary incontinence and urgency in the last two years as well as increased spasms in the low back. The patient was referred to physical therapy by her gynecologist for mixed urinary incontinence (788.33) for treatment and bladder retraining. Outcomes The following goals were set for the patient after her initial evaluation: 1. The patient will demonstrate increased strength of the pelvic floor by 1 pelvic floor muscle grade from 2/5- 3/5, to reduce the leaking of urine, especially during walking to allow the patient to be more active. 2. The patient will demonstrate decreased resting tone of the pelvic floor to allow the patient to better empty her bladder and reduce the frequency of urination to allow the patient to be more active in her community. 3. The patient's pain will decrease by 50% from 4/10- 2/10 to allow the patient to more comfortably participate in intercourse. 4. The patient will demonstrate improved core stabilization to promote pelvic and lumbar stability and improve overall pelvic floor function. Outcome The patient was able to meet all the goals except number 4 (decreasing pelvic pain). The patient had good outcomes for decreasing urinary incontinence (UI) and urgency. She will continue with therapy to work on decreasing pelvic pain. Discussion Overall, the research was compelling for this PICO question. The research was separately shown for pelvic floor training for MS patients and the treatment of low back pain for UI. This case study was important because it showed the significance of bringing those two separate treatment options together to make the best outcome for a patient.
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Multiple Sclerosis, Urinary Incontinence (UI), Pelvic Floor Muscle Training, UI, neurologic dysfunctions
Sanford, Tara. "Multiple Sclerosis and Urinary Incontinence:A Case study of Pelvic Floor Training and Postural Interventions." (2014). http://digitalrepository.unm.edu/dpt/45