Pelvic floor muscle training in multiple sclerosis patients with lower urinary tract dysfunction: A systematic review and meta-analysis

Background: Pelvic floor muscle training (PFMT) is a conservative treatment program for the management of lower urinary tract dysfunction (LUTD). This systematic review aimed to investigate the overall effectiveness of PFMT on LUTD in people with multiple sclerosis (MS). Methods: Seven databases (PubMed/Medline, Scopus, PEDro, WOS, CINAHL, Cochrane, and Embase) were searched between 1990 and July 2019. We investigated urine leakage as our primary outcome. The secondary outcomes were neurogenic bladder symptoms measured by the overactive bladder questionnaire (OAB-V8 questionnaire) and the power/endurance of pelvic floor muscles. Results: Fifteen studies were identified as eligible. Both urine leakage (standardized mean difference (SMD) = 0.50, 95% CI [-0.78, -0.23], and neurogenic bladder symptoms, SMD = -2.24, 95% CI [-4.44, -0.03] significantly decreased by PFMT in people with MS. PFMT increased the overall endurance and power of pelvic floor muscles moderately and significantly, SMD = 1.25, 95% CI [0.69, 1.81], and SMD = 0.64, 95% CI [0.24, 1.05], respectively. Conclusions: Moderate to high-quality studies showed the overall efficacy of PFMT in decreasing urine leakage and neurogenic bladder symptoms and increasing endurance and power of pelvic floor muscles. MS patients with lower urinary tract symptoms could benefit from PFMT in the short term.