Lower urinary tract dysfunctions (LUTD) occur in up to 80% of individuals with Multiple Sclerosis (MS) at some point during the disease and are among the most common symptoms of MS (1). According to the literature, in the conservative management of LUTD in individuals with MS, a single-type pelvic floor strengthening exercise program is typically applied. The aim of this study was to compare the effects of pelvic floor strengthening and relaxation exercises on LUTD, depression, and quality of life (QoL) in women with Multiple Sclerosis (WwMS).

A total of 24 participants were divided into groups by randomization method. Participants were divided into three groups: pelvic floor strengthening (n=8), relaxation (n=8), and combined (both pelvic floor strengthening and relaxation together) (n=8) exercise groups. Participants were called every week for 8 weeks and an online session was held one day per week. Participants were asked to perform the exercises 3 times a day, every other day (Figure 1). Sociodemographic and clinical characteristics (duration of MS, constipation, body mass index (BMI), medication, parity, tobacco use, etc.) were recorded. 24-Hour Voiding Diary, Urogenital Distress Inventory (UDI-6), Incontinence Impact Scale (IIQ-7), International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF), Overactive Bladder Assessment Form (OAB-V8), and Patient Health Questionnaire (PHQ) were used to evaluate.

A total of 24 participants were included in this study. The average age of the strengthening exercise group was 38.13±14.75, the relaxation exercise group was 36.5 ±10.00, and the combined exercise group was 44.88± 8.49 years old. Statistical analyses were conducted using IBM SPSS Statistics version 23.0. Assumptions of parametric tests were verified using the Shapiro-Wilk test for normality and Levene’s test for homogeneity of variances. A two-way mixed ANOVA was used to assess pre- and post-treatment interactions across groups, followed by Bonferroni-corrected simple effects analyses when significant (p< 0.05).
As a result of the study, a statistically significant difference was found in all groups in terms of UDI-6, IIQ-7, ICIQ-SF, OAB-V8 and PHQ-9 scores (p<0.05). However, in the intergroup comparison, no significant difference was found between the groups, and the groups were not superior to each other (p>0.05). According to the voiding diary results, a statistically significant difference was found in all groups in terms of voiding frequency and nocturia (p<0.05). No significant difference was found between the groups in terms of voided volume, number of urinary incontinence and amount of fluid consumed (p>0.05).

Interpretation of results: Research indicated that pelvic floor strengthening and relaxation exercises applied to WwMS with LUTD had improving effects on overactive bladder symptoms, nokturia, voiding frequency, QoL and depression.

Concluding message: As a result of our study, it was determined that pelvic floor strengthening and relaxation exercises had no superiority over one another in the treatment of LUTD in WwMS. This finding suggests that, in MS patients with LUTD, pelvic floor strengthening and relaxation exercises can be used interchangeably or in combination.

1.	Block, V., Rivera, M., Melnick, M., Allen, D.D. (2015). Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis? International Journal of MS Care. 17, 172–80.