Hypothesis / Aims of study: Lower urinary tract symptoms develop in Multiple Sclerosis (MS) as a result of disruption of the connections between the frontal and pontine micturition centers and the sacral micturition center caused by MS plaques in spinal cord (1). The most common symptoms are increased urinary frequency, urgency, urinary incontinence and impaired bladder emptying (2). The aim of this study was to investigate the correlations between overactive bladder (OAB) symptom severity, pelvic floor muscle (PFM) strength, depression, and quality of life (QoL) in women with MS (WwMS).

Study design, materials and methods: A total of 26 patients aged 18–65 years with MS and OAB symptoms were included in this study. Sociodemographic and clinical characteristics (duration of MS, constipation, body mass index (BMI), medication, parity, tobacco use, etc.) were recorded. PFM strength was assessed using EMG-Biofeedback device (Uro Solar Model). The OAB symptom severity was evaluated with the Overactive Bladder Assessment Form (OAB-V8), urinary symptoms with the Urogenital Distress Inventory (UDI-6), and QoL with the Incontinence Impact Scale (IIQ-7) and International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF). Statistical analyses were performed using SPSS version 25. Descriptive statistics were calculated for all variables. A correlation in order to evaluate between OAB symptoms, depression, QoL and PFM strength were made using Spearman analysis with a p<0.05 was performed. A multiple linear regression analysis was conducted by using the ICIQ-SF score as the dependent variable (p<0.20).

Results: A total of 26 WwMS (mean age: 40.611.7 years; BMI: 24.9 4.8 kg/m2) were included in this study. A statistically significant negative correlation was observed between OAB symptoms and PFM strength (r = -0.476, p = 0.14) while positive correlations were found between OAB symptoms and UDI-6 (r = 0.636, p < 0.001), IIQ-7 (r = 576, p = 0.002), ICIQ-SF (r = 0.624, p = 0.001). PFM strength significant negatively correlated with UDI-6 (r = -0.604, p = 0.001), and ICIQ-SF (r = -443, p = 0.023).  There was no statistically significant correlation between OAB symptoms and PHQ-9 (p = 0.147). PHQ-9 were significantly associated with duration of MS (r = -0.442, p = 0.24) and IIQ-7 (r = 0.571, p = 0.002). There were no significant associations were found for parity or constipation.
According to the results of the multiple linear regression analysis, IIQ-7 (β = 0.528, p = 0.005) and PFM strength (β = −0.313, p = 0.047) were identified as independent predictors of the ICIQ-SF score. However, OAB-V8 (p = 0.507), UDI-6 (p = 0.935), and PHQ (p = 0.129) were not found to be significant independent predictors. The model explained 75.2% of the variance in the ICIQ-SF score (R² = 0.752).

Interpretation of results: Regression analysis indicated that PFM strength is an independent predictor of QoL related to urinary symptoms. OAB symptoms were associated with PFM strength, urinary symptoms, and QoL, but not with depression. Higher PFM strength was related to fewer urinary symptoms and better QoL. Depression was associated with longer disease duration and reduced QoL.

Concluding message: PFM strength was identified as an independent predictor of QoL related to urinary symptoms in WwMS. Our findings suggest that the assessment of PFM strength should be considered in the management of WwMS presenting with OAB symptoms. Additionally, it should be taken into account that OAB symptoms are associated with reduced quality of life in this population. 

Disclosures: 
Funding: None Clinical Trial: No 
Subjects Human Ethics Committee: The study was approved by the Gazi University Ethics Committee (Approval Date: 14.06.2024, Reference No: E.975691).

1. Sparaco, M., Bonavita, S. (2022). Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis. Journal of Clinical Medicine. 31;11(7), 1941.
2. Ridder, D.D., Van Der Aa, F., Debruyne, J., D'hooghe, M.B., Dubois, B., Guillaume, D., Heerings, M., Ilsbroukx, S., Medaer, R., Nagels, G., Seeldrayers, P., Landegem, W.V., Willekens, B., Zicot, A.F. (2013). Consensus guidelines on the neurologist’s role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis. Clinical Neurology and Neurosurgery. 115(10), 2033-40.