title: [Pelvic floor muscles training, electrical stimulation, bladder training and lifestyle interventions to manage lower urinary tract dysfunction in multiple sclerosis: a systematic review].
abstract: OBJECTIVE
  To assess the effectiveness of conservative therapeutic approaches in a multiple sclerosis population.
  
  
  METHODS
  Review was performed in PubMed, PEDro, Scopus and Cochrane Library using combinations of the following keywords: multiple sclerosis; bladder dysfunction; overactive bladder; detrusor hyperreflexia; urge incontinence; urgency; stress incontinence; pelvic floor muscle; biofeedback; PTNS; tibial nerve; bladder training; physical therapy; physiotherapy; conservative treatment and behavioral therapy.
  
  
  RESULTS
  Six randomized articles including 289 patients were selected. Four papers exhibited strong scores for the methodological quality assessment. The parameters always significantly improved concerned: number of incontinence episodes (decreased from 64% to 86% after treatment versus before treatment), quality of life (P≤0.001), severity of irritative symptoms (decreased by more than 50% after treatment versus before treatment), and nocturia (P=0.035 to P<0.001). Activities and participation, maximum flow rate, mean voided volume and daytime frequency were not significantly improved in all trials.
  
  
  CONCLUSIONS
  The physical therapy techniques could be effective for the treatment of urinary disorders in multiple sclerosis populations with mild disability. However, the analyses are based on six studies within only four showed good methodological quality. No strong conclusions regarding treatment approaches can be drawn from this review.
authors.affiliation: Institute of NeuroScience, université Catholique de Louvain, Bruxelles, Belgique; Service de médecine physique et réadaptation, cliniques universitaires St-Luc, université Catholique de Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgique. Electronic address: Laurent.gaspard@uclouvain.be.
authors.forename: L
authors.initials: L
authors.lastname: Gaspard
authors.affiliation: Service d'urologie, université Catholique de Louvain, cliniques universitaires Saint-Luc, Bruxelles, Belgique.
authors.forename: B
authors.initials: B
authors.lastname: Tombal
authors.affiliation: Service de médecine physique et réadaptation, cliniques universitaires St-Luc, université Catholique de Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
authors.forename: Y
authors.initials: Y
authors.lastname: Castille
authors.affiliation: Service d'urologie, université Catholique de Louvain, cliniques universitaires Saint-Luc, Bruxelles, Belgique.
authors.forename: R-J
authors.initials: RJ
authors.lastname: Opsomer
authors.affiliation: Institute of NeuroScience, université Catholique de Louvain, Bruxelles, Belgique.
authors.forename: C
authors.initials: C
authors.lastname: Detrembleur
mesh_terms: D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D006801:Humans; D008019:Life Style; D009103:Multiple Sclerosis / Q000150:complications*; D017773:Pelvic Floor; D014570:Urologic Diseases / Q000209:etiology* / Q000628:therapy*
keywords: Behavioral treatment; Bladder training; Entraînement vésical; Exercice du plancher pelvien; Kinésithérapie; Lifestyle interventions; Lower urinary tract symptoms; Modification des habitudes de vie; Multiple sclerosis; Nerf tibial postérieur; Pelvic floor muscle training; Physical therapy; Posterior tibial nerve; Sclérose en plaques; Traitement comportemental; Troubles du bas appareil urinaire
vernacular_title: Troubles du bas appareil urinaire chez des patients atteints de la sclérose en plaques et kinésithérapie pelvi-périnéale : revue systématique.