title: Pelvic Floor Muscle Training With and Without Electrical Stimulation in the Treatment of Lower Urinary Tract Symptoms in Women With Multiple Sclerosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of intravaginal neuromuscular electrical stimulation (NMES) and transcutaneous tibial nerve stimulation (TTNS) on lower urinary tract symptoms (LUTS) and health-related quality of life in women undergoing pelvic floor muscle (PFM) training (PFMT) with multiple sclerosis (MS) and to compare the efficacy of these 2 approaches.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Thirty women with MS and LUTS were randomly allocated to 1 of 3 groups and received treatment for 12 weeks. Ten women in group 1 received PFMT with electromyographic (EMG) biofeedback and sham NMES. Ten women in group 2 underwent PFMT with EMG biofeedback and intravaginal NMES, and 10 subjects in group 3 received PFMT with EMG biofeedback and TTNS. Multiple assessments, performed before and after treatment, included a 24-hour pad test, 3-day bladder diary, assessment of PFM function (strength and muscle tone), urodynamic studies, and validated questionnaires including Overactive Bladder Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Qualiveen instrument.
  
  
  RESULTS
  All groups showed reductions in pad weight, frequency of urgency and urge urinary incontinence episodes, improvement in all domains of the PFM assessment, and lower scores on the OAB-V8 and ICIQ-SF questionnaires following treatment. Subjects in group 2 achieved significantly greater improvement in PFM tone, flexibility, ability to relax PFMs, and OAB-V8 scores when compared to subjects in groups 1 and 3.
  
  
  CONCLUSIONS
  Results suggest that PFMT alone or in combination with intravaginal NMES or TTNS is effective in the treatment of LUTS in patients with MS. The combination of PFMT and NMES offers some advantage in the reduction of PFM tone and symptoms of overactive bladder.
authors.affiliation: Adélia Lúcio, PhD, University of Campinas-UNICAMP, Campinas, SP, Brazil. Carlos Arturo Levi D'ancona, PhD, University of Campinas-UNICAMP, Campinas, SP, Brazil. Maria Carolina Perissinotto, PhD, University of Campinas-UNICAMP, Campinas, SP, Brazil. Linda McLean, PhD, Queen's University, Kingston, Ontario, Canada. Benito Pereira Damasceno, PhD, University of Campinas-UNICAMP, Campinas, SP, Brazil. Maria Helena Baena de Moraes Lopes, PhD, University of Campinas-UNICAMP, Campinas, SP, Brazil.
authors.forename: Adélia
authors.initials: A
authors.lastname: Lúcio
authors.forename: Carlos Arturo Levi
authors.initials: CA
authors.lastname: Dʼancona
authors.forename: Maria Carolina
authors.initials: MC
authors.lastname: Perissinotto
authors.forename: Linda
authors.initials: L
authors.lastname: McLean
authors.forename: Benito Pereira
authors.initials: BP
authors.lastname: Damasceno
authors.forename: Maria Helena Baena
authors.initials: MH
authors.lastname: de Moraes Lopes
mesh_terms: D000328:Adult; D004558:Electric Stimulation / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000628:therapy; D017773:Pelvic Floor; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D014549:Urinary Incontinence / Q000628:therapy