Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder
Restricted accessResearch articleFirst published online April, 2021
Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder
Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options.
Objective:
To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients.
Methods:
This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests.
Results:
Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB (p = 0.0001, p = 0.0001), Qualiveen-siup (p = 0.0001, p = 0.0001), Qualiveen-QoL (p = 0.002, p = 0.006), PVR (p = 0.0001, p = 0.21), frequency (p = 0.0001, p = 0.69), nocturia (p = 0.0001, p = 0.19), urgency (p = 0.0001, p = 0.0001), and urge incontinence (p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency (p = 0.002) in favor of TTNS.
Conclusion:
Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.
CetinelBTarcanTDemirkesenO, et al. Management of lower urinary tract dysfunction in multiple sclerosis: A systematic review and Turkish consensus report. Neurourol Urodyn2013; 32(8): 1047–1057.
2.
ZeccaCRiccitelliGCDisantoG, et al. Urinary incontinence in multiple sclerosis: Prevalence, severity and impact on patients’ quality of life. Eur J Neurol2016; 23(7): 1228–1234.
3.
LucioACPerissinotoMCNatalinRA, et al. A comparative study of pelvic floor muscle training in women with multiple sclerosis: Its impact on lower urinary tract symptoms and quality of life. Clinics2011; 66(9): 1563–1568.
4.
PheVChartier-KastlerEPanickerJN.Management of neurogenic bladder in patients with multiple sclerosis. Nat Rev Urol2016; 13(5): 275–288.
BurnsPA.A nurse led continence service reduced symptoms of incontinence, frequency, urgency, and nocturia. Evid Based Nurs2016; 9(3): 85–85.
7.
AmmiMChautardDBrassartE, et al. Transcutaneous posterior tibial nerve stimulation: Evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder. Int Urogynecol J2014; 25(8): 1065–1069.
8.
AslanEKomurcuNBejiNK, et al. Bladder training and Kegel exercises for women with urinary complaints living in a rest home. Gerontology2008; 54(4): 224–231.
9.
FerreiraAPSPegorareABSalgadoPR, et al. Impact of a pelvic floor training program among women with multiple sclerosis: A controlled clinical trial. Am J Phys Med Rehabil2016; 95(1): 1–8.
10.
LucioAD’anconaCALPerissinottoMC, et al. Pelvic floor muscle training with and without electrical stimulation in the treatment of lower urinary tract symptoms in women with multiple sclerosis. J Wound Ostomy Continence Nurs2016; 43(4): 414–419.
11.
SchneiderMPGrossTBachmannLM, et al. Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: A systematic review. Europ Urol2015; 68(5): 859–867.
12.
KabaySCanbaz KabaySCetinerM, et al. The clinical and urodynamic results of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease. Urology2016; 87: 76–81.
13.
Canbaz KabaySKabaySMestanE, et al. Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12-months results. Neurourol Urodyn2017; 36(1): 104–110.
14.
PanickerJNFowlerCJKesslerTM.Lower urinary tract dysfunction in the neurological patient: Clinical assessment and management. Lancet Neurol2015; 14(7): 720–732.
15.
BoothJConnellyLDicksonS, et al. The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review. Neurourol Urodyn2018; 37(2): 528–541.
16.
de SezeMRaibautPGallienP, et al. Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: Results of a multicenter prospective study. Neurourol Urodyn2011; 30(3): 306–311.
17.
GaspardLTombalBOpsomerRJ, et al. Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: A randomized controlled trial. Prog Urol2014; 24(11): 697–707.
18.
KurtzkeJF.Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology1983; 33(11): 1444–1452.
19.
SenS.Neurostatus and EDSS calculation with cases. Noro Psikiyatr Ars2018; 55(Suppl. 1): S80–S83.
20.
AcquadroCKoppZCoyneKS, et al. Translating overactive bladder questionnaires in 14 languages. Urology2006; 67(3): 536–540.
21.
TarcanTMangırNÖzgürMÖ, et al. OAB-V8 Aşırı aktif mesane sorgulama formu validasyon çalışması. Üroloji Bülteni2012; 21(21): 113–116.
22.
CostaPPerrouin-VerbeBColvezA, et al. Quality of life in spinal cord injury patients with urinary difficulties. Eur Urol2001; 39(1): 107–113.
23.
KarapolatHEyigörSAkkocY, et al. Quality of life in multiple sclerosis patients with urinary disorders: Reliability and validity of the Turkish version of Qualiveen. J Neurol Sci2010; 27(1): 43–49.
24.
KhalafKMCoyneKSGlobeDR, et al. The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis. Neurourol Urodyn2016; 35(1): 48–54.
25.
HommaYKoyamaN.Minimal clinically important change in urinary incontinence detected by a quality of life assessment tool in overactive bladder syndrome with urge incontinence. Neurourol Urodyn2006; 25(3): 228–235.
26.
ChancellorMFreedmanSMitchesonHD, et al. Tolterodine, an effective and well tolerated treatment for urge incontinence and other overactive bladder symptoms. Clin Drug Invest2000; 19(2): 83–91.
27.
GobbiCDigesuGAKhullarV, et al. Percutaneous posterior tibial nerve stimulation as an effective treatment of refractory lower urinary tract symptoms in patients with multiple sclerosis: Preliminary data from a multicentre. Mult Scler2011; 17(12): 1514–1519.
28.
McClurgDAsheRGLowe-StrongAS.Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis—A double blind, placebo controlled, rondomised clinical trial. Neurourol Urodyn2008; 27(3): 231–237.
29.
De RidderDVermeulenCKetelaerP, et al. Pelvic floor rehabilitation in multiple sclerosis. Acta Neurologica Belgica1999; 99(1): 61–64.
30.
LucioACCamposRMPerissinottoMC, et al. Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis. Neurourol Urodyn2010; 29(8): 1410–1413.
31.
McClurgDAsheRGMarshallK, et al. Comparison of pelvic floor muscle training. electromyography biofeedback and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: A randomized pilot study. Neurourol Urodyn2006; 25(4): 337–348.
32.
BykovieneLKubiliusRAniulieneR, et al. Pelvic floor muscle training with or without tibial nerve stimulation and lifestyle changes have comparable effects on the overactive bladder: A randomized clinical trial. Urol J2018; 15(4): 186–192.
33.
CoyneKSMatzaLSThompsonCL, et al. Determining the importance of change in the OAB-q. Urol J2006; 176: 627–632.
