pelvic floor

Managing Pelvic Floor Issues with Neurologic Diagnosis such as Multiple Sclerosis, Parkinson's Disease or Stroke

Pelvic Floor Dysfunction

The pelvic floor is a series of muscles, tissues, and nerves that support the pelvic organs and help maintain sexuality, pleasure, and proper urination (Jundt, Peschers, & Kentenich, 2015).

Because nerves play a part in proper functioning of the pelvic floor, some conditions of the brain or nerves--like Multiple Sclerosis, Parkinson’s Disease, or a stroke--can cause issues with bladder activity, bowel regulation, and pelvic floor dysfunctions including incontinence and sexual dysfunction.

Let’s review the relationship between neurological conditions and pelvic floor dysfunction, and discuss some treatment options that can help.

Multiple Sclerosis

Multiple Sclerosis (MS) is a neurological condition which can cause vision problems, muscle weakness which may limit the person’s ability to stand or walk, numbness, and/or cognitive impairments (NINDS, 2019a).

In 1976, Lilius et. al. surveyed 302 patients with MS. 72% of the female respondents reported that their sex lives had changed. This included:

MS also has a high rate of urinary incontinence. One survey of over 9,000 MS patients found that 65% had at least one urinary symptom that they would describe as “moderate to severe” (Mahajan, Patel & Marrie, 2010).

Parkinson's Disease

Parksinson’s Disease is a motor system disorder that causes unintended body movements such as tremors, rigidity, slow movements, and balance problems. Urinary problems are a common side effect in those with Parkinson’s (NINDS, 2019b).

Sexual dysfunction is also common in those with Parkinson’s. One 2004 study surveyed 32 women with Parkinson’s (out of 75 total respondents), and found:

Stroke

A stroke is a neurological event caused by an interruption of the blood supply to the brain. After having a stroke, many people experience emotional problems including depression, or have problems with paralysis, numbness, or trouble speaking (NINDS, 2019c).

Research shows that 40-60% of those admitted to a hospital after a stroke have incontinence; this incontinence remains after one year in about 15% of cases (Coupe et al, 2019).

In addition, while many people report problems having sex after having a stroke, research has found that this is not being adequately addressed by hospitals, even though many patients want to receive this information (Reeves et al, 2019).

Solutions

If you have one of these neurological conditions, there are solutions available to help improve your pelvic floor health, end incontinence, and reclaim your sexuality.

Pelvic Floor Physical Therapy

The pelvic floor muscles help to maintain continence and sexual function--and like all muscles in your body, they need to be exercised to work properly. Pelvic floor muscle training in physical therapy may consist of any combination of exercises and treatments.

Kegel exercises, named after Arnold Kegel from the University of Southern California, are one of the most common forms of exercise for strengthening weak pelvic floor muscles (Stothers & Macnab, 2010).

One study found that pelvic floor exercises helped decrease urinary incontinence in 24 women who had previously had a stroke (Tibaek, Gard, & Jensen, 2007).

In another study, 30 women with MS saw improvements in their sexual dysfunction after completing pelvic floor muscle training (Lúcio, 2014). Some people may require treatment to address muscles that are too tight due to spasms, and for this, manual therapy, biofeedback, and exercise for pelvic floor release is utilized.

Additionally, a pelvic floor physical therapist will help create a program for bladder or bowel retraining, and help to address pain and sensation difficulties.

Sex Therapy

In all of these neurological conditions, there is a relationship between poor sexual functioning and the patient’s psychological response to their diagnosis (Bancroft, 1989).

This can also be a factor for partners of those with neurological conditions, as depending on the level of care needed, some partners can feel like their role as a caretaker makes them more like a parent than a sexual partner.

Sex-focused therapy with either the individual or the couple may be able to help. By assigning “sex homework” and addressing any concerns that arise--physical or emotional--a sex therapist can help couples feel more safe, communicate better, and enjoy sex more.

Individual Therapy

Many neurological conditions have a large overlap with depression, anxiety, and other mental health issues; for instance, some studies have found a 50% prevalence of depression in patients with multiple sclerosis during their lifetime (Siegert & Abernethy, 2005).

Depression or antidepressants can further lead to sexual dysfunction (Baldwin, 2001), and some studies show a high prevalence between depression and incontinence (Zorn et. al, 1999).

Having a neurological condition, experiencing incontinence, or both can lead to difficulty with shame and low self-esteem. A therapist with experience in chronic illnesses may be able to help you relieve your depression and anxiety for better outcomes in your physical and mental health.

Medications

Some medications can cause sexual dysfunction or incontinence in patients with neurological conditions, and others can help treat it.

If you are concerned that a medication could be causing or worsening your incontinence or sexual dysfunction, or would like a medication to help alleviate these concerns, talk to your doctor.

Conclusion

You do not have to accept incontinence or sexual dysfunction as a “normal” part of your neurological condition!

If you or someone you love has a neurological diagnosis that might be causing incontinence (either urinary or fecal) or problems with enjoying sex, a healthcare provider can help come up with a treatment plan for you.

References

  1. Jundt, K., Peschers, U., & Kentenich, H. (2015). The investigation and treatment of female pelvic floor dysfunction. Deutsches Arzteblatt international, 112(33-34), 564–574. https://doi.org/10.3238/arztebl.2015.0564
  2. U.S. Department of Health and Human Services, National Institute of Neurological Disorders and Stroke (NINDS). (2019a). Multiple Sclerosis Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Multiple-Sclerosis-Information-Page
  3. Lilius HG, Valtonen FJ, Davis FA 1976 Sexual problems in patients suffering from multiple sclerosis. Journal of Chronic Diseases 29: 65–73. https://doi.org/10.1016/0021-9681(76)90021-7
  4. Mahajan, S. T., Patel, P. B., & Marrie, R. A. (2010). Under treatment of overactive bladder symptoms in patients with multiple sclerosis: an ancillary analysis of the NARCOMS Patient Registry. The Journal of urology, 183(4), 1432–1437. https://doi.org/10.1016/j.juro.2009.12.029
  5. U.S. Department of Health and Human Services, National Institute of Neurological Disorders and Stroke (NINDS). (2019b). Parkinson’s Disease Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page
  6. Bronner G, Royter V, Korczyn AD, Giladi N 2004 Sexual dysfunction in Parkinson’s disease. Journal of Sex and Marital Therapy 30: 95–105.
  7. U.S. Department of Health and Human Services, National Institute of Neurological Disorders and Stroke (NINDS). (2019c). Stroke Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page
  8. Thomas, L. H., Coupe, J., Cross, L. D., Tan, A. L., & Watkins, C. L. (2019). Interventions for treating urinary incontinence after stroke in adults. The Cochrane database of systematic reviews, 2(2), CD004462. https://doi.org/10.1002/14651858.CD004462.pub4
  9. Prior, S., Reeves, N., Peterson, G., Jaffray, L., & Campbell, S. (2019). Addressing the Gaps in Post-Stroke Sexual Activity Rehabilitation: Patient Perspectives. Healthcare (Basel, Switzerland), 7(1), 25. https://doi.org/10.3390/healthcare7010025
  10. Bancroft, J. (1989). Human sexuality and its problems(3rd ed.). Edinburgh: Churchill Livingstone.
  11. Siegert, R. J., & Abernethy, D. A. (2005). Depression in multiple sclerosis: a review. Journal of neurology, neurosurgery, and psychiatry, 76(4), 469–475. https://doi.org/10.1136/jnnp.2004.054635
  12. David S Baldwin (2001). Depression and sexual dysfunction. British Medical Bulletin, 57(1), 81–99. https://doi.org/10.1093/bmb/57.1.81
  13. Zorn, B. H., Montgomery, H., Pieper, K., Gray, M., & Steers, W. D. (1999). Urinary incontinence and depression. The Journal of urology, 162(1), 82-84. https://doi.org/10.1097/00005392-199907000-00020
  14. Marques, A., Stothers, L., & Macnab, A. (2010). The status of pelvic floor muscle training for women. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 4(6), 419–424. https://doi.org/10.5489/cuaj.10026
  15. Tibaek, S., Gard, G. & Jensen, R. (2007). Is there a long-lasting effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke?. Int Urogynecol J 18, 281–287. https://doi.org/10.1007/s00192-006-0137-3
  16. Lúcio, A. C., D'Ancona, C. A., Lopes, M. H., Perissinotto, M. C., & Damasceno, B. P. (2014). The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England), 20(13), 1761–1768. https://doi.org/10.1177/1352458514531520