Dynamic neuromuscular stabilization combined wıth pelvic floor training improves urinary and pelvic floor outcomes in women with multiple sclerosis

Abstract

Multiple sclerosis (MS) can impair pelvic floor muscle function, leading to lower urinary tract symptoms (LUTS).To investigate the effectiveness of Dynamic Neuromuscular Stabilization (DNS)-based training in addition to pelvic floor muscle training (PFMT) on LUTS and pelvic floor functions in women with MS. In this randomized controlled trial, 24 women with MS (aged 28–54) were assigned to PFMT (n=16) or PFMT+DNS (n=8). Both groups completed an 8-week remotely monitored PFMT program; the PFMT+DNS group also performed DNS-based stabilization exercises thrice weekly under physiotherapist supervision. LUTS were assessed using the Urinary Symptom Profile (USP), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Overactive Bladder-V8 (OAB-V8). Pelvic floor function was evaluated via vaginal palpation (PERFECT scheme) and electromyography (EMG).The PFMT+DNS group showed significantly greater improvements in USP-OAB (p=0.002), USP-Total (p=0.002), and OAB-V8 (p=0.049), while USP-SUI (p=0.137) and ICIQ-SF (p=0.505) scores were similar. PERFECT scheme parameters (power and endurance, p<0.01) and EMG measures (average work and peak, p<0.01) improved more in the PFMT+DNS group.The combined PFMT+DNS program was associated with greater improvements in selected urinary and pelvic floor outcomes compared with PFMT alone; however, interpretation is limited by unequal supervision/training volume and the modest sample size. Trial registration ClinicalTrials.gov, ID: NCT07166809 (URL: https://clinicaltrials.gov/study/NCT07166809 ; Registration date: September 10, 2025).