Urinary incontinence and impaired physical function are associated with expiratory muscle weakness in patients with multiple sclerosis

Abstract

Purpose

Patients with multiple sclerosis (MS) with respiratory muscle weakness could have physical function impairments, given the functional/biomechanical link of the trunk stabilising system. Thus, clinicians could employ new treatment strategies targeting respiratory muscles to improve their physical function. This study pretends to evaluate the relationship between respiratory muscle strength, pulmonary function and pelvic floor function, and also to correlate these variables with physical function (gait function, disability and quality of life) in patients with MS.

Methods

41 patients participated in this descriptive cross-sectional study. Respiratory muscle strength [maximal respiratory pressures (MIP/MEP)], pulmonary function (forced spirometry), pelvic floor function [urinary incontinence (UI)], physical function [Timed Up & Go (TUG) test, Barthel index and health status questionnaire (SF-12)] were evaluated.

Results

Respiratory muscle strength and pulmonary function were moderately related to UI (MIP: rho = −0.312; MEP: rho = −0.559). MEP was moderately related to physical function (TUG: rho = −0.508; Barthel index: rho = 0.418). Patients with and without expiratory muscle weakness showed differences in UI, pulmonary and physical function.

Conclusion

Patients with MS with greater deterioration in pulmonary function and respiratory muscle strength, especially expiratory muscles, showed greater deterioration in UI and physical function. Expiratory muscle weakness had a negative impact on urinary, physical and pulmonary function.

Implications for rehabilitation

• Pulmonary function is associated with urinary incontinence and gait functionality in patients with multiple sclerosis (MS).

• Expiratory muscle weakness is associated with impaired urinary and physical function in patients with MS.

• The inclusion of respiratory muscle training to the rehabilitation programs of patients with MS could improve their pelvic floor disorders and physical function.

Keywords:

• Disability evaluation
• health-related quality of life
• multiple sclerosis
• neurologic gait disorders
• pelvic floor disorders
• respiratory function tests and respiratory muscles

Acknowledgments

The authors like to thank the patients taking part in this study and the Mostoles Multiple Sclerosis Association, Téxum S.L Physiotherapy Center, La Salle Functional Rehabilitation Institute and the Madrileña Association of Multiple Sclerosis for their help.

Ethical approval

La Salle University Center for Advanced Studies (Madrid, Spain) (registration number: CSEULS-PI-160/2017).

Disclosure statement

No potential conflict of interest was reported by the author(s).