For women living with multiple sclerosis, the loss of bladder control is not merely a physical inconvenience but a quiet erosion of dignity and freedom. A small but carefully measured trial conducted in Turkey suggests that pairing traditional pelvic floor exercises with a deeper form of neuromuscular stabilization training may restore more of that lost ground than exercise alone. The study, involving 24 women over eight weeks, adds a modest but meaningful thread to the larger search for therapies that honor the complexity of a nervous system under siege.
Combined pelvic floor and stabilization training improves MS-related urinary symptoms
Multiple sclerosis impairs pelvic floor function in women, causing lower urinary tract symptoms that significantly impact quality of life.
Core stability may be the missing piece in pelvic floor training
Mark
Why does MS specifically damage bladder control? Is it the same mechanism that causes other MS symptoms?
Mimi
MS attacks the protective coating around nerve fibers throughout the body, including the nerves that signal the pelvic floor muscles. So yes, it's the same disease process, but the pelvic floor is particularly vulnerable because those muscles need precise coordination—they have to contract and relax at exactly the right moments.
Mark
And pelvic floor training alone wasn't enough?
Mimi
It helped, but the study found that adding stabilization work—training the deep core muscles that support the pelvis—produced better results. The theory is that the pelvic floor doesn't work in isolation; it's part of a larger system. If the core is weak or unstable, the pelvic floor has to work harder and less efficiently.
Mark
The study mentions the combined group got more supervision. Could that alone explain the difference?
Mimi
That's the honest limitation the researchers flagged. More one-on-one attention, more feedback, more accountability—those things matter. We can't fully separate the effect of the stabilization exercises themselves from the effect of having a physiotherapist watching and correcting you three times a week.
Mark
What about the stress incontinence finding—why didn't the combined approach help there?
Mimi
That's interesting. Stress incontinence is about sudden pressure on the bladder during movement. It may respond to different mechanisms than overactive bladder, which is more about nerve signaling and muscle coordination. The combined training seemed to address the coordination problem better than the pressure problem.
Mark
So what's the next step for someone with MS dealing with these symptoms?
Mimi
Right now, this study suggests it's worth asking a physiotherapist about adding stabilization work to pelvic floor training. But we need larger trials to be certain. The sample here was small, and the unequal supervision makes it hard to know exactly what's driving the benefit.
O Pulso
- Multiple sclerosis disrupts the neural pathways governing bladder control, leaving many women caught in cycles of urgency, leakage, and diminished daily life.
- A Turkish clinical trial tested whether adding Dynamic Neuromuscular Stabilization — a deep core stability technique — to standard pelvic floor training could outperform conventional exercises alone.
- Women in the combined training group showed measurably stronger pelvic floor muscle power, endurance, and electrical activity, and reported greater relief from overactive bladder symptoms.
- A critical tension remains: the combined group also received more direct physiotherapist supervision, making it difficult to isolate whether the exercises or the extra clinical attention drove the gains.
- With only 24 participants, the findings are promising but provisional — researchers call for larger, more rigorously controlled trials before integrated neuromuscular approaches can be broadly recommended.
For women living with multiple sclerosis, the loss of bladder control is not merely a physical inconvenience but a quiet erosion of dignity and freedom. A small but carefully measured trial conducted in Turkey suggests that pairing traditional pelvic floor exercises with a deeper form of neuromuscular stabilization training may restore more of that lost ground than exercise alone. The study, involving 24 women over eight weeks, adds a modest but meaningful thread to the larger search for therapies that honor the complexity of a nervous system under siege.
Multiple sclerosis quietly dismantles the nerve pathways that govern bladder function, and for many women the result is a persistent, exhausting struggle with urgency and urinary leakage. A new study from Turkey asked whether layering a core stabilization technique onto standard pelvic floor training might offer something more than conventional exercises alone.
Researchers recruited 24 women with MS between the ages of 28 and 54 and divided them into two groups for eight weeks. One group performed remotely delivered pelvic floor muscle training. The second group did the same exercises but also attended in-person sessions three times a week to practice Dynamic Neuromuscular Stabilization — a method targeting deep core stability — under direct physiotherapist guidance.
Outcomes were measured through validated urinary symptom questionnaires and two objective physical tests: vaginal palpation to assess muscle strength and endurance, and electromyography to capture the electrical quality of muscle contractions. The combined group showed significantly greater improvements in overactive bladder scores and total urinary symptom measures. Physical testing confirmed the pattern — women in the combined group gained more in muscle power, endurance, and peak contractile activity.
The picture was less clear for stress incontinence, where both groups improved at comparable rates, and neither held an advantage on a standard incontinence severity scale.
The researchers are candid about the study's constraints. The two groups were not equivalent in supervision or contact time, and 24 participants is a modest foundation for firm conclusions. Whether the stabilization exercises themselves drive the benefit — or whether the additional clinical attention plays a confounding role — remains an open question. Larger, more carefully controlled trials are needed to settle the matter. For now, the findings offer women with MS a direction worth pursuing, and the scientific community a hypothesis worth testing at scale.
Multiple sclerosis damages the nerves and muscles that control bladder function, leaving many women struggling with urinary leakage and the constant, urgent need to urinate. A new study suggests that adding a specific type of stabilization training to standard pelvic floor exercises produces measurably better results than exercise alone.
Researchers in Turkey recruited 24 women with MS, aged 28 to 54, and divided them into two groups. One group received eight weeks of pelvic floor muscle training delivered remotely—exercises designed to strengthen the muscles that support bladder control. The second group did the same pelvic floor work but also performed Dynamic Neuromuscular Stabilization exercises, a technique that focuses on deep core stability, three times a week under a physiotherapist's direct supervision. Both programs lasted eight weeks.
The researchers measured outcomes using three different questionnaires that assess urinary symptoms and bladder control, plus two objective physical tests: vaginal palpation to evaluate muscle strength and endurance, and electromyography to measure electrical activity in the muscles. The combination approach produced notably stronger improvements in overactive bladder symptoms and overall urinary symptom scores. On the Urinary Symptom Profile scale measuring overactive bladder, the combined group improved significantly more than the pelvic floor-only group. The same pattern held for total urinary symptom scores. On a separate overactive bladder questionnaire, the combined group again showed greater gains. However, when it came to stress incontinence—leakage during coughing or exercise—both groups improved similarly, and neither group showed a clear advantage on a standard incontinence severity scale.
The physical measurements told a clearer story. Women in the combined training group showed substantially greater improvements in pelvic floor muscle power and endurance when tested by hand. Electromyography readings, which measure the strength and quality of muscle contractions, also favored the combined approach, with the stabilization group showing larger gains in both average muscle work and peak muscle activity.
The findings suggest that integrating core stabilization work with traditional pelvic floor training may offer women with MS a more effective path to managing urinary symptoms. Yet the researchers acknowledge real limitations. The two groups were not equally matched in terms of supervision and training volume—the combined group received more direct physiotherapist contact, which could partly explain the difference. The sample size of 24 women is modest, making it harder to draw firm conclusions. Larger, more carefully controlled trials would be needed to confirm whether the stabilization component itself drives the improvement or whether the extra attention and supervision account for the gains.
For women with MS dealing with the daily burden of urinary symptoms, the results offer a concrete direction worth exploring further. The study was registered with ClinicalTrials.gov and received ethical approval from Ondokuz Mayıs University in Turkey, with funding from Turkish research councils.
Citações Notáveis
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.— Study authors
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