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MS research update - Yoga can help bladder symptoms - 09 November 2012

Bladder symptoms are common in MS. They are often grouped together and called neurogenic bladder dysfunction as they are most often caused by damage to the spinal cord, but sometimes to the brain, in areas that are critical to the control of the bladder. Bladder problems can have a major effect on quality of life making people reluctant to go out of the house if they don't know if toilets are readily available.

How the study was carried out

Eleven people with MS who experienced neurogenic bladder symptoms took part in the study at a centre for neurological rehabilitation in Germany. The average age of participants was 47 (range from 35 to 58) and they had MS, on average, for 17 years.

Participants were taught integrated yoga including:

  • preparatory yogic loosening and breathing practices
  • Nadishuddi pranayama (alternate nostril breathing)
  • moola bandha (anal lock)
  • kapalbhati (rapid nostril breathing)
  • deep relaxation technique

Yoga instruction was given daily for two hours a day for 21 days.

Bladder function was measured using:

  • ultrasound scanning for post void residual (PVR) urine volume. This is the amount of urine left in the bladder after someone has been to the toilet and, if high, indicates that the bladder is not emptying enough.
  • the micturition checklist (MCL). Micturition is another name for urination.
  • the incontinence impact questionnaire-7 (IIQ-7) which measures health-related quality of life (HRQOL) with urinary incontinence
  • the urogenital distress inventory-6 (UDI-6) which assesses lower urinary tract symptoms, including incontinence.

You can view the questions used in the IIQ-7 and UDI-6 here.

Measurements were taken before the yoga programme and then compared with those at the end of the programme.

What was found

There was a significant improvement in post void residual urine (62%), scores on the micturition frequency checklist (25%), incontinence impact questionnaire-7 (33%) and uro-genital distress inventory-6 (26%).

What does it mean?

The authors concluded that these yoga practices are safe and help people with bladder symptoms due to MS. As the study only involved eleven people, they suggest that further trials should be carried out.

Comment

One of the yoga exercises, known as moola bandha, which was taught in this study, is similar to the pelvic floor exercises often recommended for people with bladder symptoms.

Patil NJ, Nagaratna R, Garner C, et al.
Effect of integrated yoga on neurogenic bladder dysfunction in patients with multiple sclerosis- a prospective observational case series.
Complement Ther Med. 2012 Dec;20(6):424-30.
abstract

More about yoga

You can read more about how yoga might help people with MS in the A-Z of MS. 

More about bladder symptoms

Bladder symptoms in MS vary from one person to another and one person may experience more than one type. Storage problems include symptoms such as urgency (the need to go to the toilet immediately) and frequency (often needing the toilet) during the day and night, and incontinence (not being able to stop urine leaking out). Problems with emptying of the bladder include hesitancy (difficulty passing urine) and retention (a feeling of incomplete bladder emptying).

You can read more about bladder symptoms in the A-Z of MS. There are links to the MS Trust's book Managing your bladder which can be ordered, read online or downloaded as a pdf file. It contains suggestions on how bladder symptoms can be managed in consultation with the relevant health professionals. You can also read about the experiences of people with MS who are living with bladder symptoms.

Research by topic areas...

Diagnosis

Kelly S, Kinsella K, Duggan M, et al.
A proposed modification to the McDonald 2010 criteria for the diagnosis of primary progressive multiple sclerosis.
Mult Scler. 2012 Nov 6. [Epub ahead of print]
abstract

Symptoms and symptom management

Adamec I, Bach I, Barušic AK, et al.
Assessment of prevalence and pathological response to orthostatic provocation in patients with multiple sclerosis.
J Neurol Sci. 2012 Nov 2. doi:pii: S0022-510X(12)00562-X. 10.1016/j.jns.2012.10.006. [Epub ahead of print]
abstract

Newland PK, Thomas FP, Riley M, et al.
The use of focus groups to characterize symptoms in persons with multiple sclerosis.
J Neurosci Nurs. 2012 Dec;44(6):351-357.
abstract

Disease modifying treatments

Greenberg BM, Balcer L, Calabresi PA, et al.
Interferon beta use and disability prevention in relapsing-remitting multiple sclerosis.
Arch Neurol. 2012 Nov 5:1-4. doi: 10.1001/jamaneurol.2013.1017. [Epub ahead of print]
abstract

Cohen JA, Coles AJ, Arnold DL, et al.
Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial.
Lancet. 2012 Oct 31. doi:pii: S0140-6736(12)61769-3.10.1016/S0140-6736(12)61769-3. [Epub ahead of print]
abstract

Coles AJ, Twyman CL, Arnold DL, et al.
Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial.
Lancet. 2012 Oct 31. doi:pii: S0140-6736(12)61768-1. 10.1016/S0140-6736(12)61768-1. [Epub ahead of print]
abstract

Mezei Z, Bereczki D, Racz L, et al.
Can a physician predict the clinical response to first-line immunomodulatory treatment in relapsing-remitting multiple sclerosis?
Neuropsychiatr Dis Treat. 2012;8:465-73.
abstract

Other treatments

Hikita K, Honda M, Kawamoto B, et al.
Botulinum toxin type A injection for neurogenic detrusor overactivity: clinical outcome in Japanese patients.
Int J Urol. 2012 Nov 6. doi:10.1111/j.1442-2042.2012.03218.x. [Epub ahead of print]
abstract

Quispe-Cabanillas JG, Damasceno A, Glehn F, et al.
Impact of electroacupuncture on quality of life for patients with relapsing-remitting multiple sclerosis under treatment with immunomodulators: a randomized study.
BMC Complement Altern Med. 2012 Nov 5;12(1):209. [Epub ahead of print]
abstract

Egeberg MD, Oh CY, Bainbridge JL.
Clinical overview of dalfampridine: an agent with a novel mechanism of action to help with gait disturbances.
Clin Ther.2012 Nov 1. doi:pii: S0149-2918(12)00568-1. 10.1016/j.clinthera.2012.10.003.[Epub ahead of print]
abstract

Assessment tools

Brooks JB, Borela MC, Fragoso YD.
Assessment of cognition using the Rao's brief repeatable battery of neuropsychological tests on a group of Brazilian patients with multiple sclerosis.
Arq Neuropsiquiatr. 2011 Dec;69(6):887-91.
abstract

Quality of life

Plow M, Finlayson M.
A qualitative study of nutritional behaviors in adults with multiple sclerosis.
J Neurosci Nurs. 2012 Dec;44(6):337-350.
abstract

Psychological aspects

Kraemer M, Herold M, Uekermann J, et al.
Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.
J Neuropsychol. 2012 Nov 5. doi:10.1111/j.1748-6653.2012.02037.x. [Epub ahead of print]
abstract

Soundy A, Benson J, Dawes H, et al.
Understanding hope in patients with multiple sclerosis.
Physiotherapy. 2012 Dec;98(4):349-55.
abstract

Physical activity

Garrett M, Hogan N, Larkin A, et al.
Exercise in the community for people with multiple sclerosis -- a follow-up of people with minimal gait impairment.
Mult Scler. 2012 Nov 6. [Epub ahead of print]
abstract

Garrett M, Hogan N, Larkin A, et al.
Exercise in the community for people with minimal gait impairment due to MS: an assessor-blind randomized controlled trial.
Mult Scler. 2012 Nov 5. [Epub ahead of print]
abstract

Gender

Trojano M, Lucchese G, Graziano G, et al.
Geographical variations in sex ratio trends over time in multiple sclerosis.
PLoS One. 2012;7(10):e48078. doi:10.1371/journal.pone.0048078.
abstract

Prognosis

Tedeholm H, Lycke J, Skoog B, et al.
Time to secondary progression in patients with multiple sclerosis who were treated with first generation immunomodulating drugs.
Mult Scler. 2012 Nov 1. [Epub ahead of print]
abstract

Bone health

Ramagopalan SV, Seminog O, Goldacre R, et al.
Risk of fractures in patients with multiple sclerosis: record-linkage study.
BMC Neurol. 2012 Nov 5;12(1):135. [Epub ahead of print]
abstract

Falls

Socie MJ, Sandroff BM, Pula JH, et al.
Footfall placement variability and falls in multiple sclerosis.
Ann Biomed Eng. 2012 Nov 7. [Epub ahead of print]
abstract

Coote S, Hogan N, Franklin S.
Falls in people with MS who use a walking aid: prevalence, factors and effect of balance and strengthening interventions.
Arch Phys Med Rehabil. 2012 Nov 2. doi:pii: S0003-9993(12)01077-5. 10.1016/j.apmr.2012.10.020. [Epub ahead of print]
abstract

Stem cells

Uccelli A, Laroni A, Freedman MS.
Mesenchymal stem cells as treatment for MS - progress to date.
Mult Scler. 2012 Nov 1. [Epub ahead of print]
abstract

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