Question: Are there exercises to prevent urinary incontinence?

Answer: If you mean physiotherapy, the answer is yes. It’s essential to differentiate between stress urinary incontinence and urge urinary incontinence.

Stress urinary incontinence reflects the inability of the sphincter muscle at the bladder outlet to withstand intra-abdominal pressure exerted on the bladder. This leads to urine leakage in situations such as lifting weights, sneezing, coughing, or physical activity. This condition is common in women, with various risk factors, though multiple sclerosis is not one of them. Physiotherapy exercises aim to strengthen the pelvic floor muscles, which help the sphincter resist increased intra-abdominal pressure.

Urge urinary incontinence often represents involuntary or uncontrolled bladder contractions during the storage phase, leading to leakage. This is more common in women and men with neurological disorders like multiple sclerosis. The goal of physiotherapy in such cases is to train patients to perform exercises that allow relaxation of uncontrolled bladder contractions while simultaneously strengthening the pelvic floor muscles.

To diagnose the type of incontinence, it is recommended to consult a urologist specializing in this area. They can identify the issue and refer the patient to a physiotherapist with specific recommendations tailored to the condition.

Question: I am 54 and have recently experienced difficulty stopping urination, especially just before reaching the restroom. Additionally, I need to get up once at night to urinate. Nine years ago, I had a TVT surgery, and tests show that it is still in place. Is there anything I can do to improve urinary retention? (In my opinion, my pelvic floor muscles are strong.)

Answer: See the response to the first question. If a urologist has examined you and ruled out stress urinary incontinence (for example, through a physical examination with a full bladder where you were asked to cough, and the urologist checked for urine leakage from the urethra), it is possible that the sense of urgency represents a primary bladder storage disorder, which may also be secondary to multiple sclerosis. A urologist specializing in this field can assist with diagnosis.

Treatment options are broad and range from lifestyle and fluid intake modifications to appropriate physiotherapy, medication, or advanced treatments such as Botox injections into the bladder or sacral neuromodulation.

Question: I have had multiple sclerosis for over 20 years. My question is, can the disease cause penile shrinkage?

Answer: The male genital organ consists of smooth muscle. If there is a decline in sexual function and the number of erections achieved decreases, muscle atrophy may occur, giving the impression of penile shrinkage. It is advisable to consult a urologist specializing in sexual health for a thorough diagnosis and the initiation of appropriate treatment.

Question: Are there proven data on the disease’s impact on delayed ejaculation in men?

Answer: Male ejaculation requires an intact nervous system. Neurological impairments can lead to ejaculation disorders, either by reducing sensitivity in the genital area, causing erectile and ejaculation issues, or by directly affecting the neural mechanisms associated with ejaculation. It is recommended to consult a urologist specializing in sexual health for a complete diagnosis and suitable treatment.

Question: How can kidney damage and recurrent infections be avoided?

Answer: Kidney damage and recurrent bladder or kidney infections are often the result of impaired bladder storage capacity or high-pressure urine retention. It is essential to consult a urologist specializing in this area to evaluate bladder storage and emptying capacity. Based on the findings, behavioral or medicinal treatments can be tailored accordingly.

Recurrent urinary tract infections in multiple sclerosis patients are a red flag, indicating potentially problematic bladder management, and necessitate referral to a urologist. Ignoring this issue may lead to kidney damage, which is irreversible.