Using Kegel Exercises to Manage Neurogenic Bladder in MS

Question from an MS Patient:  My most limiting problem right now is managing neurogenic bladder. I have an Interstim implant for detruser muscle control. A Kegel program may help, but I want to know more about the frequency of exercises necessary for change. Thank you.

Most patients with MS, particularly those with more advanced disease, have a complicated neurogenic bladder that requires multidisciplinary management. Kegel exercises (also called pelvic floor exercises) are sometimes useful but the results are rarely as gratifying as the results achieved by woman with urination problems from prior pregnancies or aging. Medications and Interstim devices are usually reserved for women who do not respond to Kegel exercises. This being said, I have copied our directions for performing Kegel exercises (these come from the Mayo Clinic) in the section below. If you are unable to voluntarily learn to control the pelvic floor muscles as described in the section below, you should obtain a referral to a physical therapist specializing in pelvic floor exercises.  The physical therapist  will use biofeedback techniques to teach you the procedure.

How to do Kegel exercises
It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

1. Find the right muscles. To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you've got the right muscles.
2. Perfect your technique. Once you've identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
3. Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
4. Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day.
5. Don't make a habit of using Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can actually weaken the muscles, as well as lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.
   

--Dr. Kinkel