How to Manage Muscle Spasticity for Improved Voiding of Bladder and Bowel

I work as a pelvic floor physical therapist and often treat those with a diagnosis of multiple sclerosis (MS). As many of you may have experienced, emptying the bladder and bowel may become challenging at various stages of living with MS.

In the clinic, I often find that both men and women with MS present with tight musculature of the pelvic floor. Having tension in one’s saddle muscles can result in urinary retention and also constipation.1

Understanding the impact of muscle spasticity

A muscle group known as the hip adductors can also be impacted by muscle spasticity associated with MS. The hip adductors originate from the bony pelvis and span along the inner thigh to attach to the femur. The purpose of these muscles is to allow the legs to be drawn together, as in crossing the legs while sitting.

When spasticity affects this muscle group, it can be challenging to spread one’s legs apart and can be responsible for a “scissoring gait," which keeps the thighs together when walking and can prevent a fluid and natural gait pattern.2

How to utilize the pelvic floor muscles

What is even more interesting about the hip adductors is that they attach to the very same bone that the small pelvic floor muscles do. Those pelvic floor muscles must open up for the bladder or bowel to empty. If people with tight pelvic floor muscles cannot open them sufficiently, then urinary retention and constipation may result.1

I often teach my patients how to stretch their own pelvic floor muscles with their fingers or a wand. But what if that isn’t possible, due to modesty, physical ability, or hand dexterity?

Treating muscle spasticity

I found a research study about adolescents with cerebral palsy, who also exhibit similar spasticity to the adductors as do those with MS. In the study, when stretching was performed to the spastic muscles, the result was an increase in the range of motion of the joints and an overall reduction in muscle spasticity. Another method to decrease spasticity was the use of whole body vibration (the subjects were placed on an oscillating platform) and this was found to decrease spasticity in the lower extremities.3

What can I do on my own?

It isn’t feasible for some people to go to a pelvic floor physical therapy clinic to address their tight muscles. Nor is full body vibration something we can just go out and buy like a gallon of milk. Yet stretching tight muscles is something that many people can do from their homes or ask a caregiver to do for them.

Stretching the adductors means pulling the leg away from the body, bending the knee and allowing it to fall to the side, like a frog’s leg appears. Try this one leg at a time. Placing a pillow underneath the leg that is splayed out allows it to relax even further.

Another addition to this home program is to purchase the kind of vibrator that is used for sore muscles. Applying the vibration along the length of the inner thigh, from the groin to the inside of the knee, might allow the muscle to lengthen even further. This is a simple way to get vibration into the routine from the comfort of your home.

The power of the pelvic floor

Let’s go back to the pelvic floor muscles once more. They attach to the same bone as do the hip adductors. In stretching the adductors and lengthening them, the pelvic floor muscles will also be opened. And when pelvic floor muscles are open, the bladder and bowel can be evacuated with more ease.

I have started using this technique in the clinic with my patients who have hip spasticity associated with MS. After I perform the stretching and vibration, I ask that they go and sit on the toilet or commode to see if there is an improvement in their voiding of urine or stool. The results have been pretty promising so far.

I encourage everyone to try these ideas to see if they work for you. Then write in the comments section and we can learn together about what other techniques to try!

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