Silent Struggles: Pelvic and Sexual Health in MS

Living with multiple sclerosis (MS) means navigating a range of challenges, from fatigue and mobility issues to pain and balance problems. Yet there’s a set of symptoms that often flies under the radar until they become severe: pelvic floor dysfunctions.

Bladder problems, bowel issues, and sexual difficulties can have a huge impact on daily life and wellbeing. Because they’re sensitive topics, many people with MS hesitate to bring them up—and sometimes healthcare providers don’t either.

In this blog, we’ll explore what’s happening inside the body, why pelvic and sexual health issues are often overlooked, and most importantly, what you can do about them.

The Science Behind Pelvic Floor Problems in MS

The pelvic floor is a group of muscles and tissues at the base of your body that supports your bladder, bowels, and reproductive organs. It acts like a sling—helping you control when you go to the toilet and playing a role in sexual function.

In MS, damage to the central nervous system (CNS) can disrupt the signals between the brain, spinal cord, and pelvic floor. When the messaging system isn’t working properly, problems like urgency, accidents, constipation, or sexual changes can develop.

Let’s break down how this happens, based on research by Sparaco and Bonavita (2022).

Urinary Dysfunction: Why Bladder Control Gets Harder

Bladder problems are very common in MS—affecting between 37% and 99% of people.

You might experience:

• A sudden, strong urge to urinate

• Needing to go frequently

• Leaking before reaching the toilet (urge incontinence)

• Trouble fully emptying your bladder (urinary retention)

Here’s why:

Normally, different parts of the brain and spinal cord work together to control bladder filling and emptying. The detrusor muscle—the main muscle of the bladder—contracts to push urine out when it’s time to go.

In MS:

• If there’s damage higher up in the brain (above the “pontine micturition centre”), the detrusor muscle can become overactive, causing sudden urges and accidents.

• If there’s damage lower down in the spinal cord, the bladder and its sphincter (the muscle that keeps urine in) can get out of sync. The bladder tries to empty but the sphincter doesn’t relax properly, leading to incomplete emptying or urine retention.

According to Sparaco and Bonavita, detrusor overactivity happens in around 34–99% of people with MS, while detrusor underactivity can affect up to 40%.

Bowel Dysfunction: Why Constipation or Accidents Happen

Bowel problems are also extremely common:

• Constipation affects between 17–94% of people with MS.

• Faecal incontinence (loss of bowel control) affects around 1–69%.

Just like the bladder, bowel control relies on nerve signals. MS can slow down bowel movement through the gut, weaken the muscles that help hold things in, or interfere with the timing of when you feel the urge to go.

For example:

• Damage to spinal cord areas can slow down gut movement, leading to constipation.

• Weaker sphincter muscles can make it harder to control bowel movements.

• Poor coordination of the pelvic floor can make both problems worse.

And because the bladder and bowel share some nerve pathways, trouble in one area often leads to trouble in the other.

Sexual Dysfunction: When Intimacy Changes

Sexual health challenges affect a large number of people with MS:

• 40–80% of women

• 50–90% of men

These changes can happen for lots of reasons:

• Primary effects: MS can directly damage the nerve pathways needed for arousal, sensation, erection, ejaculation, or orgasm.

• Secondary effects: Pain, spasticity, or extreme fatigue can make sexual activity more difficult or less comfortable.

• Tertiary effects: Emotional changes, depression, or relationship stress can add extra layers to the problem.

Women may experience less lubrication or pain during intercourse. Men may have difficulty with erections or ejaculation. Reduced sexual desire is common for everyone.

And because these issues are so personal, they’re often the hardest ones to talk about—even though support is available.

Why These Issues Are Often Overlooked

Despite how common bladder, bowel, and sexual changes are, they’re often left out of conversations until they cause major problems.

Some reasons why:

• Mobility and balance issues often seem more urgent during medical appointments.

• Many people feel embarrassed or unsure about how to bring up intimate symptoms.

• Healthcare providers may focus on “visible” MS symptoms and miss the hidden ones.

Surveys show that while people with MS often feel their bladder and bowel care needs are eventually addressed, sexual health needs are much less likely to be discussed or supported.

Pelvic Floor Training: A Practical First Step

The good news? You don’t have to wait until symptoms become severe to take action.

Pelvic floor muscle training (PFMT) is one of the most promising strategies for managing bladder, bowel, and even some sexual function problems in MS.

It involves learning how to better strengthen and control your pelvic floor muscles. Research shows that PFMT can:

• Reduce urinary leaks and urgency

• Improve bowel control

• Support better sexual function

It’s important to work with someone who understands pelvic health in MS—like a continence nurse or a pelvic health physiotherapist—because everyone’s symptoms and needs are different.

How We Can Help

You don’t have to face these challenges alone.

The MS PhysiKit offers a dedicated Pelvic Health Toolkit designed specifically for people living with MS. Inside, you’ll find easy-to-follow pelvic floor exercises you can start safely at home, plus advice on when to seek extra help.

🔗 Visit the MS PhysiKit landing page to learn more.

And if you’re looking for a space where you can talk openly without judgement, join the PhysiHub community. It’s free, welcoming, and full of others who understand the ups and downs of living with MS.

🔗 Join PhysiHub today and find a supportive community that gets it!

_Reference

_{Sparaco, M., & Bonavita, S. (2022). Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis. Journal of Clinical Medicine, 11, 1941.}