{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T17:25:52Z","timestamp":1769707552932,"version":"3.49.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Introduction Multiple Sclerosis (MS) is a chronic condition affecting the central nervous system, often leading to urinary incontinence (UI), balance disturbances, and fatigue. This study examines the relationship between UI, core muscle morphology, balance, and fatigue in patients with MS (PwMS) to inform rehabilitation strategies. Methods A cross-sectional observational study was conducted with 27 PwMS (17 with UI and 10 without). Abdominal muscle thickness (transversus abdominis (TA), internal obliques, and external obliques) was assessed via ultrasound. UI-related Quality of Life was evaluated using questionnaires (ICIQ-SF and I-QOL), balance was assessed with the Trunk Impairment Scale (TIS) and Berg Balance Scale (BBS), and fatigue was measured using the Modified Fatigue Impact Scale (MFIS). Results Significant correlations were observed between UI, TA thickness during contraction and balance with the TIS demonstrating greater sensitivity than the BBS. PwMS with UI exhibited reduced TA thickness and poorer scores in balance and fatigue, particularly in the cognitive subscale of the MFIS. Logistic regression revealed that the severity of UI predicts functional balance, with an overall model accuracy of 70.8%. Conclusions Core dysfunction may link UI, balance and fatigue in PwMS. Strengthening the TA and pelvic floor muscles should be a rehabilitation priority to improve UI, postural stability, and daily function.<\/jats:p>","DOI":"10.3389\/fneur.2026.1708066","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T05:23:02Z","timestamp":1769664182000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Urinary incontinence, core morphology and their impact on balance and fatigue in multiple sclerosis: an observational study"],"prefix":"10.3389","volume":"17","author":[{"given":"Cecilia","family":"Estrada-Barranco","sequence":"first","affiliation":[{"name":"Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, Villaviciosa de Od\u00f3n","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Garc\u00eda-Ruano","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Esclerosis M\u00faltiple de Madrid","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina-Bel\u00e9n","family":"Quilca-Esparza","sequence":"additional","affiliation":[{"name":"Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, Villaviciosa de Od\u00f3n","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline-Maribel","family":"Tito-Torres","sequence":"additional","affiliation":[{"name":"Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, Villaviciosa de Od\u00f3n","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Castel-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, Villaviciosa de Od\u00f3n","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"L\u00f3pez-Ruiz","sequence":"additional","affiliation":[{"name":"Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, Villaviciosa de Od\u00f3n","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"de la Plaza-San Frutos","sequence":"additional","affiliation":[{"name":"Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Department of Physiotherapy, Villaviciosa de Od\u00f3n","place":["Madrid, Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"CD012732","DOI":"10.1002\/14651858.CD012732.pub2","article-title":"Rehabilitation for people with multiple sclerosis: an overview of Cochrane reviews","volume":"1","author":"Amatya","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising prevalence of multiple sclerosis worldwide: insights from the atlas of MS, third edition","volume":"26","author":"Walton","year":"2020","journal-title":"Mult Scler"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.29399\/npa.23418","article-title":"Multiple sclerosis: diagnosis and differential diagnosis","volume":"55","author":"\u00d6merhoca","year":"2018","journal-title":"Noro Psikiyatr Ars"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1332417","DOI":"10.3389\/fpubh.2024.1332417","article-title":"Associations between respiratory function, balance, postural control, and fatigue in persons with multiple sclerosis: an observational study","volume":"12","author":"Sanchez-Ruiz","year":"2024","journal-title":"Front Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"3531","DOI":"10.1080\/09638288.2020.1867908","article-title":"Urinary incontinence and impaired physical function are associated with expiratory muscle weakness in patients with multiple sclerosis","volume":"44","author":"Aguilar-Zafra","year":"2022","journal-title":"Disabil Rehabil"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"14","DOI":"10.7224\/1537-2073.2013-040","article-title":"Lower urinary tract symptom prevalence and management among patients with multiple sclerosis","volume":"17","author":"Khalaf","year":"2015","journal-title":"Int J MS Care"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1002\/nau.20232","article-title":"Postural and respiratory functions of the pelvic floor muscles","volume":"26","author":"Hodges","year":"2007","journal-title":"Neurourol Urodyn"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3109\/17453678909154177","article-title":"Stability of the lumbar spine. A study in mechanical engineering","volume":"230","author":"Bergmark","year":"1989","journal-title":"Acta Orthop Scand Suppl"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.purol.2022.04.005","article-title":"Association between isokinetic abdominal muscle strength, pelvic floor muscle strength and stress urinary incontinence severity","volume":"32","author":"Ghroubi","year":"2022","journal-title":"Prog Urol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1002\/nau.20285","article-title":"Relationship between abdominal and pelvic floor muscle activation and intravaginal pressure during pelvic floor muscle contractions in healthy continent women","volume":"25","author":"Madill","year":"2006","journal-title":"Neurourol Urodyn"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.3109\/09638288.2015.1106592","article-title":"Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions","volume":"38","author":"Milinis","year":"2016","journal-title":"Disabil Rehabil"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.gaitpost.2021.06.010","article-title":"The association between bladder dysfunction, balance and falls in women with multiple sclerosis: the specific contribution of fear of falling","volume":"88","author":"Soll","year":"2021","journal-title":"Gait Posture"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"166","DOI":"10.3390\/diagnostics10030166","article-title":"Ultrasound assessment of the abdominal wall muscles in women with and without primary dysmenorrhea: a cross-sectional study","volume":"10","author":"Romero-Morales","year":"2020","journal-title":"Diagnostics (Basel, Switzerland)"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.apmr.2008.06.022","article-title":"Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles","volume":"90","author":"Koppenhaver","year":"2009","journal-title":"Arch Phys Med Rehabil"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"},{"key":"ref16","first-page":"119551","article-title":"Ley Org\u00e1nica 3\/2018, de 5 de diciembre, de Protecci\u00f3n de Datos Personales y garant\u00eda de los derechos digitales","year":"2018","journal-title":"Bolet\u00edn Oficial del Estado"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"82","author":"von Elm","year":"2008","journal-title":"Rev Esp Salud Publica"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)","volume":"33","author":"Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u00abMini-mental state\u00bb. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/S0090-4295(99)80384-7","article-title":"Quality of life of persons with urinary incontinence: development of a new measure","volume":"47","author":"Wagner","year":"1996","journal-title":"Urology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1002\/nau.20041","article-title":"ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence","volume":"23","author":"Avery","year":"2004","journal-title":"Neurourol Urodyn"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1191\/0269215504cr733oa","article-title":"The trunk impairment scale: a new tool to measure motor impairment of the trunk after stroke","volume":"18","author":"Verheyden","year":"2004","journal-title":"Clin Rehabil"},{"key":"ref23","first-page":"S7","article-title":"Measuring balance in the elderly: validation of an instrument","volume":"83","author":"Berg","year":"1992","journal-title":"Can J Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"S79","DOI":"10.1093\/clinids\/18.Supplement_1.S79","article-title":"Measuring the functional impact of fatigue: initial validation of the fatigue impact scale","volume":"18","author":"Fisk","year":"1994","journal-title":"Clin Infect Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e21008","DOI":"10.5812\/iranjradiol.21008","article-title":"Reliability of rehabilitative ultrasonography to measure transverse abdominis and multifidus muscle dimensions","volume":"11","author":"Nabavi","year":"2014","journal-title":"Iran J Radiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"487","DOI":"10.2519\/jospt.2007.2548","article-title":"Rehabilitative ultrasound imaging of pelvic floor muscle function","volume":"37","author":"Whittaker","year":"2007","journal-title":"J Orthop Sports Phys Ther"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1002\/jum.14466","article-title":"Ultrasound assessment of the transverse abdominis during functional movement","volume":"37","author":"Colby Mangum","year":"2018","journal-title":"J Ultrasound Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1002\/uog.1072","article-title":"Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging","volume":"23","author":"Dietz","year":"2004","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.ultrasmedbio.2006.08.020","article-title":"Ultrasound evaluation of dynamic responses of female pelvic floor muscles","volume":"33","author":"Peng","year":"2007","journal-title":"Ultrasound Med Biol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1249\/MSS.0b013e31818cb278","article-title":"Progressive statistics for studies in sports medicine and exercise science","volume":"41","author":"Hopkins","year":"2009","journal-title":"Med Sci Sports Exerc"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.3109\/09638288.2010.533243","article-title":"Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients","volume":"33","author":"Do\u011fan","year":"2011","journal-title":"Disabil Rehabil"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/biomet\/78.3.691","article-title":"A note on a general definition of the coefficient of determination","volume":"78","author":"Nagelkerke","year":"1991","journal-title":"Biometrika"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.physio.2018.02.002","article-title":"The Berg balance scale as a clinical screening tool to predict fall risk in older adults: a systematic review","volume":"104","author":"Lima","year":"2018","journal-title":"Physiotherapy"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e47086","DOI":"10.7759\/cureus.47086","article-title":"Pelvic floor muscle training and its benefits for multiple sclerosis patients suffering from urinary incontinence and sexual dysfunction","volume":"15","author":"Sapouna","year":"2023","journal-title":"Cureus"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1007\/s11255-021-02804-y","article-title":"The effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients","volume":"53","author":"Altunan","year":"2021","journal-title":"Int Urol Nephrol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1589\/jpts.26.1161","article-title":"Effects of co-contraction of both transverse abdominal muscle and pelvic floor muscle exercises for stress urinary incontinence: a randomized controlled trial","volume":"26","author":"Tajiri","year":"2014","journal-title":"J Phys Ther Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.3390\/biomedicines11082193","article-title":"Neurogenic lower urinary tract symptoms, fatigue, and depression\u2014are there correlations in persons with multiple sclerosis?","volume":"11","author":"Jaekel","year":"2023","journal-title":"Biomedicine"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1136\/jnnp.2006.101642","article-title":"Trunk performance after stroke: an eye catching predictor of functional outcome","volume":"78","author":"Verheyden","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1080\/09638288.2017.1373409","article-title":"Development of the Italian version of the trunk impairment scale in subjects with acute and chronic stroke. Cross-cultural adaptation, reliability, validity and responsiveness","volume":"41","author":"Monticone","year":"2019","journal-title":"Disabil Rehabil"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"700","DOI":"10.12968\/bjon.2021.30.12.700","article-title":"Continence issues in individuals living with multiple sclerosis","volume":"30","author":"Yates","year":"2021","journal-title":"Br J Nurs"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"104010","DOI":"10.1016\/j.msard.2022.104010","article-title":"The effects of incontinence on functionality, disability, and quality of life in male and female patients with multiple sclerosis","volume":"66","author":"Abakay","year":"2022","journal-title":"Mult Scler Relat Disord"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1007\/s10072-017-2948-z","article-title":"Cross-sectional study of urinary problems in adults with cerebral palsy: awareness and impact on the quality of life","volume":"38","author":"Y\u0131ld\u0131z","year":"2017","journal-title":"Neurol Sci"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1002\/nau.20722","article-title":"Patient reported outcomes tools in an observational study of female stress urinary incontinence","volume":"29","author":"van de Vaart","year":"2010","journal-title":"Neurourol Urodyn"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1016\/j.apmr.2006.06.002","article-title":"Risk factors for falling among people aged 45 to 90 years with multiple sclerosis","volume":"87","author":"Finlayson","year":"2006","journal-title":"Arch Phys Med Rehabil"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1708066\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T05:23:03Z","timestamp":1769664183000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1708066\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":44,"alternative-id":["10.3389\/fneur.2026.1708066"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1708066","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"1708066"}}