I'm sorry to say that with MSA, you can only manage the symptoms. My spouse experienced symptoms (primarily REM sleep disorder and occasional orthostatic hypotension) for many years before receiving a diagnosis, By the time he was diagnosed in 2021, he was already quite ill.
In my opinion, PT played a major role in maintaining a good quality of life. He had PT off and on for about five years after the diagnosis, but he consistently did his exercises six days a week — up until the last two or three months of his life.
His positive attitude and determination to keep trying, along with medications for various symptoms such as blood pressure, sleep, etc, also helped improve his quality of life.
As for bladder issues: early on, he received Botox injections, which were very helpful in managing daytime symptoms, though they weren’t as effective at night. For nighttime, he used condom catheters for five years, which helped him avoid major urinary tract/bladder infections until 2024.
Despite all our efforts, there was a steady decline which is part of this disease. He passed away this past spring. Still, I believe he had a good quality of life overall, thanks to a combination of his personal attitude, regular exercise, symptom management, and the dedicated care of his physicians, nurse practitioners, and caregivers. After 2023 his POLST requested no invasive procedures which included feeding tubes. His MSA diagnosis was confirmed by a brain autopsy.

I truly wish you and your friend strength and support on this journey. The MSA journey is not something anyone would choose, but know that good moments and quality of life are still possible along the way.