Pelvic Floor Dysfunction and Rehabilitation in Neurological Disorders: Bridging Pathophysiology With...

Area of Science:

• Neurology
• Rehabilitation Medicine
• Urology

Background:

• Pelvic floor dysfunction (PFD) is a common complication of neurological disorders including multiple sclerosis (MS), Parkinson's disease (PD), and stroke.
• PFD significantly impacts bladder, bowel, and sexual function, leading to reduced quality of life and psychosocial distress.
• The pathophysiology of neurogenic PFD is complex, involving intricate neural mechanisms.

Purpose of the Study:

• To review current evidence on the pathophysiology, clinical presentation, and rehabilitation strategies for neurogenic PFD in major neurological conditions.
• To synthesize findings from clinical and experimental studies on PFD in neurological populations.
• To highlight the role of rehabilitation interventions in managing neurogenic PFD.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases.
• Studies published between 1990 and 2025 focusing on urinary and PFD in neurological conditions were included.
• Rehabilitation interventions such as pelvic floor muscle training (PFMT), biofeedback, neuromuscular electrical stimulation (NMES), and percutaneous tibial nerve stimulation were specifically examined.

Main Results:

• Neurogenic PFD is highly prevalent, affecting up to 90% of MS patients, 60% of PD patients, and nearly half of stroke survivors with urinary symptoms.
• Conservative rehabilitation, especially PFMT combined with biofeedback and NMES, demonstrates efficacy in improving muscle function, reducing incontinence, and enhancing quality of life.
• A significant challenge identified is the lack of standardized rehabilitation protocols and barriers to patient adherence.

Conclusions:

• A multidisciplinary approach integrating PFMT with adjunct modalities is recommended for managing neurogenic PFD.
• Further large-scale randomized controlled trials are necessary to develop standardized, evidence-based clinical guidelines.
• Optimizing rehabilitation strategies is crucial for improving outcomes in patients with neurogenic PFD.