The cerebro-pelvic axis: a unified framework linking higher brain function, pelvic floor control, and lower urinary...

Area of Science:

• Neuroscience
• Urology
• Gerontology

Background:

• Higher brain disorders and pelvic floor dysfunction frequently co-occur but are treated separately.
• Overlapping risk factors include aging, frailty, and medications.
• Existing clinical practice fails to address the interconnectedness of these conditions.

Purpose of the Study:

• To propose a control-loop framework linking descending executive control and ascending interoceptive signaling for lower urinary tract (LUT) and pelvic floor coordination.
• To introduce two failure-mode categories: top-down disintegration and bottom-up disturbance.
• To conceptualize Coordinated Axis Neuromodulation (CAN) as a novel intervention.

Main Methods:

• Hypothesis-generating control-loop framing.
• Phenotyping based on control-architecture mapping.
• Development of Coordinated Axis Neuromodulation (CAN) concept.
• Outlining a validation route including synchronized neurophysiology-pelvic physiology paradigms and RCTs.

Main Results:

• The proposed framework yields testable predictions regarding cortical and peripheral biomarkers.
• Differential response profiles of CAN protocols are predicted across failure-mode cohorts.
• The study provides a roadmap for empirical validation of the CAN hypothesis.

Conclusions:

• The control-loop framework offers a novel perspective on the clinicobiological mismatch between higher brain and pelvic floor disorders.
• Coordinated Axis Neuromodulation (CAN) presents a promising, hypothesis-driven intervention strategy requiring validation.
• Further research is needed to refine and validate the proposed framework and intervention.