Central neural control of pelvic floor control - Insights from functional brain imaging

Functional neuroimaging, particularly functional MRI (fMRI), has become essential for studying human brain activity, as it provides an indirect measure of this activity. As its technical capabilities evolve, fMRI continues to offer new insights into the central nervous system. This review summarizes neuroimaging research since 2019 on bladder, pelvic floor, and sexual function in both healthy individuals and those with dysfunction.

Recent studies examine the central neural control of the lower urinary tract (LUT), highlighting brain regions such as the periaqueductal gray, thalamus, and prefrontal cortex involved in bladder control. fMRI has revealed differences in brain activity between sexes and between healthy individuals and those with overactive bladder (OAB) or neurogenic LUT dysfunction (NLUTD). Research on chronic pelvic pain syndrome (CPPS) suggests abnormal sensory processing and disrupted brain connectivity. Additionally, studies on pelvic floor muscle contraction (PFMC) and micturition identify key brain regions, including the primary motor cortex and cerebellum. Advancements in neuroimaging have also uncovered brain activation patterns linked to sexual dysfunctions such as delayed orgasm, anejaculation, and erectile dysfunction.

This review highlights critical brain regions involved in bladder, pelvic floor, and sexual function, emphasizing the effects of various dysfunctions like OAB, NLUTD, and CPPS. Neuroimaging has revealed alterations in brain activity, paving the way for potential therapeutic approaches. Ongoing research promises to deepen our understanding of these systems and lead to more effective treatments for related disorders.