Neurogenic Pelvic Floor Dysfunctions Across Neurological Disorders: Mechanisms, Phenotypes, and Precision Rehabilitation Pathways-A Narrative Review.
Neurogenic Pelvic Floor Dysfunctions Across Neurological Disorders: Mechanisms, Phenotypes, and Precision Rehabilitation Pathways-A Narrative Review.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Centro, IT · Author affiliation
IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.Location evidence
Messina, IT · Author affiliation
IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.Location evidence
L'Aquila, IT · Author affiliation
Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università Degli Studi Dell'Aquila, 67100 L'Aquila, Italy.Location evidence
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Original abstract
Background: Pelvic floor dysfunction (PFD) is frequent in neurological disorders, but it is often approached as a secondary urological or gynecological problem rather than a functional rehabilitation target. Neurological disease can disturb cortical, pontine, spinal, sacral, autonomic, somatic, and sensory pathways that regulate bladder storage, voiding, bowel evacuation, sexual function, and pelvic pain modulation. Methods: This narrative review synthesized biomedical evidence identified through PubMed searches from database inception to 2 May 2026. Search concepts included neurogenic lower urinary tract dysfunction, urinary and bowel dysfunction, sexual dysfunction, pelvic pain, pelvic floor rehabilitation, biofeedback, electrical stimulation, neuromodulation, telerehabilitation, robotics, and major neurological disorders. The review was oriented according to the Scale for the Assessment of Narrative Review Articles (SANRA) and was not designed as a systematic review or meta-analysis. Results: Evidence from multiple sclerosis, stroke, Parkinson's disease, Alzheimer's disease and related dementias, spinal cord injury, and fibromyalgia or nociplastic pain syndromes supports a phenotype-based framework in which pelvic floor muscle training, bladder and bowel training, biofeedback, neuromuscular electrical stimulation, posterior tibial nerve stimulation, sacral neuromodulation, telerehabilitation, robotics, and multidisciplinary care are considered complementary rather than interchangeable strategies. Conclusions: PFD in neurological disorders may be more appropriately conceptualized as a multidimensional neurorehabilitation target. Effective care depends on disease-informed phenotyping, individualized rehabilitation goals, attention to cognition and adherence, and standardized outcome measurement. Future studies should test phenotype-specific pathways that integrate bladder, bowel, sexual, pain, participation, safety, and caregiver outcomes.