Pelvic floor dysfunction and rehabilitation in neurological disorders: bridging pathophysiology with multidisciplinary approaches—a focused mini-review

Abstract

Background.: Pelvic floor dysfunction (PFD) is a frequent yet underrecognized complication of neurological disorders such as multiple sclerosis (MS), Parkinson’s disease (PD), and stroke. Its multifactorial pathophysiology involves complex neural mechanisms affecting bladder, bowel, and sexual function, often resulting in decreased quality of life and psychosocial distress. Objective.: This focused mini-review aims to synthesize current evidence on the pathophysiology, clinical features, and rehabilitation approaches for neurogenic PFD in major neurological conditions. Methods.: A targeted literature search was performed in PubMed, Scopus, and Web of Science databases to identify clinical and experimental studies published between 1990 and 2025 addressing urinary and PFD in neurological populations. Special attention was given to rehabilitation-based interventions such as pelvic floor muscle training (PFMT), biofeedback, neuromuscular electrical stimulation (NMES), and percutaneous tibial nerve stimulation. Findings.: Neurogenic PFD is highly prevalent, with up to 90% of MS patients, 60% of PD patients, and nearly half of stroke survivors experiencing urinary symptoms. Conservative rehabilitation, particularly PFMT combined with biofeedback and NMES, improves muscle function, reduces incontinence frequency, and enhances quality of life. However, standardized rehabilitation protocols are lacking, and adherence remains a major barrier. Conclusion.: Evidence supports a multidisciplinary rehabilitation approach integrating PFMT and adjunct modalities for neurogenic PFD. Further large-scale randomized studies are required to establish standardized, evidence-based clinical guidelines.