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Addressing Pelvic Floor Disorders in Patients with Neurogenic Bladder

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Female Pelvic Medicine

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Abstract

Lower urinary tract symptoms (including urinary incontinence) and pelvic floor disorders are commonly reported by women with neurological conditions. Their evaluation and treatment may differ considerably from neurologically intact women. In this chapter, we particularly focus on the evaluation and treatment of women with multiple sclerosis (MS), Parkinson’s disease, and spinal cord injury. Patients with these conditions may have more complex lower urinary tract disorders that may require a more intensive diagnostic evaluation and specific interventions tailored to those findings.

Commentary by W. Stuart Reynolds, Vanderbilt University Medical Center, Department of Urology, Nashville, TN, USA

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Author information

Authors and Affiliations

  1. Wilmington Health, Department of Urology, Wilmington, NC, USA

    Deborah S. Hess

  2. University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA

    Gary E. Lemack

Authors
  1. Deborah S. Hess
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  2. Gary E. Lemack
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Correspondence to Gary E. Lemack .

Editor information

Editors and Affiliations

  1. Department of Urology, Virginia Mason Medical Center, Seattle, WA, USA

    Kathleen C. Kobashi

  2. Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

Commentary

Commentary

  • W. Stuart Reynolds 

While lower urinary tract dysfunction, such as neurogenic overactive bladder and incomplete emptying or retention, is frequently encountered in caring for patients with neurologic diseases, pelvic floor disorders are less appreciated in many of these patients. This chapter does an excellent job of reviewing pelvic floor disorders in a number of neurologic diseases, highlighting important nuances that make treating these disorders challenging at times. There is also a general lack of information or clinical data on many important aspects of these disorders in these populations, including on prevalence, impact on the patient, and optimal management strategies.

Changing demographics means increased prevalence of some disorders [32, 33], and providers will likely see an increasing number of men and women with neurologic diseases and concomitant pelvic floor disorders in their practices. Being able to recognize these disorders and provide meaningful management will increasingly become important. In many situations, a multidisciplinary approach to care of patients with neurologic diseases may be necessary or advantageous. The diversity of neurologic manifestations and variable range of physical impairment typically require a highly individualized approach to manage lower urinary tract dysfunction and pelvic floor disorders. Pathophysiologic changes inherent to the underlying condition likely affect outcomes of traditional treatment modalities – for example, in a woman with neurologic disease, should we expect the same outcomes for a transvaginal, native tissue pelvic organ prolapse repair or suspension? What would be the impacts of increased weight-bearing for self-transfer on pelvic floor musculature or on outcomes of a procedure? How would pelvic floor muscle paralysis impact on a such a repair? Lastly, bowel dysfunction is also common in patients with neurologic diseases. Management of concurrent neurogenic bowel disorders in neurogenic patients often falls to the pelvic floor provider. As is nicely highlighted in this chapter, for all scenarios, the medical literature is deficient and further study is needed to help direct management of pelvic floor disorders in neurogenic patients.

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Hess, D.S., Lemack, G.E. (2021). Addressing Pelvic Floor Disorders in Patients with Neurogenic Bladder. In: Kobashi, K.C., Wexner, S.D. (eds) Female Pelvic Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-54839-1_19

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  • DOI: https://doi.org/10.1007/978-3-030-54839-1_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-54838-4

  • Online ISBN: 978-3-030-54839-1

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