Fundamentals of a Neurological Pelvic Floor Assessment

Introduction Management of pelvic floor muscle (PFM) function in neurological disease or injury needs a comprehensive overview including the associated neurogenic lower urinary tract, bowel and sexual structure and function. Methods A narrative review of International Continence Society terminology statements was conducted alongside a PubMed search for guidelines relating to neurogenic bladder, bowel, and sexual function. Relevant sources were synthesised to identify key descriptors to inform and the neurological pelvic floor assessment. Results Innervation of the pelvic organs is distributed peripherally by autonomic plexuses and the pudendal nerves. The spinal centres are located at sacral and thoracolumbar levels. Higher central nervous system centres provide top-down modulation of spinal reflex pathways. Neurological disease can affect these directly, or indirectly by affecting mobility, endocrine, autonomic regulation and neurotransmitter levels (e.g. dopamine, acetylcholine). Assessment of pelvic organ function needs to recognise lower urinary tract, bowel and sexual symptoms that may be associated with a neurological condition or injury. Pelvic floor muscle examination needs to evaluate sensation, pelvic floor muscle contraction and reflexes, along with wider impact of the underlying neurological condition. Conclusion This document provides an overview of neurological lower urinary tract, bowel and sexual function anatomy, clinical presentation and neurological PFM assessment for clinicians in practice.