Neurologic Conditions

Published January 1, 2026

What You Need to Know 

Pelvic health physical therapy is essential for individuals with neurological conditions, helping address bladder, bowel, and sexual dysfunction caused by disrupted nerve communication.

• Neurological conditions commonly cause pelvic floor dysfunction: Patients with spinal cord injuries, Parkinson’s disease, MS, and stroke often experience urinary and bowel issues, as well as sexual dysfunction, impacting daily life and emotional well-being.

• Physical therapists provide individualized, holistic care: Tailored evaluations and treatment plans aim to restore function, reduce caregiver strain, and minimize reliance on medications.

• Effective interventions include pelvic floor training, behavioral strategies, and strength work.

Pelvic health physical therapy in the neurological population has a critical opportunity to help patients restore, improve, and understand changes that occur within the bladder, bowel, and sexual organs with central/peripheral nerve changes. The communication between the brain, spinal cord, and peripheral nerves are essential in emptying and storing of the bowel and bladder as well as sexual function. Patients with neurological conditions such as spinal cord injuries, Parkinson’s disease (PD), Multiple Sclerosis (MS), and strokes can present with a variety of dysfunction including: urinary stress incontinence, urinary urgency/frequency, urinary retention, constipation, fecal incontinence, and sexual dysfunction which can impact activities of daily living, walking, anxiety/depression, fall risk, overall quality of life.( Sparaco & Bonavita , 2022). Physical therapists will perform a customized assessment based on the patient’s primary complaints and areas of concern. The therapist, patient, and caregiver will develop a plan of care with individualized goals to improve quality of life and confidence in bowel, bladder, and sexual function.

It is well documented that pelvic floor dysfunction impacts a patient’s psychological well being and pelvic floor therapists have an opportunity to serve these specific patient populations to improve quality of life, caregiver burden, and reduced medication costs. (McDonald et al., 2017). It is estimated that more than 40% of patients with a spinal cord injury have urinary incontinence and more than 50% of those same patients had a urinary tract infection requiring antibiotics. (Elliott et al., 2025). While neurogenic bowel dysfunction was reported at 20-60%. (Holmes & Blanke, 2019). Bowel dysfunction in patients with PD is theorized to have large gastrointestinal aspects with some patients demonstrating GI symptoms prior to motor disturbances. (Skjærbæk et al., 2021) More than 50% of patients with PD have bowel disorders with constipation being the highest incidence. (Skjærbæk et al., 2021; Ramu et al., 2024). Constipation is a highly predictive component for bladder dysfunction and affects patients with PD just as much. (Vaughan et al., 2019). Current interventions for the PD population due to cognitive changes include behavioral training, pelvic floor coordination training. (Vaughan et al., 2019). Similar to patients with spinal cord injuries and PD, patients with MS have a > 30% incidence of bladder, bowel, and sexual dysfunction. Interventions for this patient population include abdominal strength training, pelvic floor coordination, endurance/ strength training, and electrical stimulation (Sparaco & Bonavita, 2022; Kajbafvala et al., 2022). 

As patients with strokes have a variety of physical and mental disruptions the bowel and bladder system can also be affected in a variety of ways depending on location of the infarct. The incidence of urinary incontinence is estimated to be more than >35% and new onset constipation >40% in patients in the acute phase. (Wang et al., 2024; Tian et al., 2025). The impact of pelvic floor dysfunction is more than 25% in each sub-population. This should be a large area of focus and subjective questioning while discussing goals, quality of life, and mental burden on quality of life. Patients with these dysfunctions should be evaluated and treated holistically by a pelvic floor therapist to improve bowel, bladder, and sexual function as part of their inter-disciplinary care.

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